Effects of Prolonged Waiting Time on Visual Outcomes of Patients with Pediatric Cataract in a Tertiary Public
Marie Jeazelle Redondo Villanueva1, Alvina Pauline D Santiago1,2,3,4
1Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
Insights
Pediatric cataract surgery delays are common, but delayed operations did not negatively impact visual outcomes in children. Early consultation is crucial for better results in pediatric cataract management.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Public Health
Background:
- Pediatric cataract is a leading cause of preventable childhood blindness globally.
- Timely intervention is critical for optimal visual development and rehabilitation in children with cataracts.
Purpose of the Study:
- To determine the average waiting time for pediatric cataract surgery from initial consultation.
- To compare the impact of delayed versus timely surgery on visual outcomes in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric cataract patients from January 2015 to June 2022.
- Analysis of intervals between consultation and surgery, defining "delayed surgery" as >2 weeks post-consultation.
- Comparison of pre-operative and post-operative visual acuity between delayed and non-delayed surgical groups.
Main Results:
- A median age of 4.9 years at consultation and 5.2 years at surgery was observed.
- No significant difference in visual outcomes was found between children who had surgery within 2 weeks and those who had delayed surgery.
- Surgery admission was faster during the pandemic, but overall waiting times did not differ significantly.
Conclusions:
- Pediatric cataract patients at the Philippine General Hospital experience delays in diagnosis and surgery.
- Delayed surgery did not correlate with poorer visual outcomes, potentially due to delayed initial consultations.
- Emphasizes the need to address consultation delays for improved pediatric cataract care.
Background:
Pediatric cataract is one of the most common preventable cause of childhood blindness worldwide. Early and timely intervention of pediatric cataract is important to maximize the visual outcomes and start prompt visual rehabilitation.
Objectives:
This study aimed to determine the average time from the day of initial consult at the outpatient clinic to the day of the cataract surgery and compare the effects of delayed surgery on visual outcomes of patients.
Methods:
This is a retrospective chart review of medical records from January 2015 to June 2022. The dates of the different steps in the process up to the day of intervention were noted and the average interval duration and the total waiting time were determined. Patients operated on within 2 weeks from initial consult was defined as no delay while those operated >2 weeks had delayed surgery. Pre-operative and post-operative best corrected log MAR visual acuity were compared within each group to determine if delay in surgical intervention has a significant effect on the visual outcomes of patients.
Results:
Median age at initial consult was 4.9 years while median age at surgery was 5.2 years. Ninety-nine (99) patients had developmental cataract and 123 patients had bilateral cataract. Leukocoria was the most common chief complaint (63.45%). Pre-operatively, 94 patients had strabismus, 49 had eye preference, 48 had nystagmus, and 43 had amblyopia in the diagnosis. There was significantly faster admission to cataract surgery during the pandemic compared to pre-pandemic period but there was no difference in the total waiting time. Patients with congenital cataract had the least total waiting time followed by developmental, and rubella cataract. There is no significant difference in visual outcomes between patients operated without delay and with delay.
Conclusion:
There is delayed age at diagnosis and surgery of pediatric cataract patients in the Philippine General Hospital. Early surgery did not reflect better visual outcomes compared to delayed surgery probably due to delay in consultation of patients.
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