ARVO: Children with 'Lazy Eye' View Themselves Poorly

FORT LAUDERDALE, Fla. May 10 -- Amblyopia may affect children's self-esteem as well as their visual acuity and fine-motor coordination, according to Australian researchers.

Children with amblyopia have significantly poorer depth perception, impaired stereo vision, and more difficulty with fine motor skills than do age-matched controls, reported Ann Louise Webber, M.S., of the School of Optometry at the Queensland University of Technology in Brisbane, and colleagues.

Problems accomplishing tasks that come naturally to other children wears away at their self-image and self-confidence, said Webber at the Association for Research in Vision and Ophthalmology meeting here.

"Many children with amblyopia have poor depth perception in addition to poor vision in one eye," she said. "We were interested in how these may impact on skills important to children, particularly in their early education. Our finding that children with amblyopia do have poorer fine motor skills and lower perception of social acceptance means that, in addition to treating a child's eye condition, eye care practitioners may be able advise parents of potential functional consequences."

Webber and colleagues conducted a case-control study to evaluate fine motor skills, reading eye movements, and perceived self esteem in children with amblyopia, or "lazy eye," compared with age-matched controls with normal vision.

They looked at 82 children with visual defects, and 37 controls, with a mean age of about 8.2 years.

The children with amblyopia had a range of oculomotor defects: 22 had amblyopia caused by infantile esotropia (one or both eyes cross inward), 28 had acquired strabismus, 15 had anisometropia (eyes with different refractive power), 13 had mixed etiology (both anisometropia and strabismus), and nine had stimulus deprivation amblyopia.

Both the children with amblyopia and controls were assessed for visual acuity with minimum angle of resolution (logMAR), stereopsis (depth perception) by the Randot Preschool stereopsis test, and reading eye movements, as measured by the Developmental Eye Movement test.

The investigators assessed the children's fine motor skills using the Visual-Motor Control and Upper Limb Speed and Dexterity subtests of the Brunicks-Oseretsky Test of Motor Proficiency, and they evaluated how children perceived their self-esteem using the Harter Self Perception Profile for Children.

The authors found, as might be expected, that the children with amblyopia had significantly greater difference in interocular visual acuity and significantly reduced stereoacuity than controls (P<0.05).

In addition, on 10 of 16 sub-tests, children with amblyopia had significantly poorer fine motor skills, and scored significantly lower than controls on overall age-standardized scores for both visual-motor control, and upper limb speed and dexterity. Children with amblyopia did not, however, have any more difficulties with reading eye movements than controls.

When the authors turned to the self-perception tests, they found that children with amblyopia rated their level of social acceptance lower than that of controls. This was the only self-esteem measure that was significantly different between the groups.