Motor skills of children with unilateral visual impairment in the Infant Aphakia Treatment Study

Aim To assess motor functioning in children aged 4 years 6 months enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills. Method One hundred and four children (53% female) with unilateral aphakia randomized to intraocular lens or contact lens treatment were evaluated at 4 years 6 months (age range 4y 6mo–4y 11mo) for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement Assessment Battery for Children – Second Edition (MABC‐2). Visual acuity was operationalized as log10 of the minimum angle of resolution (logMAR) value for treated eye, best logMAR value for either eye, and intraocular logMAR difference. Results Student's t‐tests showed no significant differences in MABC‐2 scores between the intraocular lens and contact lens groups. The mean total score was low (6.43; 18th centile) compared with the normative reference group. Motor functioning was not related to visual acuity in the treated eye or to intraocular logMAR difference, but was predicted in a regression model by the better visual acuity of either eye (usually the fellow eye), even after accounting for the influence of age at surgery, examiner, orthotropic ocular alignment, and stereopsis. Interpretation Children with unilateral congenital cataract may have delayed motor functioning at 4 years 6 months, which may adversely affect their social and academic functioning. What this paper adds Children treated for unilateral congenital cataract had delayed motor functioning at 4 years 6 months. There were no differences in motor functioning between children randomized to intraocular lens versus contact lens treatment. Motor test performance was associated with best monocular visual acuity. Visual acuity accounted for motor skills after controlling for demographic and medical variables. This article is commented on by Hallemans on page 114 of this issue.