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Priyanka Kumar, Phoebe Lenhart, Scott R Lambert; Referral basis for infantile cataracts. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3099.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Pediatrics recommends all newborns undergo a red reflex evaluation at birth and 6-8 weeks. We conducted a retrospective, observational study to determine the referral basis for infantile cataracts in a busy US pediatric ophthalmology practice.
A retrospective consecutive case series between January 2010 and September 2015 at one tertiary-care center of children less than 1 year of age diagnosed with infantile cataract. Referral indications were categorized into four groups: 1) referral initiated by pediatric healthcare provider because of suspected cataract, 2) referral initiated by parent/caregiver because of concerning ocular signs or symptoms, 3) referral initiated because of a positive family history of infantile cataracts, or 4) routine eye exam.
A total of 50 patients and 74 eyes were included in the study. Twenty-one of the 50 children were male (42%), 29 were female (58%). Twenty-four had bilateral cataracts (48%), while the remainder had unilateral cataracts (52%), with 15 affecting the left eye. Cataract types were anterior polar (11), cortical (2), lamellar (7), nuclear (15), mature (29), and posterior polar (10). Thirty-one patients were referred by their primary care provider, 11 were brought in by concerned parents or caregivers, 5 were identified during retinopathy of prematurity screening, and 3 were referred because of a strong family history. The age at diagnosis ranged from 1 week to 10 months of age. Twenty-six children had seen an average of at least one other eye care provider prior to their referral to the tertiary care center. Twenty-one were diagnosed before 8 weeks of age (42%), and 41 children (82%) were advised to undergo surgical removal of the cataract(s) to improve visual potential of the affected eye.
This study demonstrates that less than half of all patients diagnosed with infantile cataracts are identified within 6-8 weeks of birth, which can delay the institution of critical vision-saving interventions. However, pediatric providers initiate the referral to an eye care provider in almost two-thirds of cases. We hope that the results of this study stimulate discussion about the utility of current practice and referral guidelines regarding infantile cataracts.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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