Stereopsis Results at 4.5 Years of Age in the Infant Aphakia Treatment Study

Abstract

Purpose To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used. Design Randomized prospective clinical trial Methods The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1 to 7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using three different tests: 1) Frisby; 2) Randot Preschool; and 3) Titmus fly. Results Twenty-eight patients (25%) had a positive response to at least one of the stereopsis tests. There was no statistically significant difference in stereopsis between the two treatment groups. Frisby (contact lens, 6 (11%); IOL, 7 (13%); p=0.99), Randot (contact lens, 3 (6%); IOL, 1 (2%); p=0.62) or Titmus: (contact lens, 8 (15%); IOL, 13 (23%); p=0.34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 versus 2.4 months; p=0.002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs. 20/252; p=0.0003). Conclusion The type of optical correction did not influence stereopsis outcomes. However, two other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis.

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

“…[9][10][11] We have previously reported a positive stereopsis response to at least one stereopsis test at age 4.5 years in 25% of children in the IATS cohort. 12 We reported that positive stereopsis responses occurred more often in children who underwent cataract surgery at a younger age, had a better visual outcome, and were orthophoric at age 5 years. 12,13 The purpose of this study was to identify baseline factors, postoperative findings, and treatment compliance factors associated with both good visual acuity and stereopsis.…”

“…12 We reported that positive stereopsis responses occurred more often in children who underwent cataract surgery at a younger age, had a better visual outcome, and were orthophoric at age 5 years. 12,13 The purpose of this study was to identify baseline factors, postoperative findings, and treatment compliance factors associated with both good visual acuity and stereopsis. Our hope was that by identifying these factors that treatment protocols would be modified to allow a higher percentage of children to achieve nearly normal visual function after unilateral congenital cataract surgery.…”

“…16 A more detailed description of the procedures used for testing stereopsis have been published previously. 12 Ocular motility testing Ocular alignment was assessed at age 5 years at near and distance by an IATS-certified investigator using procedures that have been described previously. 13 Investigators were instructed to measure any deviation in the appropriate optical correction.…”

Quality of life and functional vision in children treated for cataract—a cross-sectional study

“…Visual outcomes are often disappointing. Younger age at surgery is associated with better visual outcomes 5,6 . Unilateral cases have a worse visual prognosis in the affected eye than bilateral: at six years after surgery, a median visual acuity 0.48 in bilateral and 1.0 logMAR (affected eye) in unilateral cases has been reported 3 .…”

Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study

“…1,2 However, compared with older children and adults, young children tend to have a more substantial inflammatory response to cataract surgery. 3,4 This inflammatory response, which is characterized by the presence of cells and flare in the anterior chamber, occurs when the blood-aqueous barrier is compromised.…”