All Children with Spastic CP Should Have Detailed Eye Exams, Study Suggests

The common occurrence of eye problems in children with spastic cerebral palsy suggests that all such children should have a detailed ophthalmologic evaluation, according to a recent study.

The report, “Ocular findings in patients with spastic type cerebral palsy,” was published in the journal BMC Ophthalmology.

Clinicians have noted that a large proportion of children with cerebral palsy have various problems with their eyes, and studies report that between 50% and 90% of patients may be affected. Earlier studies also have noted that the specific type of eye-related problems tends to vary between patients with different types of cerebral palsy.

Researchers at Seoul National University in Korea reviewed medical charts of 105 children with spastic disease to get a picture of eye problems typical of this patient group.

Most children had diplegia (a form of cerebral palsy marked by tense muscles and spasms), followed by hemiplegia (a type of cerebral palsy that results from damage to the part of the brain that controls muscle movements; the paralysis is on one vertical half of the body), and tetraplegia (a subset of spastic cerebral palsy that affects all four limbs). Children also had varying brain defects and causes for their cerebral palsy.

The eyes of all participants in the study, aged between 2 and 22 years, were examined at the Seoul National University Bundang Hospital. The mean follow-up time was 8.7 months.

Many children had difficulties in visually fixing an object and following it as it moved. Four patients could not do this at all.

The study found that 70.5% of the children had misaligned eyes, which was the most common eye problem in the group. Outward-turning eyes were more common than inward-turning.

A large proportion of children with misaligned eyes also had abnormal eye movements. This was caused most often by over-action of the inferior and superior oblique eye muscles.

Refractive errors were found in 53.3% of patients, with farsightedness being more common than nearsightedness. Many children also had astigmatism with farsighted astigmatism, again, being more common. It was not uncommon to find children with different errors in the two eyes; 24 patients had a difference of more than 1 diopter, and seven patients had more than 2 diopters difference.

Researchers admit that the study may have overestimated the frequency of eye problems in children with spastic cerebral palsy, as the study examined only patients who were already admitted for an eye examination at a specialty clinic.

Nonetheless, the team concluded, “Children with spastic type cerebral palsy have a high prevalence of strabismus and refractive errors. … All children with spastic type of cerebral palsy may require a detailed ophthalmologic evaluation.”