Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas.
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas.
JAMA Ophthalmol. 2019 May 1;137(5):499-506. doi: 10.1001/jamaophthalmol.2018.7075.
Deficits in fine motor skills and slow reading speed have been reported in school-aged children and adults with amblyopia. These deficits were correlated with lower self-perception of athletic and cognitive competence. Although perceived competence and social acceptance are key determinants of developing self-perception in young children, the association of amblyopia with self-perception and the association of altered self-perception with fine motor skills to date have not been reported for young children aged 3 to 7 years.
To investigate whether amblyopia is associated with altered self-perception in young children and to assess whether any differences in self-perception are associated with deficits in vision and fine motor skills.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, conducted at a pediatric vision laboratory from January 10, 2016, to May 4, 2018, healthy children aged 3 to 7 years (preschool to second grade) were enrolled, including 60 children with amblyopia; 30 children who never had amblyopia but had been treated for strabismus, anisometropia, or both; and 20 control children.
Self-perception was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, which includes the following 4 specific domains: cognitive competence, peer acceptance, physical competence, and maternal acceptance (total score range, 1-4; higher scores indicate higher perceived competence or acceptance). Fine motor skills were evaluated with the Manual Dexterity and Aiming and Catching scales of the Movement Assessment Battery for Children, second edition (score range, 1-19; higher scores indicate better skill performance). Visual acuity and stereoacuity also were assessed.
Children with amblyopia (28 girls and 32 boys; mean [SD] age, 6.3 [1.3] years) had significantly lower mean (SD) peer acceptance and physical competence scores compared with the control children (peer acceptance, 2.74 [0.66] vs 3.11 [0.36]; mean difference, 0.37; 95% CI for difference, 0.06-0.68; P = .04; and physical competence, 2.86 [0.60] vs 3.43 [0.52]; mean difference, 0.57; 95% CI for difference, 0.27-0.87; P = .009). Among the children with amblyopia, self-perception of physical competence was significantly correlated with aiming and catching skills (r = 0.43; 95% CI, 0.10-0.67; P = .001) and stereoacuity (r = -0.39; 95% CI, -0.05 to -0.65; P = .02). Children treated for strabismus or anisometropia, but who never had amblyopia, also had significantly lower mean (SD) physical competence scores compared with control children (2.89 [0.54] vs 3.43 [0.52]; 95% CI for difference, 0.23-0.85; P = .03).
These findings suggest that lower self-perception of peer acceptance and physical competence identify the broad effects of altered visual development in the everyday life of children with amblyopia.
在弱视的学龄儿童和成年人中，已经报道了精细运动技能缺陷和阅读速度缓慢。这些缺陷与较低的运动和认知能力的自我感知相关。尽管感知能力和社会接受度是幼儿自我认知发展的关键决定因素，但弱视与自我认知的关联以及感知改变与精细运动技能的关联，迄今为止尚未报道 3 至 7 岁的幼儿。
研究弱视是否与幼儿的自我认知改变有关，并评估自我认知的任何差异是否与视力和精细运动技能缺陷有关。
设计、设置和参与者：在这项 2016 年 1 月 10 日至 2018 年 5 月 4 日在儿科视觉实验室进行的横断面研究中，纳入了健康的 3 至 7 岁儿童（幼儿园至二年级），包括 60 名弱视儿童；从未患有弱视但曾接受过斜视、屈光不正或两者治疗的 30 名儿童；以及 20 名对照儿童。
使用儿童感知能力和社会接受度图片量表评估自我认知，该量表包括以下 4 个特定领域：认知能力、同伴接受度、身体能力和母亲接受度（总分范围为 1-4；得分越高表示感知能力或接受度越高）。精细运动技能使用儿童运动评估电池的手动灵巧度和瞄准与捕捉量表进行评估，第二版（得分范围为 1-19；得分越高表示技能表现越好）。还评估了视力和立体视锐度。
弱视儿童（28 名女孩和 32 名男孩；平均[标准差]年龄为 6.3[1.3]岁）的同伴接受度和身体能力得分明显低于对照组儿童（同伴接受度，2.74[0.66] vs 3.11[0.36]；平均差异，0.37；95%置信区间的差异，0.06-0.68；P=0.04；身体能力，2.86[0.60] vs 3.43[0.52]；平均差异，0.57；95%置信区间的差异，0.27-0.87；P=0.009）。在弱视儿童中，身体能力的自我感知与瞄准和捕捉技能（r=0.43；95%置信区间，0.10-0.67；P=0.001）和立体视锐度（r=-0.39；95%置信区间，-0.05 至 -0.65；P=0.02）显著相关。曾接受过斜视或屈光不正治疗但从未患有弱视的儿童的身体能力得分也明显低于对照组儿童（2.89[0.54] vs 3.43[0.52]；95%置信区间的差异，0.23-0.85；P=0.03）。
这些发现表明，较低的同伴接受度和身体能力的自我感知可以识别弱视儿童日常生活中视觉发育改变的广泛影响。
