Impact of early dietary intake and blood lipid composition of long-chain polyunsaturated fatty acids on later visual development.

Background: In contrast to human milk, current infant formulas in the United States do not contain omega3 and omega6 long-chain polyunsaturated fatty acids. This may lead to suboptimal blood lipid fatty acid profiles and to a measurable diminution of visual function in developing term infants. The need for docosahexaenoic acid and arachidonic acid supplementation in the infant diet was evaluated in a double-blind, randomized clinical trial.

Interobserver test-retest reliability of the Randot preschool stereoacuity test.

Purpose: Random dot stereoacuity can be quantified to between 40 and 800 seconds of arc in preschool children by using the Randot Preschool Stereoacuity test (Stereo Optical Co, Inc, Chicago, Ill). To incorporate this test into clinic and research settings, the reliability of its stereoacuity scores obtained by separate examiners needs to be evaluated. The purpose of this study was to evaluate its interobserver test-retest reliability.

Infant hyperacuity for radial deformation.

Purpose: Poor response rates and/or the confounding of motion and offset responses make it difficult to interpret results of previous studies of infant hyperacuity. The aim of the present study was to design a protocol that overcomes these limitations and to investigate the normal maturation of hyperacuity.

Methods: Hyperacuity of 31 healthy term infants aged 4 to 12 months was measured using radial deformation of static circular D4 patterns with a two-alternative, forced-choice, preferential-looking (FPL) protocol and maximum likelihood threshold estimation.

Co-development of VEP motion response and binocular vision in normal infants and infantile esotropes.

Purpose: To determine the maturational course of nasotemporal asymmetry in infantile esotropia and to define the relationships among the symmetry of the motion visual evoked potential (MVEP), eye alignment, fusion, and stereopsis.

Methods: Sixty healthy term infants and 34 infants with esotropia participated. Nasotemporal MVEP asymmetry was assessed by the presence of a significant F1 response component with an interocular phase difference of approximately 180 degrees and by an amplitude "asymmetry index.

Hyperacuity deficits in anisometropic and strabismic amblyopes with known ages of onset.

In order to evaluate the influence of etiology of amblyopia and of age at onset of amblyopia on the resulting constellation of spatial vision deficits, resolution/vernier and recognition/resolution acuity ratios were measured in groups of children with either strabismic amblyopia or anisometropic amblyopia with known ages of onset. Strabismic amblyopia with infantile onset (<9 months) and strabismic amblyopia with late onset (18-30 months) were both associated with abnormally low resolution/vernier and abnormally high recognition/resolution acuity ratios. Among amblyopes with infantile onset (<9 months), moderate amblyopia was associated with different resolution/vernier and recognition/resolution acuity ratios in anisometropic and strabismic groups.

Factors influencing stereoacuity in accommodative esotropia.

Purpose: Despite successful optical realignment, many children with accommodative esotropia (ET) have abnormal stereoacuity. In a prospective study, we examined the influence of age of onset, age at alignment, duration of constant misalignment, and accommodative convergence/accommodation ratio on random dot stereoacuity outcomes in accommodative ET.

Methods: Participants were 111 consecutive children with accommodative ET.

Why does early surgical alignment improve stereoacuity outcomes in infantile esotropia?

Purpose: Recent studies of infantile esotropia suggest that early surgical alignment may enhance stereopsis and that alignment during the first 6 months of life may be optimal. Early surgery both establishes alignment during an early critical period for the development of stereopsis and minimizes the duration of misalignment. Here we examine the role of these 2 factors in promoting improved stereopsis outcomes.

Motion VEPs, stereopsis, and bifoveal fusion in children with strabismus.

Purpose: The link between nasal-temporal motion asymmetries and anomalous binocular sensory function in infantile esotropia (ET) has led to the idea that visual evoked potential responses to horizontal motion (mVE) is an alternative measure of sensory binocularity to stereopsis. A second hypothesis is that the mVEP response is a marker for bifoveal fusion. The purpose of this study was to directly evaluate these two hypotheses by examining the correspondence between the mVEP response and both stereoacuity and bifoveal fusion in a cohort of strabismic patients with variable binocular sensory function.

The natural history of infantile esotropia during the first six months of life. Pediatric Eye Disease Investigator Group.

Purpose: The present study addresses the natural history ocular alignment in infantile esotropia that presents at 2 to 4 months of age.

Methods: Eye alignment during the first 6 months of life was evaluated in two cohorts of healthy infants who initially had esotropia at 2 to 4 months of age; 80 infants were enrolled in a prospective study at the Retina Foundation of the Southwest (RFSW), and 41 infants were reviewed retrospectively as a pilot study for the Early Surgery for Congenital Esotropia (ESCET) multicenter trial. In addition, 79 of the 80 children in the RFSW cohort were reexamined at 4.

Fatty acid profile of buccal cheek cell phospholipids as an index for dietary intake of docosahexaenoic acid in preterm infants.

Cheek cells (buccal epithelia) were utilized as a noninvasive index of fatty acid status in a study of the effects of n-3 long chain polyunsaturated fatty acid supplementation on visual function in preterm infants. The fatty acid profile of cheek cell phospholipids was directly correlated with the dietary docosahexenoic acid (DHA) intake of infants receiving: (i) primarily human milk; (ii) n-3 fatty acid-deficient, corn oil-based, commercial formula (CO); (iii) alpha-linolenic acid-enriched, soy oil-based, commercial formula; or (iv) experimental formula enriched with soy and marine oils providing a DHA level equivalent to that in human milk. In a subset of infants with complete cheek cell fatty acid profiles and visual function assessments, preterm infants at both 36 wk (n = 63) and 57 wk (n = 45) postconceptional age had significantly (P < 0.

Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants.

The need for a dietary supply of docosahexaenoic acid (DHA) and arachidonic aid (AA) in term infants was evaluated in a double-masked randomized clinical trial of the effects of supplementation of term infant formula with DHA (0.35% of total fatty acids) or with DHA (0.36%) and AA (0.

Early treatment of congenital unilateral cataract minimizes unequal competition.

Purpose: Dense congenital unilateral cataracts may compromise visual development through visual deprivation and biased interocular competition, whereas dense congenital bilateral cataracts compromise visual development primarily through visual deprivation alone. Differences in sensory deficits between the two patient groups with these disorders may reflect the specific effects of unequal competition. To determine whether early treatment (at <8 weeks of age) minimizes the adverse effects of unequal competition, grating acuity deficits during the immediate posttreatment period and contrast sensitivity deficits at 6 to 8 years of age were assessed in 29 children with histories of dense congenital unilateral or bilateral cataracts who had had treatment between 1 and 8 weeks or 12 and 30 weeks.

Rod photoresponses in 6-week and 4-month-old human infants.

Rod-only electroretinograms (ERGs) were recorded from 6-week and 4-month-old normal human infants. The leading edge of the rod a-wave was fitted with a model of the activation phase of phototransduction to provide estimates of S (a sensitivity parameter) and RmP3 (the maximum saturated photoreceptor response) at each of the investigated ages. Both S and RmP3 increased over the first postnatal months but followed different developmental time courses with S approaching adult-like values sooner than RmP3.

Infant random dot stereoacuity cards.

Purpose: The overall goal was to develop a simple test of random dot stereoacuity that can be used during the first 24 months of life to measure sensory outcomes following treatment of ophthalmopediatric disorders, both in the context of clinical trials and in the context of clinical management.

Methods: A series of random dot stereoacuity test cards were constructed using vectographic vertical bar stimuli with crossed disparities ranging from 1735 to 45 sec. A two-alternative, forced-choice, preferential-looking test protocol was used to measure stereoacuity in 95 healthy term infants (173 tests) over the 1.

Random dot stereoacuity of preschool children. ALSPAC "Children in Focus" Study Team.

Purpose: Commercially available book-format random dot stereopsis tests for children are quick and simple to use, but provide accurate measurement of stereoacuity only in children age 5 years or older. Alternative methods for preschool children provide only pass/fail information or require lengthy laboratory-based protocols. To address the need for a quick and accurate measure of random dot stereoacuity in the preschool age range, we developed a new book-format random dot stereoacuity test.

Light reduction and the electroretinogram of preterm infants.

Aims: To examine the effects of light on retinal development and function in preterm infants as measured by the electroretinogram (ERG). Secondary outcomes included visual acuity testing, the incidence of retinopathy of prematurity, and general wellbeing, reflected in feeding tolerance, rate of weight gain, and length of hospital stay.

Methods: Eligibility criteria for enrollment were birthweight < or = 1250 g and gestational age < or = 31 weeks.

The critical period for surgical treatment of dense congenital unilateral cataract.

Purpose: Early treatment of dense congenital unilateral cataract is associated with better acuity outcomes. It is unclear whether there is a gradual worsening of prognosis with delay of treatment from the time of birth (linear model) or whether there exists an early window of time during which treatment is maximally effective, followed by declining success (bilinear model). The aim of the current study was to determine which model better describes the response to treatment.

FPL and VEP measures of fusion, stereopsis and stereoacuity in normal infants.

Dynamic random dot fusion, stereopsis and stereoacuity were evaluated in 149 healthy, fullterm infants, using both forced-choice preferential looking (FPL) and steady-state visual evoked potential (VEP) protocols. Few infants aged 2-3 months demonstrated fusion or stereopsis in either the FPL or VEP protocol; most infants aged 5 months and older demonstrated fusion and stereopsis in both protocols. Both FLP and VEP stereoacuity approached adult-level (< 60 sec) by 6-7 months of age.

Role of essential fatty acids in the function of the developing nervous system.

The basis for n-3 fatty acid essentially in humans includes not only biochemical evidence but functional measures associated with n-3 deficiency in human and nonhuman primates. Functional development of the retina and the occipital cortex are affected by alpha-linolenic acid deficiency and by a lack of docosahexaenoic acid (DHA) in preterm infant formulas and, as reported more recently, in term diets. Functional effects of n-3 supply on sleep-wake cycles and heart rate rhythms support the need for dietary n-3 fatty acids during early development.

Intraindividual variation in the basal metabolic rate of women: Effect of the menstrual cycle.

The validity of using the basal metabolic rate (BMR) to calculate an individual's energy requirements is based upon the assumption that the intraindividual variation in BMR is small. Early studies (pre-1940) on BMR in women had shown that the menstrual cycle may have a profound effect, contributing to high levels of intraindividual variation. To investigate this issue further, and to explore whether BMR is indeed a biological constant in women, sequential measurements of BMR were made in women over one menstrual cycle.

Random dot stereoacuity following surgical correction of infantile esotropia.

Surgical correction of infantile esotropia prior to age 2 is associated with a higher prevalence of fusion and stereopsis than surgical correction after 2 years of age. The advantages and disadvantages of surgical intervention at the early or late end of this window have been debated in the literature. In the present study, random dot (RD) stereoacuity outcomes were evaluated in order to determine whether a binocular sensory benefit is associated with early or late surgery.

Delayed consecutive exotropia following 7-millimeter bilateral medial rectus recession for congenital esotropia.

The rate of delayed consecutive exotropia after bilateral 7-millimeter medial rectus recession for large angle congenital esotropia in 88 patients was 27% (24/88), larger than previously reported. The rate was 38% (8/21) in infants having surgery prior to 7 months of age, 20% (10/49) in infants undergoing surgery at 7 to 12 months of age, and 33% (6/18) in patients undergoing surgery at 13 months of age or later. The onset of consecutive exotropia averaged 26.

Safety and efficacy of omega-3 fatty acids in the nutrition of very low birth weight infants: soy oil and marine oil supplementation of formula.

Because formula-fed preterm infants may be at risk of omega 3 essential fatty acid deficiency, we tested experimental formulas supplemented with soy oil to provide alpha-linolenic acid or marine oil to provide preformed omega 3 long-chain polyunsaturated fatty acids at a level comparable to that of human milk. This report addresses the effect of feeding formula supplemented with soy oil or with soy and marine oils on growth, clinical tolerance, coagulation test results, changes in erythrocyte membrane fluidity, and plasma concentrations of vitamins A and E in very low birth weight infants from 30 to 57 weeks of postconceptional age. "Healthy" preterm infants were maternally selected to receive human milk or selected at random to receive commercial ready-to-feed liquid formula, which provided limited omega 3 fatty acid, or experimental formulas supplemented with soy oil or soy and marine oils.

Outcome after very early treatment of dense congenital unilateral cataract.

Purpose: To evaluate whether very early treatment for congenital unilateral cataract results in better long-term functional outcomes, grating acuity, contrast sensitivity, recognition acuity, and random-dot stereoacuity were evaluated in two groups of children.

Methods: Grating acuity and contrast sensitivity data were obtained with standard forced-choice protocols. Stereoacuity data were obtained both in a forced-choice laboratory protocol and by the Randot test.