A series consisting of 41 1 non-selected school children, 7 to 15 years of age, was examined. Decreased visual acuity (less than 0.8 in one or both eyes without correction) was found in 55 children (13.4%), the frequency increasing from 3.7% to 29.1 % with age. The frequency of hyperopic eyes (+ 2.0 D. or more) decreased from 19.1% to 3.6% and the frequency of myopic eyes (-0.5 D. or more) increased from 1.9% to 21.8% with age. Altogether, myopia, hyperopia, or astigmatism (1 D. or more) in one or both eyes was found in 93 children (22.6%). Manifest strabismus was found in 19 children (4.6%). and heterophoria (8 prism dioptres or more for near or distance) in 28 cases (6.8%), increasing significantly with age, from 1.2 to 13.6%. Amblyopia (visual acuity 0.6 or.less) due to strabismus or refractive errors was found in 5 cases. Subnormal vision due to congenital nystagmus, unilateral macular scar, congenital rubella retinopathy and unilateral Coats' disease was diagnosed with one case of each. Signs of external inflammatory disease were seen in I3 cases. In this series the annual need for ophthalmological consultation increased from 5% at the age of 7-8, to 30% of the children aged 14-15, if follow-up examinations and visits for the prescribing of glasses were included.
. S.M. and A.S. contributed equally to this article. Abbreviations: DCCT, Diabetes Control and Complications Trial; E/I ratio, ratio of length of R-R intervals during expiration to inspiration; ETDRS, Early Treatment of Diabetic Retinopathy Study; HF, high frequency; HFnorm, normalized high frequency component; HRV, heart rate variability; LF, low frequency; LFnorm, normalized low frequency component; RMSSD, square root of the mean square of R-R interval differences; TP, total power; UAER, urinary albumin excretion rate; VLF, very low frequency.A OBJECTIVE -Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function. There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS -In 1985, possible risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications (HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed in 83 of these patients (age 32 ± 1 years, duration of diabetes 22 ± 1 years). RESULTS -Poor glycemic control (measured as lifetime glycemic exposure or HbA 1c in 1985)was the most important independent predictor of decreases in all measures of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized HF and LF, LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based on lifetime glycemic exposure (A 1c months). Glycemic exposure in the tertiles averaged 194 ± 25 A 1c months (20 years of HbA 1c 0.8% above normal), 556 ± 19 A 1c months(20 years of HbA 1c 2.3% above normal), and 963 ± 30 A 1c months (20 years of HbA 1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required high glycemic exposure (20 years of HbA 1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest tertile of glycemic exposure.CONCLUSIONS -TP and retinopathy score were much more sensitive to antecedent glycemia than conventional tests of autonomic function or UAER and were significantly abnor-
In 48 children with cerebral palsy the characteristics of the squint and amblyopia were analyzed, also with respect to the features of cerebral palsy and to birth weight. Strabismus of congenital esotropia type was found to be common, as was also exotropia of early onset. Spontaneous alternation or an accommodative component of the squint was present only in a few cases. There was no evidence of an accumulation of any strabismus type in the different subgroups of cerebral palsy, whereas amblyopia or an obvious risk for amblyopia was found in the great majority of the cases. Some kind of amblyopia treatment was given to 34. Most of them showed improvement of the visual capacity which encourages treatment of amblyopia, even in children with cerebral palsy.
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