Is Patching after Age 4 Beneficial for Children Born with a Unilateral Congenital Cataract?

Abstract

Purpose: The goal of these analyses is to provide evidence that can help parents and healthcare providers determine whether or not to continue occlusion therapy once a reliable measure of optotype acuity can be obtained in children who are born with a unilateral congenital cataract.

Design: Data from the Infant Aphakia Treatment Study (IATS) are used in a cohort design.

Participants: A total of 105 children who participated in the IATS and did not have a vision-threatening adverse event.

Methods: We assessed the relationship between visual acuity (VA) at age 10.5 years and average daily hours of patching reported by caregivers on quarterly 48-hour recall interviews and annual 7-day patching diaries obtained between 48 and 60 months of age.

Main outcome measures: Monocular VA was assessed at the clinic visit closest to 48 months of age using the Amblyopia Treatment Study HOTV protocol. Final VA was measured at age 10.5 years using the electronic ETDRS testing protocol.

Results: Visual acuity measurements obtained at age 4 years were reliable, with a single-measure intraclass correlation coefficient of 0.83 (95% confidence interval [CI], 0.78-0.88), and predictive of those obtained at age 10.5 years (r_Spearman = 0.83; P < 0.01). In 38% (n = 40) of the children, the VA measured at age 10.5 years was within ±0.10 logarithm of the minimum angle of resolution of the measurement obtained at age 4 years. The amount of patching that was received between the fourth and fifth birthdays was unrelated to changes in VA.

Conclusions: These analyses suggest that optotype acuity measures obtained early in the fifth year of life are reliable and predictive of final visual outcomes. Additionally, our results suggest that less-aggressive patching protocols, or discontinuing patching altogether, may be justified in some children, particularly those with poor vision, once optotype acuity can be measured. However, the potential impact of latent nystagmus on uniocular VA measurement and the effect of patching on the child's quality of life, family relationships, and binocular visual field need to be considered before discontinuing occlusion therapy.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Occlusion therapy; Patching; Preschool-aged children; Unilateral congenital cataract; Visual acuity.