Too much or too little: neonatal ocular misalignment frequency can predict later abnormality.
BACKGROUND
214 orthoptists' infants have been followed for up to 15 years, relating neonatal misalignment (NMs) and first convergence onset to later childhood ocular abnormalities. NMs are shown in a companion paper to reflect the onset of first convergence, but if frequent or absent may predict a higher risk of refractive error and esodeviation.


METHODS
In a prospective postal survey, orthoptist mothers observed their own infants during the first months of life and regularly reported ocular behaviour and alignment, visual development, and any subsequent ocular abnormalities.


RESULTS
Later strabismus and refractive error were less common in infants who showed NMs occasionally compared with those who never or frequently did. There was a significant linear trend for fewer ocular abnormalities to be found in children with more frequent NMs (p<0.001). Hypermetropes were later to show first convergence than emmetropes or myopes (p = 0.006)


CONCLUSIONS
NMs usually reflect an emerging and normally developing vergence system. This study suggests that delayed onset of convergence (and lack of NMs) is associated with later defects, especially hyperopia. Possible causal relations are discussed.
Horwood
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A
Orthoptic Department, Royal Berkshire Hospital, London, UK. a.m.harwood@reading.ac.uk
D000367:Age Factors; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003290:Convergence, Ocular; D005139:Eyeglasses / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D009216:Myopia / Q000209:etiology; D015835:Ocular Motility Disorders / Q000151:congenital / Q000175:diagnosis*; D011446:Prospective Studies; D012030:Refractive Errors / Q000209:etiology; D013285:Strabismus / Q000209:etiology