Behaviors of children with unilateral vision impairment in the Infant Aphakia Treatment Study

Abstract

Purpose: To determine whether behavioral functioning of 4.5-year-olds differs between two treatments for unilateral cataract and whether behavioral functioning is predicted by visual acuity in the treated eye.

Methods: The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with contact lens correction or implantation of an intraocular lens. Patching data were collected during the year preceding a visit at age 4.5 years, when both visual acuity and caregiver-reported behavioral functioning were assessed for 109 participants. Caregiver stress was assessed with the Parenting Stress Index at 4.25 years.

Results: There were no treatment group differences in behavioral functioning as measured by the Child Behavior Checklist. Poorer visual acuity was associated with more externalizing behavior problems (attention problems and aggressive behavior) and total behavior problems in regression models that did not include caregiver stress. Both caregiver stress and dichotomized visual acuity significantly predicted externalizing problems.

Conclusions: Treatment assignment did not affect caregiver-reported behavior. Poor visual acuity may confer risk for problems with attention and aggressive behavior in preschoolers treated for unilateral cataract.

Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Figures

FIG 1

Consort diagram for Infant Aphakia Treatment Study. The 1 patient randomized to the IOL group but not treated was found intraoperatively to have stretching of the ciliary processes; the investigator decided that an IOL could not be safely implanted, and the patient was left aphakic and treated with a contact lens. One patient not assessed in the IOL group had developmental delay and could not complete the HOTV visual acuity test at age 4.5 years. In the contact lens group, 2 patients had a secondary IOL implanted at 1.3 and 3.0 years after randomization. A third patient had a secondary IOL implanted at 4.7 years after randomization and after the primary endpoint was assessed but before the last clinical examination at age 5 years.