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Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress
Carolyn Drews-Botsch1, George Cotsonis2, Marianne Celano3
1Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia.
Insights
Occlusion therapy for unilateral congenital cataract (UCC) in children did not negatively impact child or family functioning. These findings support current treatment guidelines for UCC, reassuring parents about potential adverse outcomes.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Child Psychology
Background:
- Parents express concerns regarding potential negative effects of occlusion therapy on children with unilateral congenital cataract (UCC).
- Assessing the impact of occlusion therapy on child and family functioning is crucial for guiding treatment decisions.
Purpose of the Study:
- To investigate whether occlusion therapy for children with UCC and poor visual outcomes is associated with adverse child and/or family functioning.
- To provide evidence-based information to alleviate parental concerns regarding occlusion therapy.
Main Methods:
- A cohort study utilizing data from the Infant Aphakia Treatment Study (IATS) included children with a visual acuity (VA) of 20/200 or worse.
- Parent-reported outcomes included parenting stress and child behavior problems; child outcomes included motor skills and self-perception.
- Statistical analyses compared outcomes across different levels of daily patching duration (minimal, moderate, extensive).
Main Results:
- No significant negative associations were found between occlusion therapy duration and parenting stress, child behavior problems, motor functioning, or self-perception.
- Specifically, there were no significant differences in parenting stress or children's global self-worth between minimal and extensive patching groups.
- The study analyzed data from 47 children, with varying durations of patching reported.
Conclusions:
- Occlusion therapy for unilateral congenital cataract (UCC) in children with poor visual outcomes does not appear to negatively affect child or family functioning.
- The findings suggest that current practice guidelines for occlusion therapy are appropriate and do not require modification.
- This study offers reassurance to parents regarding the safety and efficacy of occlusion therapy in this patient population.
Importance:
Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC).
Objective:
To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning.
Design, Setting, And Participants:
This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023.
Exposure:
Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day).
Main Outcome Measures:
At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching.
Results:
Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points).
Conclusions And Relevance:
Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.
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