Current guidelines insufficient to protect vision in children with small cataract

This prospective study found that current consensus guidelines are not sufficient to prevent visual deprivation and long-term visual impairment in infants and preschool children with small, partial or noncentral cataracts.

However, 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 noncentral cataracts who could benefit from cataract extraction.

The study included 40 consecutive children diagnosed with small, partial or noncentral cataracts at 1 week to 2.5 years of age.

American Academy of Ophthalmology Preferred Practice Pattern 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.

Twenty-four of the children (60 percent) had abnormal visual acuity at 4 to 11 years of age, including 9 (23 percent) 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.

The authors note that while there is clear evidence that dense central cataracts less than 3 mm in diameter warrant prompt intervention to prevent deprivation amblyopia, guidelines for the management of small, partial and noncentral cataracts are not evidence-based.

They conclude that additional data are needed to determine whether the availability of early visual acuity and contrast sensitivity testing results in better long-term visual acuity outcomes.