The Pediatric Cataract Register (PECARE): Challenges in scientific evaluation of visual development

The purpose of this study was to analyse visual acuity tests and methods used in children who have undergone cataract surgery in Sweden as well as the success rate of visual acuity testing, in order to improve current treatment. Children registered in PECARE who underwent cataract surgery between 1st January 2007 and 31st July 2016 were included. Visual acuity test methods were analysed at the follow-up ages of 1, 2, 5 and 10 years. A total of 424 children were operated, 209 girls (49%) and 215 boys (51%). The number of operated eyes was 584, of which 320 (55%) were bilateral cataracts and 264 (45%) unilateral. A total of 660 follow-up visits took place, and successful visual acuity measurements were achieved in 416 of these cases: 106/228 (46%) at 1 year of age, 128/226 (57%) at 2 years of age, 169/193 (88%) at 5 years of age, and 13/13 (100%) at 10 years of age. Visual acuity test methods differed among the follow-up clinics, making comparisons challenging. The Kasper test was widely used before the age of 2, and has been validated, but not been published scientifically. The success rate was higher for Kasper than for other tests. A challenging diversity of methods for testing visual acuity are used in Swedish paediatric cataract care. Age-related national guidelines regarding visual acuity tests methods are needed for the development and improvement of current treatment. Scientific evaluation of visual development is an important outcome in order to reach equal care. Furthermore, the Kasper test needs to be scientifically re-validated. Keywords: paediatric cataract, congenital, visual acuity test