Early Patching Behaviors that Improve the Chances of Good Visual Acuity in Children Treated for Unilateral Congenital Cataract.

Abstract

Objective: Achieving near normal vision following unilateral congenital cataract surgery is possible but requires early surgery, optical correction and consistent patching. Patching is often challenging for children and their caregivers. The goal of these analyses is to examine the association between reported consistency in patching during the first year after surgery and visual acuity.

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

Participants: 101 children whose caregivers completed a prospective, 7-day patching diary two months after surgery or at 13 months of age.

Methods: Consistent patching was defined as patching every day, and either an average patch start time before 9:00 am, or the interquartile range of the first time a patch was applied of 60 minutes or less.

Main outcome measures: Recognition visual acuity was assessed at ages 54 + 1 months and 10½ years. Near normal visual acuity was defined as visual acuity of 20/40 or better.

Results: Diary data were available for 101 children. Overall, 55% of children whose caregivers reported consistent patching at age 13 months had near normal vision at age 54+1 months and 45% had near normal vision at age 10.5 years compared to 14% and 18%, respectively, when caregivers reported less consistent patching (Relative risk 54 months of age 3.55, 95% CI 1.61,7.80; RR at 10.5 years of age 2.31, 95% CI 1.12,4.78).

Conclusion: Consistent patching in the first year following surgery for unilateral congenital cataract is associated with better visual acuity. These findings can be used to provide evidence-based guidance to caregivers to help improve visual acuity outcomes for their children.