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

Abstract

Purpose To identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study. Patients and methods Infants with a unilateral congenital cataract (n = 114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis. Results Thirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P = 0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (Po0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years. Conclusion Among children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.

Clinical Profile and Outcomes of Congenital Cataracts at a Reference Center in Mexico

“…Numerous studies have been conducted to investigate how to reduce the incidence of strabismus in children with unilateral congenital cataract and some have suggested that patching the dominant eye for long periods reduces the risk of developing strabismus while others advocate that reduced patching hours improves stereopsis (10). A retrospective study, including patients of the Infant Aphakia Treatment Study (IATS), suggested that patching 4 h/day during the rst year of life, 3 h/day from 1-3 years and 2 h/day at age 4 increased the chances of good visual acuity and stereopsis (11). Compared to other studies, we found a similar incidence of strabismus and nystagmus among patients with congenital cataracts.…”

Targeted next generation sequencing gene panels used to improve diagnosis of congenital cataract and current treatment strategies

“…Early removal of congenital cataracts is essential to stop deprivation of vision during the sensitive and critical period of vision development [7]. There are a few options that can be undertaken to correct the resulting aphakia; primary intraocular lens (IOL) implantation, the use of spectacles or contact lenses, or secondary IOL implantation.…”

Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study

“…One-half of the children in the IATS with 20/40 or better vision had measurable stereopsis whereas stereopsis was rare in children with vision worse than 20/40. 18,19 Second, children with better vision in their treated eye may be more adherent with treatment regimens in general. We have previously reported an association between good patching adherence and better visual acuity in the treated eye.…”