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Julia Johnston, Dilshad Contractor, Bibiana Jin Jin Reiser; Five year epidemiologic review of pediatric cataracts managed at Children’s Hospital Los Angeles. Invest. Ophthalmol. Vis. Sci. 2018;59(9):166.
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© ARVO (1962-2015); The Authors (2016-present)
Pediatric cataract is the most common causes of treatable blindness worldwide, accounting for 5-20% of childhood blindness. We performed a retrospective chart review to determine how pediatric cataract patients are being identified in a large urban area, in addition to studying the effects of delayed diagnosis with regards to development of amblyopia and glaucoma.
We analyzed longitudinal data from patients aged 0-18 years with diagnosis of cataract seen at Children’s Hospital Los Angeles (CHLA) between 1/1/2010-12/31/2015. Information collected included source of diagnosis, demographics, type of cataract, and necessity for surgery. Outcome measures such as visual acuity, intraocular pressure, and development of amblyopia and/or glaucoma were collected for patients who required cataract extraction. Patients with cataracts due to secondary causes (trauma, radiation, etc.) were identified but excluded from the outcome data set.
CHLA is a tertiary referral center, with patients referred from 14 counties, across 4 different states. Cataracts were diagnosed in 331 patients (471 eyes), at an average age of 4.26 years (range: 2 days-18 years). Ophthalmologists/optometrists were the primary source of initial diagnosis (66%), followed by pediatricians/primary care providers (17%) and parent(s) or family members (12%).Cataract extraction was required in 338 eyes. 6% of eyes developed glaucoma and 33% developed amblyopia after surgery. 47% of patients were not diagnosed until ≥3 years of age, with 20% of such eyes developing amblyopia within 6 months after surgery. Patients with unilateral cataracts were more likely to develop amblyopia than bilateral cases.
Parents and family members play a front-line role in noticing changes or abnormalities in the child’s vision or eye. Increased awareness and education about cataracts in children could help them be more vigilant about visual or behavioral changes, enabling parents to advocate for improved screening at well-child visits; and facilitate quicker referrals to a specialist. Lack of access to specialists may also impact referral times, and interfere with post-operative follow-up and visual therapy. Reducing delays in diagnosis and surgery is vital for improving the visual potential of pediatric cataract patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1: Geographical distribution of cataract referrals
Table 1: Demographic information
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