The Pediatric Cataract Register (PECARE): Challenges in scientific evaluation of visual development
DOI:
https://doi.org/10.15626/sjovs.v18i1.4351Keywords:
paediatric cataract, congenital, visual acuity testAbstract
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
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References
Adoh, T. O., & Woodhouse, J. M. (1994). The Cardiff acuity test used for measuring visual acuity development in toddlers. Vision Research, 34(4), 555–60. https://doi.org/10.1016/0042-6989(94)90168-6
Anstice, N. S., & Thompson, B. (2014). The measurement of visual acuity in children: An evidence-based update. Clinical and Experimental Optometry, 97 (1), 3–11. https://doi.org/10.1111/cxo.12086
Chan, W. H., Biswas, S., Ashworth, J. L., & Lloyd, I. C. (2012). Congenital and infantile cataract: Aetiology and management. European Journal of Pediatrics, 171(4), 625–30. https://doi.org/10.1007/s00431-012-1700-1
Euroscreen vision & hearing. (2023). https://www.euscreen.org
Gilbert, C., & Foster, A. (2001). Childhood blindness in the context of VISION 2020–the right to sight. Bulletin of the World Health Organisation, 79(3), 227–32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566382/pdf/11285667.pdf
Haargaard, B., Nystrom, A., Rosensvard, A., Tornqvist, K., & Magnusson, G. (2015). The Pediatric Cataract Register (PECARE): Analysis of age at detection of congenital cataract. Acta Ophthalmologica, 93(1), 24–6. https://doi.org/10.1111/aos.12445
Harris, S. J., Hansen, R. M., & Fulton, A. B. (1984). Assessment of acuity in human infants using face and grating stimuli. Investigative Ophthalmology & Visual Science, 25(7), 782–6.
Harris, S. J., Hansen, R. M., & Fulton, A. B. (1986). Assessment of acuity of amblyopic subjects using face, grating, and recognition stimuli. Investigative Ophthalmology & Visual Science, 27 (7), 1184–7.
Kasper visual test chart. (2023). https://www.syntavlor.se/
Lundström, M., Stenevi, U., & Thorburn, W. (2002). The Swedish national cataract register: A 9-year review. Acta Ophthalmologica Scandinavica, 80(3), 248–57. https://doi.org/10.1034/j.1600-0420.2002.800304.x
Lyons, C. J., & Lambert, S. (2022). Taylor and Hoyt’s pediatric ophthalmology and strabismus (6th). Elsevier.
Magnusson, G., Haargaard, B., Basit, S., Lundvall, A., Nystrom, A., Rosensvard, A., & Tornqvist, K. (2018). The Paediatric Cataract Register (PECARE): an overview of operated childhood cataract in Sweden and Denmark. Acta Ophthalmologica, 96(1), 51–55. https://doi.org/https://doi.org/10.1111/aos.13497
Maurer, D., & Barrera, M. (1981). Infants’ perception of natural and distorted arrangements of a schematic face. Child Development, 52(1), 196–202.
Morton, J., & Johnson, M. H. (1991). CONSPEC and CONLERN: A two-process theory of infant face recognition. Psychological Review, 98(2), 164–81. https://doi.org/10.1037/0033-295x.98.2.164
Moutakis, K., Stigmar, G., & Hall-Lindberg, J. (2004). Using the KM visual acuity chart for more reliable evaluation of amblyopia compared to the HVOT method. Acta Ophthalmologica Scandinavica, 82(5), 547–51. https://doi.org/10.1111/j.1600-0420.2004.00307.x
PECARE. (2025). Pediatric Cataract Register. http://rcsyd.se/pecare/
Rydberg, A. (2013). Burian lecture: Assessment of visual function in children. Strabismus, 21(2), 61–6. https://doi.org/10.3109/09273972.2013.787636
SFS 2017:30. (2017). Svensk Hälso- och sjukvårdslag [The Swedish Health and Medical Care Act]. Retrieved September 1, 2025, from https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/halso-och-sjukvardslag-201730_sfs-2017-30
Teller, D. Y., McDonald, M. A., Preston, K., Sebris, S. L., & Dobson, V. (1986). Assessment of visual acuity in infants and children: The acuity card procedure. Developmental Medicine & Child Neurology, 28(6), 779–89. https://doi.org/10.1111/j.1469-8749.1986.tb03932.x
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Copyright (c) 2025 Jenny Gyllén, Birgitte Haargaard, Alf Nyström, Arzu Karatepe Hashas, Anna Linnarsson Wiklund, Eric Trocmé, Annika Rosensvärd, Ulrika Kjellström, Jenny Wallander, Kristina Tornqvist, Gunilla Magnusson

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