Visual Impairment and Reading Ability in High and Low Socioeconomic Status Children with a Unilateral Congenital Cataract Open Access

Momkus, Jennifer (Spring 2020)

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Background: Even with treatment, children born with a unilateral congenital cataract (UCC) often have poor vision in the affected eye. It is important to understand the functional impact of this unilateral impaired vision to inform clinical decision-making. We examined the association between visual impairment (VI) in the affected eye with reading ability to understand how UCC affects learning. We also investigated if this association differs based on socioeconomic status (SES).

Methods: A cohort of children who received treatment for UCC in early infancy were followed throughout childhood. At age 10 ½ years, visual acuity was ascertained, and reading rate and eye movements during silent reading were assessed using a ReadAlyzer. We compared distributions of reading rates, proportion of and number of regressive saccades while reading between three categories of visual acuity in the affected eye; near normal (20/40 or better), mild-moderate VI (20/40 to 20/200), and severe VI (20/200 or worse). We performed a linear and logistic regression with reading as a function of visual acuity controlling for relevant confounders. We also examined the possibility of interaction by insurance status (public vs. private) as a proxy for SES.

Results: After controlling for covariates, there was no significant difference in the average reading rate (near normal=158wpm, mild to moderate VI=173wpm, 1 severe VI=158wpm, p=0.70), number of regressive saccades (near normal=38, mild to moderate VI=28, severe VI=43, p=0.29), or the average regressive saccade to fixation ratio (near normal=22%, mild to moderate VI=18%, severe VI=22%, p=0.36) between the three visual acuity categories. However, the odds of poor reading outcomes among those with severe VI differed meaningfully by socioeconomic status (low SES: ORslow reading=2.26, 95% CI [0.45, 11.26], ORhigh# regr saccades=3.54, 95% CI [0.72, 17.32], ORhigh regr/fixation ratio=3.61 [0.74,17.66] vs. high SES: ORslow reading=0.48, 95% CI [0.12, 2.02], ORhigh# regr saccades=0.93, 95% CI [0.21, 4.22], ORhigh regr/fixation ratio=0.35 [0.07, 1.82])

Conclusions: There did not appear to be a significant benefit of better visual outcomes on silent reading in 10-year old children treated for UCC. However, socioeconomic status is associated with poorer reading and poor vision in the treated eye may exacerbate this concern.  

Table of Contents

Table of Contents

Introduction. 1

Methods. 4

Results. 8

Discussion. 10

Strengths and Weaknesses: 13

Future Directions: 14

References. 15

Tables. 20

Table 1. Characteristics of Study Population, Infant Aphakia Treatment Study (IATS) with Available Data on Silent Reading. 20

Table 2. Summary Statistics Comparing Reading Outcomes by Private Insurance Status among IATS Participants. 20

Table 3. Summary Statistics Comparing 3rd Grade Silent Reading Outcomes at age 10 ½ Years by Visual Acuity Level among IATS Participants. 21

Table 4. Linear Associations between LogMAR VA in Treated Eye and Silent Reading Outcomes in IATS Participants (N=91) 21

Table 5. Prevalence Odds Ratios for the Relationship Between Vision Impairment in the Treated Eye (Severe VI vs. Normal to Moderate VI) and Poor Reading Outcomes. 22

Table 6. Prevalence Odds Ratios for the Relationship Between Vision Impairment in the Treated Eye (Severe VI vs. Normal to Moderate VI) and Poor Reading Outcomes Stratified by SES. 22

Figures. 23

Figure 1. Distribution of Reading Rate by Visual Acuity in the Treated Eye. 23

Figure 2. Distribution of Regressive Saccades by Visual Acuity in the Treated Eye. 23

Figure 3. Distribution of Regression to Fixation Ratio by Visual Acuity in the Treated Eye. 24

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