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Carolyn Drews-Botsch, Marianne Celano, George Cotsonis, Lindreth DuBois, Scott R. Lambert; Parenting Stress and Adherence to Occlusion Therapy in the Infant Aphakia Treatment Study: A secondary analysis of a randomized clinical trial. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5196.
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Patching is a mainstay in treating unilateral congenital cataract, but adherence is often difficult for caregivers. Thus, patching may be affected by parenting stress. As a secondary aim of the Infant Aphakia Treatment Study (IATS) we hypothesized that parents reporting greater levels of stress would report less adherence to prescribed patching.
This analysis used data from a randomized clinical trial comparing intraocular lens implantation at the time of cataract extraction with leaving an eye aphakic following cataract extraction in 114 children with a unilateral congenital cataract who were born between 2004 and 2009 and had cataract surgery before 6 months of age. Occlusion of the fellow eye was prescribed for 50% of waking hours to age 5 years and was assessed in quarterly semi-structured telephone interviews that reported hours of patching over the previous 48 hours. The average number of hours of patching per day was calculated for the first three months after surgery, and for six months before and after each of the three assessments of parenting stress. Parenting stress was assessed using the long-form of the Parenting Stress Index (PSI) completed by the primary caregiver three months after surgery (n=106) and at approximately 15 (n-97) and 54 (n=96) months of age.
The table provides details about the distribution of reported patching and parenting stress. Overall, higher levels of reported stress were associated with fewer reported hours of patching particularly in the first year after surgery (figure). For example, even after controlling for patching prior to the 1st caregiver interview, caregivers who reported the lowest levels of total stress three months after surgery (i.e., 25th percentile) reported nearly an hour a day more patching in thethree to nine months after surgery than caregivers reporting the highest stress levels (i.e., the 75th percentile) (i.e., 4.8 hours per day versus 3.8 hours per day). The association was similar, but no longer statistically significant 12 months after surgery. Patching and parenting stress were not associated at 4½ years of age.
These results support the hypothesis that in the first months following cataract extraction, higher levels of parenting stress are associated with poorer adherence to patching, and thus may contribute to reduced early adherence to patching.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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