Reduced quality of life, functional vision seen in children after cataract surgery
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Children who underwent congenital and developmental cataract surgery experienced a lower quality of life and reduced functional vision, and the effects were felt among parents as well, according to a study.
“Although treatments for congenital and developmental cataracts are highly successful, their effects on the [quality of life] and functional vision of postoperative children and their families are still significant,” Siyi Gu, of the Eye Hospital and School of Ophthalmology and Optometry at Wenzhou Medical University in China, and colleagues wrote in Frontiers in Public Health. “Families and their children would benefit from receiving clinical support, educational interventions, psychosocial interventions and peer support.”
Gu and colleagues conducted a retrospective, cross-sectional study of 107 children, aged 0 to 11 years, who had undergone congenital and developmental cataract surgery and compared them with a control group of 59 visually healthy children of similar age.
Researchers employed the Pediatric Eye Questionnaire (PedEyeQ) to assess eye-related quality of life and functional vision in the children, with one parent for each child completing the age-specific Proxy 0–4 PedEyeQ or Proxy 5–11 PedEyeQ, as well as the Parent PedEyeQ.
Overall, the researchers observed lower PedEyeQ scores across all questionnaire domains in children with congenital and developmental cataracts compared with the control group. The greatest mean difference in the PedEyeQ Proxy 0 to 4 year group was 27 points worse in the Functional Vision domain (P < .001), which focuses on children's daily activities and school-related tasks. Researchers noted nystagmus (P < .005) and strabismus (P < .005) were the primary factors affecting the children’s functional vision.
In the PedEyeQ Proxy 5 to 11 year group, the greatest mean difference was 23 points worse in the same domain (P < .001), with nystagmus reported as the main contributing factor (P < .05).
Compared with controls, the parent PedEyeQ 0 to 4 year group score was 46 points worse on the Worry about their Child's Eye Condition domain (P < .001), with a similar outcome of 30 points worse reported in the parent PedEyeQ 5 to 11 year group (P < .005).
Gu and colleagues further observed that nystagmus, strabismus and amblyopia are all likely to have an impact on daily activities: Patients with amblyopia are more likely to have slower reading speeds, and those with strabismus are more likely to experience motor skill deficiencies. Researchers also noted that physically noticeable nystagmus or strabismus, or having to wear glasses or eye patches as a result of these conditions, may prompt negative attention from children’s peers.
“Both patients and their parents should actively participate in therapy, especially in terms of the management of nystagmus, strabismus and amblyopia,” Gu and colleagues concluded. “Alternatively, engaging in outpatient follow-up is important, because these children’s eye conditions change with time. As such, an experienced clinician is needed to formulate the correct diagnosis and treatment plan.”
Perspective
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Almost every optometrist will eventually encounter children with pediatric or developmental cataracts. The resulting visual sequelae such as nystagmus, strabismus or amblyopia can have devastating effects on the quality of life (QOL) of these children and their parents. The findings of this study suggest that nystagmus and strabismus are the two most influential consequences reducing the QOL for both the patient and their parent and, additionally, for the older the child, the further reduction in QOL reported by both child and parent. This study also states that some experts suggest performing cataract surgery as early as 6 weeks from birth to minimize the development of amblyopia, nystagmus and strabismus. Intervention this early would minimize the reduced QOL experienced by these families.
Therefore, clinicians need to be prepared to have a conversation with the families of these children and educate them on the availability and importance of early intervention. The results of this study imply that each clinician should have a good working relationship with a pediatric ophthalmic surgeon or a pediatric ophthalmic surgery center to which the clinician can refer the families. The pace of advancing technology requires each optometrist to stay up-to-date with the latest treatments and guidelines, as optometrists are likely to be the first eye care provider with whom the majority of these families consult.
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