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Aetiology of childhood cataract in south India
M Eckstein1, P Vijayalakshmi, M Killedar
1Department of Preventive Ophthalmology, Institute of Ophthalmology, London.
Insights
Nearly half of childhood cataracts in South India stem from preventable causes like congenital rubella syndrome (CRS) and hereditary factors. Further research is needed to determine the causes of the remaining undetermined cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Childhood cataract is a significant cause of visual impairment in children.
- Identifying etiological factors is crucial for prevention and early intervention strategies.
Purpose of the Study:
- To determine the causes of childhood cataract in South India.
- To emphasize potentially preventable factors contributing to pediatric cataracts.
Main Methods:
- A study of 514 children with cataract was conducted at an eye hospital outpatient clinic.
- Standardized questionnaires and serology for congenital rubella syndrome (CRS) were utilized.
- Clinical investigations were performed as indicated.
Main Results:
- Among non-traumatic cataracts, 25% were hereditary, 15% due to CRS, and 51% undetermined.
- In infants, 25% of cataracts were rubella-related; nuclear cataracts had a 75% positive predictive value for CRS.
- Traumatic cataracts (29% of cases) were often linked to injuries from sticks, thorns, or firecrackers.
Conclusions:
- Potentially preventable causes, including CRS and autosomal dominant diseases, account for nearly half of non-traumatic childhood cataracts in South India.
- Further investigation is required to elucidate the causes of undetermined childhood cataracts, representing at least half of the cases.
Aim:
To identify the causes of childhood cataract in south India with emphasis on factors that might be potentially preventable.
Methods:
A total of 514 consecutive children with cataract attending an eye hospital outpatient clinic were examined and their parents interviewed by a trained interviewer using a standardised questionnaire in the local language. Serology was performed on children under 1 year of age to detect congenital rubella syndrome (CRS). Other investigations were performed as clinically indicated.
Results:
Of the 366 children with non-traumatic cataract 25% were hereditary, 15% were due to congenital rubella syndrome, and 51% were undetermined. In children under 1 year of age 25% were due to rubella and cataract of nuclear morphology had a 75% positive predictive value for CRS. Mothers of children in the undetermined group were more likely to have taken abortifacients than a group of age matched controls (p = 0.1) but use of other medications in pregnancy was similar in both groups. Of the 148 (29%) children with traumatic cataracts three quarters were over the age of 6 years. Stick injuries were responsible for 28%, thorn injuries for 21%, and firecrackers for 5%.
Conclusion:
Nearly half of non-traumatic cataract in south India is due to potentially preventable causes (CRS and autosomal dominant disease). There is need for further work to identify the factors leading to childhood cataract in at least half of the cases for which no definite cause can as yet be determined.