Prevalence of eccentric visual fixation among children with ophthalmic pathology

Introduction. The prevalence of amblyopia is reported to reach 6% among children and 5.6% among adults. Patients with amblyopia exhibit reduced reading speed, impaired learning abilities, disrupted fine motor skills, and diminished or absent stereopsis. The state of visual fixation significantly impacts treatment outcomes, as children with central visual fixation (CVF) and eccentric visual fixation (EVF) require different management strategies. However, there is a lack of analytical data regarding the prevalence of EVF among patients with various ophthalmic pathologies and methods for its evaluation. Objective: to identify and recommend the most common method for assessing visual fixation for clinical practice and to determine the prevalence of EVF among children with different ophthalmic condition. Materials and methods. This study reviewed the findings of both Russian and international research on the prevalence of EVF in children. The review included 30 experimental, observational, retrospective, and comparative publications that provided data on visual fixation status in patients with various ophthalmic conditions and the methods used to assess it. Results. Analysis of full-text articles led to the selection of eight studies published between 2017 and 2024 and one from 2009. These studies encompassed data on the ophthalmic status, visual fixation, and methods of assessment for 1,510 individuals. Among patients with anisometropia, 93.1% exhibited CVF, 6% had EVF, and five patients demonstrated unstable CVF. For patients diagnosed with strabismus without concomitant pathology, 74.2% had CVF, 21.7% had EVF, and 4.2% showed unstable CVF. Among patients with strabismus combined with anisometropia, CVF was found in 72.3%, EVF in 25.5%, and unstable CVF in 2.2%. The highest prevalence of EVF (27.5%) was observed among children with amblyopia and/or strabismus. The most commonly utilized and accessible method for assessing visual fixation across nine studies was direct ophthalmoscopy, performed in three-quarters of the cases. Conclusion. EVF is most frequently encountered in children with strabismus and amblyopia. The use of direct ophthalmoscopy as a diagnostic method for EVF is accessible for any ophthalmology office and is recommended for widespread implementation in clinical practice.

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