Patching after age 4 does not modify visual acuity in children treated for unilateral congenital cataract: Study

Pediatric ophthalmology researcher Carolyn Drews-Botsch's research helps parents and health care providers decide whether or not to continue patching their children who were treated for unilateral congenital cataract (UCC) after the child’s vision can be reliably tested.

Her paper published in Ophthalmology reports:

• Patching children after age 4 does not dramatically change their ability to see fine details at a distance (visual acuity).

• Optotype acuity assessments in 4-year-olds who were treated for unilateral congenital cataract are reliable and predictive of their visual acuity at age 10.

• Less-aggressive patching protocols may be warranted in some children if patching is a source of stress for the family and/or distress for the child since continued aggressive patching is unlikely to provide significant improvements to vision after age 4.

• Before discontinuing eye patching, consider the effect of patching on the child’s quality of life, family relationships, visual field with one and two eyes (including latent nystagmus, a type of involuntary, rhythmic eye movement in one eye).

Optotype acuity is the measurement of a person’s ability to see fine details and distinguish between different visual elements, like an O and a Q. An eye chart is used to measure how well a person can see at various distances.

Other UCC research from Drews-Botsch finds that:

• Established patching habits in infants approximately doubles the likelihood that children with UCC will strengthen their vision to normal level, considered 20/40 or better.

• Prolonged eye patching does not have negative impact on family stress levels or child’s development.

Children with UCC are born with cloudy or opaque vision in one eye that, if left untreated, can result in blindness in that eye. After the surgery, occlusion therapy is prescribed to avoid lazy eye (deprivation amblyopia). Also known as patching, occlusion therapy is when the child wears a patch covering the eye that did not have the cataract and it is needed to allow vision in the affected eye. However, even with the best treatment, about half of these children will remain legally blind in the treated eye.

Reference:

Drews-Botsch, Carolyn D. et al., Is Patching after Age 4 Beneficial for Children Born with a Unilateral Congenital Cataract?, Ophthalmology, DOI: 10.1016/j.ophtha.2024.11.005