Long term follow up of premature infants: detection of strabismus, amblyopia, and refractive errors.

AIM: To establish recommendations for long term ophthalmological follow up of prematurely born infants. METHODS: 130 infants with a gestational age (GA) <37 weeks and born between 1 November 1989 and 31 October 1990 were enrolled in a prospective study about the development of strabismus, amblyopia, and refractive errors. Infants were subdivided in three groups according to GA: A <28 weeks (n=32), B >/=28-32-<37 weeks (n=34). Ophthalmological assessment took place at the postconceptional age of 32 weeks, at term and at 3, 6, 12, and 30 months post term. At the age of 5 years parents received a questionnaire and a majority of the children was examined again (n=99). RESULTS: At the age of 5 years 46 infants were known to have strabismus (n=29) and/or amblyopia (n=22) and/or refractive errors (n=22). Statistical analysis showed that gestational age, duration of supplementary oxygen, and duration of hospitalisation were important predictive variables for the development of strabismus, amblyopia, or refractive errors (SAR) at the age of 5 years (p<0.05). Infants with a GA 32 weeks, who developed an incidence comparable with the normal population. Strabismus developed mainly in the first year of life and at the age of 5 years. Most infants with amblyopia were detected at the age of 2-3 years. Refractive errors were found in the first year of life and at the age of 2.5 and 5 years. CONCLUSION: Infants with a GA <32 weeks should be selected for long term ophthalmological follow up. These infants should be screened at the age of 1 year, in the third year of life (preferably at 30 months), and just before school age (including testing of visual acuity with optotypes).

[Convergence insufficiency and school difficulties (author's transl)]. / Schulschwierigkeiten und Konvergenzschwäche

124 lowgrade hypermetropic pupils aged from 6 to 9 years, with normal I.Q. showed exophoria for near vision combined with weakness of convergence and school difficulties in several disciplines. These were treated as follows: training of the physiological diplopy, training of convergence, and surgical treatment by unilateral or bilateral resection of the medial rectus (the last-mentioned method has been applied on failure of so-called "ophthalmologic home-work"). Results were satisfactory in only 19%. The subjective primary complaints, similar to asthenopy, disappeared within a few weeks (65%). The effect of ophthalmological treatment was examined by the school psychological service as to acceleration in learning. Supported by comparisable objective effects (reading- and writing tests) with 50 control persons an improvement of concentration and motivation (77% and 62%), of reading capacity (44%) and of writing capacity (42%) was obtained within a space of 6 weeks to four months. Without taking up a too great percentage of the available school time, more attention should be paid in the elementary school age to a more accurate examination of the eyes, in order to detect even minor defects.