Association of Occlusion Therapy and Optotype Visual Acuity
JAMA Ophthalmology, August 2016
Although patching has been a mainstay of treatment for children with unilateral congenital cataract, its efficacy has not been rigorously assessed. Drews-Botsch et al. performed a secondary analysis of a randomized clinical trial (the Infant Aphakia Treatment Study [IATS]) to examine the association between patching and visual acuity (VA) in a cohort of children from that trial. They found an association between a greater number of reported hours of patching in the first 4 years of life and better VA at 4.5 years.
Data from 109 children in the IATS were analyzed for the present study. All participants were prescribed refractive correction (contact lenses or intraocular lens) for 100% of waking hours. Caregivers were instructed to patch the fellow eye for 1 hour daily until the child was 8 months old; thereafter, occlusion was to be used for 50% of waking hours. Adherence to the patching regimen was assessed in quarterly semistructured telephone interviews with caregivers, and the mean number of hours of patching per day was calculated from surgery to the first birthday (n = 92) and between 12 and 48 months of age (n = 102). Caregivers reported patching their child for a mean (SD) of 3.73 (1.47) hours/day in the first year of life and 3.43 (2.04) hours/day between 12 and 48 months of age. No differences were identified in reported patching for children who received an IOL versus those left aphakic. Monocular optotype acuity was assessed using an HOTV chart at 4.5 years of age.
Regression analysis supported an association between patching adherence and VA. Children who wore a patch at least 4 hours/day throughout the first 4 years of life had the best VA, while those who wore a patch fewer than 2 hours per day had the worst. However, there was a wide range of VA outcomes even among children who were patched for similar amounts of time.
The authors stated that these data could be used to support caregivers’ continuing efforts to adhere to the prescribed regimen and to encourage them regarding the efficacy of patching.
The original article can be found here.