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QuestionÌý Among families with a child treated for a unilateral congenital cataract and who had a poor visual outcome, is continued patching negatively associated with parenting stress or with motor development, child behavior, or self-perception?

FindingsÌý In this cohort study of 47 children with patching data, patching between ages 42 and 54 months was not associated with parenting stress or child functioning in children with a poor visual outcome following treatment for unilateral congenital cataract.

MeaningÌý These findings do not contradict current practice guidelines in which patching is prescribed to children treated for unilateral congenital cataract throughout the amblyogenic period.

ImportanceÌý Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC).

ObjectiveÌý 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 ParticipantsÌý 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.

ExposureÌý 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 MeasuresÌý 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.

ResultsÌý 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 RelevanceÌý 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.