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F Thorn, J Gwiazda, A A Cruz, J A Bauer, R Held

The development of eye alignment, convergence, and sensory binocularity in young infants

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Purpose: To measure and compare the development of ocular alignment, sensory binocularity, and convergence in infants during the first 5 months of life.

Methods: Healthy infants were tested between 2 and 21 weeks of age. Ocular alignment was measured by the Hirschberg test; convergence was determined by visual examination as an illuminated toy approached an infant's face; and sensory binocularity was measured by preferential looking for fusible versus rivalrous gratings. In experiment 1 we compared the proportion of infants at different ages demonstrating orthotropic ocular alignment with those showing convergence. In experiment 2, we compared the age of onset of convergence to that of sensory binocularity.


Results: Experiment 1: Most infants were orthotropic during the first month, and almost all of the others showed small amounts of exotropia. None of the infants showed accurate convergence until 6 weeks of age. By 4 months of age virtually all were orthotropic and had good convergence. Experiment 2: The onset of sensory binocular fusion occurred at 12.8 +/- 3.3 weeks. Full convergence did not occur until 13.7 +/- 3.2 weeks, although the first signs of convergence occurred slightly earlier. For individual infants there was a high correlation between the age of onset of sensory binocularity and convergence, and both onsets occurred earlier in girls than in boys.

Conclusions: Ocular alignment did not require the development of binocularity mechanisms, and the development of binocularity mechanisms did not await the onset of good ocular alignment. The relatively sudden onset of binocularity, both sensory (preference for fusion and stereopsis) and motor (convergence) at about 3 months of age and the high correlation between these measures indicate a common causal mechanism that probably involves refinements in striate cortex circuitry.

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