Unilateral Congenital and Developmental Cataracts in Children in India: How Useful Were Long-Term Outcomes of Surgery? Miraj Pediatric Cataract Study 4.

PURPOSE: To study visual outcomes and stereopsis after a 3-8 year follow-up in unilateral congenital and developmental cataracts. DESIGN: Clinical case series. METHODS: Children who underwent surgery for unilateral pediatric cataract from 2004 to 2008 were traced and reexamined prospectively from 2010 to 2011. Demographic and clinical factors were noted from their retrospective chart readings. All children underwent visual acuity assessment and comprehensive ocular examinations including stereoacuity in a standardized manner during the prospective follow-up visits. Details of amblyopia management were recorded for univariate and multivariate analyses. RESULTS: Forty-eight eyes of 48 children had a mean follow-up of 4.4 years between surgery and assessment (SD, 1.6 years). Twenty-four (50%) were boys, and the average age at surgery was 10.2 years (SD, 4.1). Two (4.2%) were congenital, 14 (29.2%) developmental, and 32 (66.7%) congenital/developmental cataracts. Preoperatively, 38 (79.2%) had vision less than 3/60. After surgery, 12 (25%) had improved best-corrected visual acuity (BCVA) of 6/18 or greater, 4 (8.3%) had BCVA of 6/24 to 6/60, and 32 (66.7%) had BCVA of less than 6/60. Eleven (22.9%) had binocular single vision 480 seconds or less of arc on Titmus test. Preoperative vision (P = 0.034) was significantly associated with postoperative visual outcomes, but not age at surgery (P = 0.14), sex (P = 0.897), type of surgery (P = 0.371), or type of intraocular lens (P = 0.66). The use of phacoemulsification was associated with better vision, but it was not significant (P = 0.069). CONCLUSIONS: Long-term visual outcomes in unilateral pediatric cataracts were subnormal due to deprivation amblyopia, but vision improved over preoperative levels and helped in binocular stereoacuity. Some preoperative vision was associated with better visual outcomes.

Barriers to follow-up for pediatric cataract surgery in Maharashtra, India: how regular follow-up is important for good outcome. The Miraj Pediatric Cataract Study II.

BACKGROUND: Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery. AIM: To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up. SUBJECTS: 262 children (393 cataracts) who underwent cataract surgery in 2004-8. MATERIALS AND METHODS: The children were identified and examined in their homes and a "barriers to follow-up" questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed. STATISTICAL ANALYSIS: SPSS version 19. RESULTS: Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group ( P < 0.001), less education of mother ( P = 0.012), father's occupation ( P = 0.031), how much money spent on travel ( P = 0.033) and was it paid or free surgery ( P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up. CONCLUSION: Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.

Spectacle compliance amongst rural secondary school children in Pune district, India.

BACKGROUND: Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users. AIM: To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles. SETTINGS AND DESIGN: Cross-sectional follow-up study of rural secondary school children in western India. MATERIALS AND METHODS: The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire. STATISTICAL ANALYSIS: Chi-square test and multiple logistic regression used for data analysis. RESULTS: Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were 'lost spectacles' 67(9.3%), 'broken spectacles' 125 (17.4%), 'forgot spectacles at home' 117 (16.3%), 'uses spectacles sometimes' 109 (15.2%), 'teased about spectacles' 142 (19.8%) and 'do not like the spectacles' 86 (12%). CONCLUSION: Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.