Oral reading after treatment of dense congenital unilateral cataract

Background

Good long-term visual acuity outcomes for children with dense congenital unilateral cataracts have been reported after early surgery and good compliance with postoperative amblyopia therapy. However, treated eyes rarely achieve normal visual acuity, and there has been no formal evaluation of the utility of the treated eye for reading.

Methods

Eighteen children previously treated for dense congenital unilateral cataract were tested monocularly with the Gray Oral Reading Test, 4th edition (GORT-4) at 7 to 13 years of age with the use of 2 passages for each eye, one at grade level and one at +1 above grade level. In addition, right eyes of 55 normal children age 7 to 13 served as a control group. The GORT-4 assesses reading rate, accuracy, fluency, and comprehension.

Results

Visual acuity of treated eyes ranged from 0.1 to 2.0 logMAR and of fellow eyes from −0.1 to 0.3 logMAR. Treated eyes scored significantly lower than fellow and normal control eyes on all scales at grade level and at +1 above grade level. Monocular reading rate, accuracy, fluency, and comprehension were correlated with visual acuity of treated eyes (r_s = −0.575 to −0.875, p < 0.005). Treated eyes with 0.1-0.3 logMAR visual acuity did not differ from fellow or normal control eyes in rate, accuracy, fluency, or comprehension when reading at grade level or at +1 above grade level. Fellow eyes did not differ from normal controls on any reading scale.

Conclusions

Excellent visual acuity outcomes after treatment of dense congenital unilateral cataracts are associated with normal reading ability of the treated eye in school-age children.

Introduction

Good long-term visual acuity outcomes have been reported after surgery for dense congenital unilateral cataracts by 6 weeks of age in tandem with prolonged optical and occlusion therapy.1, 2, 3, 4, 5 However, treated eyes rarely achieve normal visual acuity.1, 2, 3, 4, 5 There has been no formal evaluation of the utility of the treated eye for reading in the event of injury to the sound eye.

Reading is a critical measure of the potential utility of the affected eye because it is the foundation for academic success and there is a clear link between academic success in childhood and long-term social and economic outcomes.⁶ Oral reading is a particularly demanding task because it requires the decoding of graphemes into phonemes and the assembly of phonemes into words.⁷ Visual impairment may make decoding of graphemes more difficult, resulting in slow and/or inaccurate oral reading. In addition, if a visually impaired child directs more attention to decoding graphemes, less attention may be directed toward comprehension. We evaluated the oral reading ability of treated eyes with a standardized assessment of reading fluency and comprehension.