Abstract
Purpose: :
Cataracts affect 1 in 250 children under the age of 6 years in the US. While there is clear evidence that dense central cataracts greater than 3 mm diameter warrant prompt intervention to prevent deprivation amblyopia, guidelines for management of small, partial or non-central cataracts are not evidence-based. Most are currently managed by observation and/or pharmacologic pupillary dilation unless the child develops strabismus, nystagmus, or loss of vision (Am Acad Ophthalmol Preferred Practice Pattern 2007). However, neither nystagmus recording nor visual acuity testing is a routine part of a pediatric eye examination for children less than 3 years old. Here we evaluate the long term visual acuity outcomes of the standard management protocol and determine whether sensory testing during infancy and early childhood may provide useful information for treatment decisions.
Methods: :
Monocular visual acuity and contrast sensitivity at 6 spatial frequencies were measured in 18 children with small, partial, or non-central cataracts (11 unilateral, 7 bilateral) prior to surgery, and at regular intervals during visual development using forced-choice preferential looking. Visual acuity outcome was tested using crowded HOTV or ETDRS at 4-7 years.
Results: :
Two of the children had abnormal visual acuity and contrast sensitivity at the time of the first visit, 5-8 months prior to the clinical decision to treat surgically. Both had abnormal visual acuity outcomes post-operatively (20/80-20/100). Of the remaining 16 children, 9 had abnormal contrast sensitivity with borderline visual acuity >3 months prior to the clinical decision to treat surgically; 8 of these had abnormal visual acuity outcomes post-operatively (20/40-20/200). The final 7 children had normal visual acuity and contrast sensitivity throughout follow-up; all have normal visual acuity at 4-7y (20/15-20/30; 1 had cataract surgery; 6 remain phakic).
Conclusions: :
Overall, 56% of children with small, partial, or non-central cataracts managed according to current practice guidelines developed deprivation amblyopia. Visual acuity and contrast sensitivity testing provided early indicators of amblyopia and may be a useful adjunct to clinical assessment as a basis for treatment decisions.
Keywords: amblyopia • visual development: infancy and childhood • cataract