Association of neighborhood Child Opportunity Index with visual outcomes in children with unilateral pediatric cataract

Abstract

Purpose

To demonstrate the association between neighborhood quality, using the Child Opportunity Index (COI), and the visual outcomes in children with unilateral pediatric cataract.

Methods

We retrospectively reviewed the medical records of patients ≤18 years of age who presented at Boston Children’s Hospital between 2000 and 2022 with unilateral cataracts and underwent cataract extraction. The collected data included patient demographics, residential addresses, the reason for the initial presentation, the age at presentation, the morphology of the cataract, and the final visual acuity. The COI was used as a metric of neighborhood quality. We analyzed the association between the COI scores and the final visual acuity.

Results

We included a total of 80 patients in the study. The mean age at presentation was 2.59 ± 2.97 years. The most common reason for the initial presentation was a failed vision screen (27.5%), followed by an abnormal red reflex (25.0%). Posterior cataract was the most common type of cataract (66.3%). In the adjusted analysis, we found that a lower overall COI (β = −0.17; 95% CI, −0.31 to −0.02; P = 0.02) was associated with higher logMAR visual acuity (ie, worse visual acuity) at the final follow-up visit. Lower education and health and environment COI subdomains were associated with higher logMAR visual acuity at the final follow-up visit (P = 0.01 and P = 0.02, resp.).

Conclusions

Neighborhood environment quality is a potentially important variable for predicting visual outcomes in pediatric cataracts. Lower COI scores were associated with worse visual outcomes.