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Cataract surgery outcomes in bangladeshi children
Guy S Negretti1, Tariq Ayoub1, Sadeq Ahmed2
1Moorfields Eye Hospital, London, United Kingdom.
Insights
Pediatric cataract surgery in Bangladesh improved vision for some, but many still face visual impairment due to amblyopia and nystagmus. Early detection and treatment are crucial for better visual outcomes and educational access.
Area of Science:
- Ophthalmology
- Public Health
- Pediatric Medicine
Background:
- Childhood cataracts cause significant visual impairment globally.
- Effective surgical interventions can restore sight, but long-term outcomes require evaluation.
- Understanding the social impact, including educational attainment, is vital for holistic patient care.
Purpose of the Study:
- To assess visual acuity (VA) outcomes, complication rates, and social impact of cataract surgery in children in Bangladesh.
- To evaluate long-term results following pediatric cataract surgery.
- To identify factors influencing visual outcomes and school attendance.
Main Methods:
- A case series design was employed, following children who underwent cataract surgery.
- Data were collected via questionnaires and comprehensive ocular examinations.
- Operative data, where available, were analyzed alongside clinical findings.
Main Results:
- A significant proportion of participants (53%) remained severely visually impaired or blind (VA <20/200) post-surgery.
- Refractive correction improved VA in 33%, but 33% still had VA <20/200 in their better eye.
- Nystagmus, delayed presentation, and refractive error were key predictors of poor visual acuity.
Conclusions:
- Approximately one-third of participants achieved a best-corrected visual acuity (BCVA) of ≥20/60 in their better eye.
- Amblyopia and nystagmus significantly limited visual outcomes, highlighting the need for early detection and intervention.
- This study establishes a link between pediatric cataract surgery outcomes and educational access, aligning with a millennium development goal.
Purpose:
To measure visual acuity (VA) outcomes, complication rates, and the social impact of cataract surgery in a cohort who underwent surgery as children in Bangladesh.
Design:
Case series.
Participants:
A total of 471 of 850 children from 6 Bangladeshi districts who had been identified as cataract blind using key informants (KIs) between 2004 and 2009 during the Bangladesh Childhood Cataract Campaign (BCCC) together with all those children not included in the BCCC database but in the Child Sight Foundation (CSF) database who had been identified as cataract blind.
Methods:
The subjects and families were contacted again by KIs and transported to local examination centers, where parents and subjects were administered a questionnaire and subjects underwent full ocular examination. Where operative data were available (15%), they were analyzed in conjunction with questionnaire and examination findings. Statistical analysis was performed using SPSS Statistics (IBM, Armonk, NY).
Main Outcome Measures:
Presenting and best-corrected visual acuities (BCVAs), cause(s) of poor outcome, postoperative refraction, and school attendance.
Results:
A total of 407 of the participants had undergone bilateral surgery as children, with a mean follow-up of 8.8 years. The mean age at examination was 16 years (range, 5-28 years; standard deviation [SD], 4.6 years); 63% of those examined were male; 22% had a binocular presenting VA of >20/60; and 53% were severely visually impaired or blind (VA <20/200). After refraction, 33% had VA >20/60 in their better eye and 33% had VA <20/200. Factors that predicted poor VA in multivariate logistic regression analysis were nystagmus (P < 0.001), longer delay in presentation (P < 0.001), and magnitude of absolute spherical equivalent refractive error (P<0.001). Some 50% had nystagmus, and 69% of those currently aged ≤16 years were attending school. Better acuity was associated with school attendance (P < 0.001), whereas gender was not.
Conclusions:
Approximately one third of all participants had a BCVA of ≥20/60 in their better eye. Amblyopia and nystagmus limited visual outcome, indicating the need for earlier detection and treatment. This is the first study to show the link between pediatric cataract outcome and access to education, a millennium development goal.
