Have Deprivation Amblyopia Outcomes Improved for Infants With Unilateral Cataracts?

An aspiration of modern medicine is for disease treatment to improve progressively. Here we examine outcomes of treatment for monocular deprivation amblyopia, caused by a congenital cataract, at an academic medical center over several decades. The question we addressed was whether outcomes have improved substantially, or whether they have remained stubbornly disappointing.

Retrospective, trend study.

Patients with deprivation amblyopia due to primary monocular congenital cataract removed before 1 year of age were studied. Preoperative and outcome data were collated from sequential examinations to document corrected distance visual acuity (CDVA), binocular visuomotor behaviors, anterior segment and vitreo-retinal health, adherence to therapies, demographic variables, and the need for subsequent surgical interventions. Biometry measurements were recorded at the time of initial cataract surgery. The primary outcome measure was CDVA. Additional outcomes measures were prevalence of nystagmus, strabismus, ocular hypertension (OHT)/glaucoma, and number of ocular surgeries.

A total of 80 children met inclusion criteria, with a median follow-up age of 12 years. Median CDVA of amblyopic eyes at last follow-up was 1.40 logMAR or 20/500 (interquartile range = 0.75-CF). There were no significant differences in CDVA for patients with cataract extraction between 1990 and 1999, 2000 and 2009, and 2010 and 2022 (P = .25), with medians of 1.00, 1.44, and 1.40 logMAR, respectively. Better CDVA was related systematically to earlier age at surgery, but the correlation was weak (P = .06). In all, 96% of the children (77 of 80) had secondary implantation of an intraocular lens. Strabismus developed in 98% of the children (78 of 80), and fusion maldevelopment nystagmus in 73% (58 of 80). A total of 43% (34 of 80) required subsequent surgery for removal of a secondary cataract, and 30% (24 of 80) required surgery to treat aphakic or pseudophakic OHT/glaucoma. The median number of total ophthalmic surgeries was 5 (IQR = 3-6).

Visual acuity outcomes for monocular deprivation amblyopia remain disappointing. Adherence to patching therapy and contact lens wear is burdensome and often is not achieved. Children with the condition require an average of 4 subsequent surgeries in the first decade of life for intraocular lens implantation, removal of a secondary cataract, strabismus, or glaucoma.