Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

Abstract

for the Infant Aphakia Treatment Study Group IMPORTANCE Patching has been a mainstay in treating unilateral congenital cataract. However, its efficacy has not been rigorously assessed.OBJECTIVE To examine the association between patching and visual acuity in a cohort of children treated for unilateral congenital cataract. DESIGN, SETTING, AND PARTICIPANTSThis study was a secondary analysis of a randomized clinical trial (Infant Aphakia Treatment Study) of infants born from August 1, 2004, through December 31, 2008, who were treated with 1 of 2 treatments for unilateral congenital cataract and followed up to 5 years of age. Data analysis was performed from March 1, 2013, to March 1, 2016.INTERVENTIONS Cataract extraction and randomization to receipt of an intraocular lens vs being left aphakic for the first 5 years of life. MAIN OUTCOMES AND MEASURESCaregivers reported patching in the previous 48 hours in quarterly semistructured telephone interviews. The mean number of hours of patching per day was calculated from surgery to the first birthday (n = 92) and between 12 and 48 months of age (n = 102). Monocular optotype acuity was assessed at 4½ years of age by a traveling examiner using the Aphakia Treatment Study HOTV protocol. RESULTSThe Infant Aphakia Treatment Study enrolled 114 children; 57 were randomized to each treatment group. At 4½ years of age, optotype visual acuity was assessed in 112 children. The current analyses exclude an additional 3 children (2 who had adverse events that limited visual potential and 1 who had Stickler syndrome), leaving 109 total children analyzed (59 female [54.1%] and 92 white [84.4%]). Caregivers reported patching their children a mean (SD) of 3.73 (1.47) hours per day in the first year of life and 3.43 (2.04) hours per day thereafter. An association between reported patching and treatment was not identified (mean difference in first year, −0.29 hours per day; 95% CI, −0.90 to 0.33 hours per day; mean difference between 12 and 48 months of age, −0.40 hours per day; 95% CI, −1.20 to 0.40 hours per day). Visual acuity was associated with reported hours of patching in the first year of life (r = −0.32; 95% CI, −0.49 to −0.13) and between 12 and 48 months of age (r = −0.36; 95% CI, −0.52 to −0.18). However, patching accounted for less than 15% of the variance in logMAR acuity at 4½ years of age. CONCLUSIONS AND RELEVANCEThese results support the association of occlusion throughout the preschool years with improved visual acuity in infants treated for unilateral congenital cataract. However, similar visual outcomes were achieved with varying amounts of patching. These conclusions should be interpreted in the context of limitations related to generalizability from incomplete data collected in a clinical trial. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134

Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study

“…28 While this finding may appear to be paradoxical with the findings reported in this study, one possible explanation would be that a certain amount of patching is necessary to achieve good visual acuity after unilateral congenital cataract surgery. 29 Furthermore, this threshold may differ for each child.…”

Outcome of Pediatric Cataract Surgeries in a Tertiary Center in Switzerland

“…Amblyopia therapy was primarily performed in children with unilateral cataract. According to the Infant Aphakia Treatment Study, the number of reported hours of patching throughout the first four years of life is associated with a better visual acuity in cases of unilateral congenital cataracts [ 25 ]. Patching compliance was found to be one of the most important determinants of visual outcome [ 26 ].…”

Association of Contact Lens Adherence With Visual Outcome in the Infant Aphakia Treatment Study

“…For example, research has shown that memory can be improved by asking the caregiver to recall what time the child woke, when he/she was dressed, and when he/she had breakfast, and then asking if the child was wearing his/her contact lens at these times. The reliability and validity of this questionnaire for assessing adherence to patching have previously been described (reference 6 – which now probably should be reference 9 ) …”

“…6,9 We modeled our assessment of adherence after dietary assessments that have been used in a variety of epidemiologic studies including in preschool-aged children.…”