Stereopsis Following Surgery in Children with Congenital and Developmental Cataracts

Authors: Lohia K, Soans R S, Agarwal D, Tandon R, Saxena R, Gandhi T K.

Geographical coverage: USA, UK, Germany, Korea, France, Italy, Poland, Czechia, Japan, and India

Sector: Cataract surgery

Sub-sector: Stereopsis

Equity focus: Not reported

Study population: Children (< 18 years) with congenital or developmental cataracts

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background:

Stereopsis (depth perception) is crucial for normal visual development and day-to-day functioning. In congenital and developmental cataracts, early visual deprivation severely disrupts binocular vision. Although surgical techniques have advanced, post-operative recovery of stereopsis remains variable. Outcomes depend on the critical period for binocular development, timing of surgery, and the presence of amblyopia or strabismus. Methodological differences among studies further complicate assessment. A clear understanding of these factors is vital for optimising paediatric visual rehabilitation.

Objective:

To systematically review and analyse the prevalence of, and factors influencing, stereopsis after cataract surgery in children with congenital and developmental cataracts.

Main findings:

Twenty studies met the inclusion criteria (2 cohort studies, 14 case series, 1 case report, 3 clinical trials) from the USA, UK, Germany, Korea, France, Italy, Poland, Czechia, Japan and India.

Congenital cataract

*Early surgery = performed before 4–6 months of age.

Developmental cataract

Overall, developmental cataracts yielded superior stereopsis compared with congenital cases.

Methodology: 

Searches of PubMed, Embase and Web of Science (English-language articles, 1995–2020) identified studies reporting monocular and binocular depth-perception outcomes. Two reviewers independently extracted data. Study quality was appraised using National Institutes of Health tools and certainty assessed with GRADE. Random-effects meta-analysis was conducted; heterogeneity was quantified with I² and publication bias evaluated via funnel plots. Sub-group analysis Applicability/external validity: The review did not explicitly discuss the applicability or external validity of its findings. However, the review highlighted the limited number of published studies that reported stereoacuity outcomes following cataract surgeries. Additionally, the review authors were unable to perform postoperative refractive error analysis due to insufficient number of follow-up studies. The review emphasised the need for more prospective studies with large sample size and longer follow-up.

Geographic focus: The review did not apply any geographical limits. The included studies were conducted across the globe, including USA, UK, Germany, Korea, France, Italy, Poland, Czechia, Japan, and India.

Summary quality assessment

There is low confidence in the review conclusions. Manual reference-list searches were not conducted, and a list of excluded studies were not provided. In addition, English-language restriction and unclear details on independent screening may limit the reliability of review findings.