Preoperative visual acuity and contrast sensitivity in children with small, partial, or non-central cataracts

Abstract

Background While there is clear evidence that dense central cataracts >3 mm diameter warrant prompt intervention to prevent deprivation amblyopia, guidelines for management of small, partial and non-central cataracts are not evidence-based. Consensus guidelines advise managing affected infants and preschool children by monitoring for possible progression in size or density and pharmacologic pupillary dilation, if indicated. Extraction is deemed necessary if the cataract progresses sufficiently to obscure the visual axis or if strabismus or nystagmus develops. We evaluated the long-term visual acuity outcome of the consensus guidelines and whether sensory testing during infancy and early childhood may be helpful in guiding treatment. Methods A total of 40 consecutive children diagnosed with small, partial, or non-central cataracts at 1 week to 2.5 years of age were enrolled in a prospective study of forced-choice preferential looking visual acuity and contrast sensitivity development. Long-term visual acuity outcome was assessed by crowded HOTV or ETDRS at 4–11 years. Results Of the 40 children managed by consensus guidelines, 24 (60%) had abnormal visual acuity at 4–11 years of age, including 9 (23%) who had moderate to severe visual impairment (20/80 or worse) in one or both eyes. Abnormal visual acuity and contrast sensitivity during development were predictive of abnormal long-term visual acuity outcomes. Conclusions Visual acuity and contrast sensitivity tests were sensitive to the effects of visual deprivation on the developing visual system and may be useful in early identification of children with small, partial, or non-central cataracts who could benefit from cataract extraction.

Clinical Contrast Sensitivity Function in Patients with Infantile Nystagmus Syndrome Before and After Eye Muscle Surgery

“…Several reports suggest it is clinically reasonable to measure CS to assess visual system disability in patients with multisystem vision disease [21,[34][35][36][37]. Anatomical and electrophysiological anomalies found in human albinos are reflected by reduced contrast sensitivity.…”

“…Anatomical and electrophysiological anomalies found in human albinos are reflected by reduced contrast sensitivity. Testing of CS in patients with INS has repeatedly shown it to be abnormal [21,[34][35][36][37]. High astigmatic errors, nystagmus and other retinal/neural anomalies may result in abnormal meridional differences in sensitivity.…”

“…Visual Acuity (VA) testing was performed with the patient's full optical correction in place using the electronic ATS protocol [21]. Measurements of Best Visual Acuity (BVA) were obtained both binocularly and monocularly in the patient's habitual head position (using either their static null position or during the patient's least nystagmus intensity if diagnosed clinically or using eye movement recordings with IAPAN) [12][13][14][15][16][17][18][19][20][21].…”

Pediatric cataract: challenges and future directions

“…62 In a recent report, Birch et al found that abnormal visual acuity and contrast sensitivity in young children with partial cataracts was associated with poor long-term visual acuity outcomes. 63 This suggests that while conservative treatment can be used, it must be done so with caution, and ancillary tests such as glare testing must be utilized to ensure the lens opacity is not visually significant.…”

Do the Pelli-Robson and Test Chart 2000 Xpert demonstrate comparable contrast sensitivity results?

“…[2][3][4] Thus contrast sensitivity testing is recommended in the assessment of visual impairment and for use in low vision clinics. 5 Furthermore, studies have shown that contrast sensitivity assessment can aid in the detection and evaluation of the progression of ocular diseases such as optic neuritis, 6,7 infantile and age-related cataract, [8][9][10][11] glaucoma, 9,10 age-related macular degeneration, 11 stroke patients, 12 thyroid-associated ophthalmopathy 13 and amblyopia. 14 A study by the Cryotherapy for Retinopathy of Prematurity Cooperative Group demonstrated the effect of cryotherapy on visual functions.…”