Secondary Analyses of data from the Infant Aphakia Treatment Study: Patching in Children with Unilateral Congenital Cataracts and Poor Visual Acuity

项目标题：对婴儿无晶状体眼治疗研究数据的二次分析：儿童无晶状体眼修补 单眼先天性白内障与视力低下 项目摘要：单侧先天性白内障(UCC)是儿科最棘手的问题之一。 眼科。早期手术干预和一致的光学矫正和修补治疗是 考虑到这只眼睛获得良好视力的可能性是必要的。目前，接受UCC治疗的儿童 被建议在生命的头五年里，在清醒的50%的时间里给未受影响的眼睛戴上眼罩，而且经常 进入小学阶段。即使是早期手术和持续的补片，这些眼睛也相对较少 在孩子入学前培养良好的视力(VA)。不这样做的儿童比例很高 在接受治疗的眼睛中形成可用视力，许多照顾者难以为他们的孩子修补眼罩 规定的时间长度。因此，对于注定视力不佳的眼睛，延长补片的效用是 不清楚，而且治疗的成本需要与可能的好处进行权衡。然而，很少有数据是 关于如何帮助照顾者遵守规定的修补程序或帮助提供者和 护理者决定这种补丁的成本何时超过潜在的好处。这些差距有 限制了治疗方案的开发，以满足这一人群的需求。因此，几乎没有 可用于指导临床医生和护理人员决定提供多少补丁和 何时停止修补。 拟议的项目将利用在婴儿无晶状体眼治疗研究中收集的独特的辅助数据 (IATS)，以便为建立可能改善结果的打补丁习惯提供指导。我们还将 进行分析，以提高对打补丁后半部分的成本和收益的理解 接受UCC治疗的儿童的学龄前阶段。具体来说，我们将确定是否有可能准确地 使用收集的信息确定最终将在受影响眼睛中几乎没有可用视力的儿童 生命的头四年，如果儿童的生活质量受到长期补丁的影响，他们最终会 看不清楚。 IATS是一项随机对照试验，旨在比较两种治疗UCC的方法：离开儿童 无晶状体眼与白内障手术时植入人工晶状体的比较。这项初步研究是 目前可获得的治疗UCC的最大儿童队列，并提供了关于 这些儿童在入学前的结果。建议的R21将利用来自这一独特的、良好的 接受UCC治疗的儿童的特征队列，他们被跟踪超过10年，产生 对与UCC治疗相关的重要问题的新认识。

Project Title: Secondary Analyses of data from the Infant Aphakia Treatment Study: Patching in Children with Unilateral Congenital Cataracts and Poor Visual Acuity Project Summary: Unilateral congenital cataracts (UCC) are one of the most difficult problems in pediatric ophthalmology. Early surgical intervention, and consistent optical correction and patching therapy are necessary to allow for the possibility of achieving good vision in this eye. Currently, children treated for UCC are advised to patch the unaffected eye for 50% of waking hours throughout the first five years of life, and often into the elementary school years. Even with early surgery and consistent patching relatively few of these eyes develop good visual acuity (VA) by the time the children enter school. A high proportion of children who do not develop useable vision in the treated eye and many caregivers have difficulty patching their children for the prescribed amount of time. Therefore, the utility of extended patching in eyes destined to have poor vision is unclear, and the costs of therapy need to be weighed against possible benefits. However, few data are available regarding how to help caregivers adhere to prescribed patching protocols or to help providers and caregivers determine when the costs of such patching outweigh the potential benefits. These gaps have limited the development of treatment protocols to address the needs of this population. Therefore, there is little evidence which can be used to guide clinicians and caregivers in deciding how much patching to provide and when to discontinue patching. The proposed project will leverage unique secondary data collected in the Infant Aphakia Treatment Study (IATS) in order to provide guidance on establishing patching habits that may improve outcomes. We will also conduct analyses that will improve understanding of the costs and benefits of patching in the latter part of the preschool period in children treated for UCC. Specifically, we will determine whether it is possible to accurately identify children who will ultimately have little usable vision in their affected eye using information collected in the first four years of life, and if quality of life is impacted by prolonged patching in children who ultimately will not see well. The IATS is a randomized controlled trial designed to compare two treatments for UCC: leaving children aphakic versus implanting an intraocular lens (IOL) at the time of cataract surgery. The primary study is one of the largest currently-available cohorts of children treated for UCC, and has provided important evidence about outcomes in these children prior to school-entry. The proposed R21 will leverage data from this unique, well- characterized cohort of children treated for UCC who have been followed for more than 10 years to generate new knowledge about important questions related to treatment of UCC.