Behaviors of children with unilateral vision impairment in the Infant Aphakia Treatment Study

Abstract

Purpose To determine whether behavioral functioning of 4.5-year-olds differs between two treatments for unilateral cataract and whether behavioral functioning is predicted by visual acuity in the treated eye. Methods The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with contact lens correction or implantation of an intraocular lens. Patching data were collected during the year preceding a visit at age 4.5 years, when both visual acuity and caregiver-reported behavioral functioning were assessed for 109 participants. Caregiver stress was assessed with the Parenting Stress Index at 4.25 years. Results There were no treatment group differences in behavioral functioning as measured by the Child Behavior Checklist. Poorer visual acuity was associated with more externalizing behavior problems (attention problems and aggressive behavior) and total behavior problems in regression models that did not include caregiver stress. With multiple imputation, both caregiver stress and dichotomized visual acuity significantly predicted externalizing problems. Conclusions Treatment assignment did not greatly affect caregiver-reported behavior. Poor visual acuity may confer risk for problems with attention and aggressive behavior in preschoolers treated for unilateral cataract.

Beyond Visual Acuity—The Importance of Studying Motor Skills and Self-perception in Children Treated for Unilateral Congenital Cataract

“…In this issue of JAMA Ophthalmology, Birch et al 3 present important data regarding the possible association of UCC and deprivation amblyopia on self-perception and motor skills in young children. Their findings support our earlier observations that young children with deprivation amblyopia have worse fine and gross motor skills than expected 4 and behavior problems 5 and extend our understanding of the effect of UCC on the self-perception of young children, particularly related to peer acceptance and physical competence.…”

Vergence Formula for Estimating the Refractive Status of Aphakic Eyes in Pediatric Patients

“…The main advantages of this method are its objectivity and ease of use. These features are desirable when measuring eyes with high refractive errors, poor coordination, or irregular pupils and corneas (13). The formula requires the input of the axial length, which can be obtained using a variety of methods.…”

Psychosocial Impact of Patching in Unilateral Congenital Cataract

“…The psychosocial impact of unilateral congenital cataract (UCC) on children and their families deserves careful consideration, particularly when intensive treatments yield suboptimal visual outcomes . Patching, a long-standing first-line treatment for visual rehabilitation, has been associated with parental stress and child functioning in various forms of amblyopia .…”