Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
JAMA Ophthalmol. 2024 Jun 1;142(6):503-510. doi: 10.1001/jamaophthalmol.2024.0800.
Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC).
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.
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).
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.
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).
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.
对于接受单侧先天性白内障（UCC）治疗的儿童，父母可能会担心遮盖疗法的不良后果。
确定在 UCC 治疗中视力结果不佳的儿童中，遮盖疗法是否与儿童和/或家庭功能较差有关。
设计、地点和参与者：这是一项 2023 年进行的队列研究，使用了 2006 年至 2016 年期间在婴儿无晶状体治疗研究（IATS）中收集的数据。纳入了视力（VA）为 20/200 或更差的 IATS 参与者。统计分析于 2022 年 7 月至 2023 年 10 月进行。
在 4.5 岁时进行 VA 评估前的 12 个月内，看护人报告平均每天遮盖的分钟数为 4.5 分钟。遮盖分为轻度（每天<15 分钟）、中度（每天 15 至<120 分钟）和重度（每天≥120 分钟）。
在 4.25 岁和 10.5 岁时，看护人使用父母压力指数和眼部治疗指数报告与育儿角色相关的压力，以及使用 Achenbach 儿童行为检查表报告儿童行为问题。在 54 个月时使用儿童运动评估电池-第二版评估运动技能。儿童在 10.5 岁时完成哈特尔儿童自我知觉量表。使用单因素方差分析和 χ2 检验比较不同遮盖量的结果。
在视力为 20/200 或更差的 53 名儿童中，有 47 名（88.7%）提供了遮盖数据。在包括在研究中的 47 名有遮盖数据的儿童中，20 名（42.5%）为女性，27 名（57.5%）为男性，12 名（25.5%）每天遮盖时间少于 15 分钟，11 名（23.4%）每天遮盖 16 至 119 分钟，24 名（51.1%）每天遮盖至少 120 分钟。在所有组别中，父母压力、儿童行为问题、运动功能和儿童自我知觉相似。例如，在调整性别和保险状况后，报告轻度遮盖的父母与报告每天至少遮盖 120 分钟的父母之间的平均压力评分差异无统计学意义（11.0[95%CI，-4.5 至 26.5]分），并且儿童对自身总体自我价值感的报告差异无统计学意义（0.0[95%CI，-0.4 至 0.3]分）。
遮盖疗法与家庭或儿童功能无不良关联。尽管样本量有限，但这些结果不支持改变当前的实践指南。
