Childhood cataract in sub-Saharan Africa

Investment by organizations and agencies has led to a growing body of evidence and information to assist ophthalmologists and others to meet the needs of children with cataract in Africa. The geographic distribution of research, training, and programme development across Africa has been uneven; investment has been greatest in eastern and southern Africa. Population based surveys (using key informants) suggest that 15–35% of childhood blindness is due to congenital or developmental cataract. There may be up to 82,000 children with non-traumatic cataract in Africa, with approximately 19,000 new cases each year.Effective strategies to find and refer children are those that engage the community in case detection. Identification and referral does not automatically mean surgical intervention with distance to the surgical facility being the most common reason for failure to seek care. Surgical management has become more specialized and a team based approach has been adopted by many paediatric ophthalmologists and their programmes. Although many children still present late for surgery, outcomes of surgery are much improved from previous experiences. Research suggests that post-operative follow up, still a challenge, can be improved through adoption of specific strategies. There has been limited success in ensuring that children are placed in appropriate educational settings. While eye care professionals may feel their responsibility ends with clinical care, it is important for the paediatric eye care team to be engaged with educational and rehabilitation services.     

Factors associated with Subsequent Eye Care for Children in Taiwan: A Population-based Historical Cohort Study

Purpose: To investigate patterns and factors associated with subsequent eye care for Taiwan’s children.

Methods: We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants’ ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children’s ocular conditions was defined by physician’s diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use.

Results: Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn’t receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3–4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother’s education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years.

Conclusions: Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child’s ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children.     

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study

Background

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks.

Methods

Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care.

Results

One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders.

Conclusions

This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.     

A test battery of child development for examining functional vision (ABCDEFV)

A battery of 22 tests is described, intended to give an integrated assessment of children's functional visual capacities between birth and four years of age. As well as sensory visual measures such as acuity, visual fields and stereopsis, the battery is intended to tap a range of perceptual, motor, spatial and cognitive aspects of visual function. Tests have been drawn from practice in ophthalmology and orthoptics, vision research, paediatric neurology, and developmental psychology to give an overall view of children's visual competences for guidance in diagnosis, further investigation, management and rehabilitation of children with developmental disorders. ‘Core vision tests’ require no motoric capacities beyond saccadic eye movements or linguistic skills and so assess basic visual capacities in children of any age. ‘Additional tests’ have age-specific requirements and are designed to pinpoint specific deficits in the perceptual, visuo-motor and spatio-cognitive domains. Normative data are reported on nine age groups between 0–6 weeks and 31–36 months, each including 32–43 typically developing children. Pass/fail criteria for each test are defined. These data allow the selection of a subset of tests for each age group which are passed by at least 85% of normally developing children, and so are appropriate for defining normal development. The normalized battery has been applied to a range of at-risk and clinical groups. Aspects of children's visual performance are discussed in relation to neurobiological models of visual development.     

生活方式与儿童干眼相关性的研究进展

干眼是一种以泪膜稳态失衡为特征的多因素眼表疾病,产生的眼部不适和视力障碍严重影响人们的生活质量和工作质量。近年来随着环境、生活方式的改变,儿童干眼的发病率逐年上升,引发众多关注。干眼的发病受到遗传因素、非遗传因素的影响,而非遗传因素如生活方式等可以通过人为干预进行改善。生活方式调整具有经济、安全、有效的特点,其对干眼发病风险的保护效力已被大量研究证实,故探明生活方式与儿童干眼的关联性具有十分重要的意义。相关研究分析了视频终端、角膜接触镜、低浓度阿托品滴眼液、睡眠不足、饮食等生活方式与儿童干眼的关系,本文对以上研究结果进行归纳并提出相关预防措施,为预防儿童干眼、延缓疾病发展提供理论依据。     

陕西省西安市低龄儿童弱视现状调查及危险因素分析

目的:分析陕西省西安市低龄儿童弱视发病现状,并探讨相关危险因素.方法:采用简单随机抽样法不重复抽样本市2012-03/2016-04期间8所幼儿园的10268名3~6岁儿童进行调查,主要行视力、眼位及眼球运动等检查,并予以10 g/L阿托品散瞳验光,行眼底检查,排除器质性病变,统计弱视儿童528例,将其作为观察组,选取同期在我院就诊的健康儿童500例为对照组,分别进行儿童弱视单因素分析和多元Logistic回归分析.结果:经调查统计,陕西省西安市低龄儿童弱视发病率约5.14%,其中屈光不正性弱视发病率最高(61.4%),且病变程度多为轻中度,屈光参差性弱视(24.1%)、斜视性弱视(12.9%)次之,少见形觉剥夺性弱视(1.7%).经一般资料分析,两组母亲妊娠年龄、孕周及孕次、父母吸烟史、近视家族遗传史均存在统计学差异(P<0.05);经多因素Logistic回归性分析,母亲妊娠年龄大、孕周时间短、母亲有吸烟史、有近视家族遗传史均是诱发低龄儿童弱视发病的危险因素(P<0.05).结论:陕西省西安市低龄儿童存在一定弱视发病风险,应予以重视,并予以眼保健知识宣教,定期组织视力筛查,做到早发现、早诊断、早治疗.     

Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital

Background

Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital.

Methods

The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018.

Results

The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%).

Conclusions

The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.     

History of community health center affiliations with The New England College of Optometry

BackgroundSince the 1970s, The New England College of Optometry (NECO) has been a leader in community-based educational programming. This was accomplished through the development of affiliation agreements with health care facilities that care for the underserved, notably community health centers (CHCs). The college's clinical system, the New England Eye Institute (NEEI), develops CHC programs, manages professional services agreements, initiates teaching affiliation agreements, and leads staff recruitment and retention efforts.OverviewCHC collaborations, which effectively address disparities in access to health care and visual health status, represent a significant component of the college's primary care clinical training venues. Since their inception in 1972, these CHC academic–community partnerships have provided more than 650,000 eye examinations to the underserved and have trained more than 3,200 graduates in community-based eye care, interdisciplinary care management environment, clinical prevention strategies, and population health.ConclusionsThis report describes NECO's longstanding success with CHCs, explains the scope of practice at CHCs, explains how students are involved in the CHCs' eye care services, and discusses the various management and business arrangements. The benefits and challenges of CHC affiliations with optometry schools and colleges are also discussed.     

Examen oftalmológico durante el control del niño sano en atención primaria: conocimiento y dificultades de los miembros del equipo de salud

IntroductionThe red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown.Material and methodsA survey was performed in primary community health centres of XXX Santiago de Chile.ResultsThe WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests.ConclusionIn this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.     

儿童干眼症相关因素的研究进展

干眼症是成年人最常见的眼部疾病之一,目前对成年人干眼症的临床研究已相对完善,然而对于儿童干眼症的研究报道却十分匮乏,导致儿童干眼症在临床工作中十分容易被忽视。了解儿童干眼症相关因素的研究进展,对于提高临床医师重视儿童这一特殊人群的干眼症意义重大。因此,有必要将目前儿童干眼症相关因素研究进展予以综述。     

屈光参差性弱视儿童双眼与正常眼SD-OCT参数的比较

目的:比较单眼屈光参差性弱视儿童双眼与正常眼黄斑区视网膜厚度及视盘周围视网膜神经纤维层(RNFL)厚度的差异。方法:选取2021-01/2022-10于成都市妇女儿童中心医院就诊的单眼屈光参差性弱视儿童62例124眼作为试验组,另选取同时间段就诊的正常视力儿童60例60眼(右眼)作为对照组。采用频域光学相干断层成像(SD-OCT)检测两组儿童黄斑区视网膜厚度及视盘周围RNFL厚度,并进行对比分析。结果:试验组儿童弱视眼黄斑区视网膜厚度和视盘周围RNFL厚度均厚于对照组,且多数具有显著差异性(P<0.05)。试验组儿童对侧非弱视眼黄斑区视网膜厚度和视盘周围RNFL厚度多较对照组变薄,但多数无显著差异(P>0.05)。结论:单眼屈光参差性弱视儿童弱视眼和对侧非弱视眼黄斑区视网膜厚度及视盘周围RNFL厚度与正常眼存在一定差异性,且对侧非弱视眼并不能完全等同于正常眼。     

Eye casualty services in London

The combined pressures of the European Working Time Directive, 4 h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London''s 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London''s two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76 034 patients in 2010/11) and 9.6% per year (to 31 128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel ‘referral pathway'' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London''s eye casualty services in the future.     

Cataract management in children: a review of the literature and current practice across five large UK centres

Congenital and childhood cataracts are uncommon but regularly seen in the clinics of most paediatric ophthalmology teams in the UK. They are often associated with profound visual loss and a large proportion have a genetic aetiology, some with significant extra-ocular comorbidities. Optimal diagnosis and treatment typically require close collaboration within multidisciplinary teams. Surgery remains the mainstay of treatment. A variety of surgical techniques, timings of intervention and options for optical correction have been advocated making management seem complex for those seeing affected children infrequently. This paper summarises the proceedings of two recent RCOphth paediatric cataract study days, provides a literature review and describes the current UK ‘state of play’ in the management of paediatric cataracts.Subject terms: Hereditary eye disease, Paediatrics     

Why optometry must work from urban and regional Aboriginal Health Services

The gap in vision and ocular health between Aboriginal and Torres Strait Islander Australians and other Australians continues to be significant, yet three‐quarters of the identified Aboriginal and Torres Strait Islander population live in urban and regional areas of Australia where existing eye‐care services are available. In urban Australia, an improvement in the access and use of eye‐health services is required to provide equitable eye‐care outcomes for Australia's Indigenous peoples. Optometric services need to be available within Aboriginal Health Services in urban areas to effectively close the gap for vision.     

Ketamine anaesthesia for paediatric ophthalmology surgery

AIMS: Children with treatable, vision impairing conditions may not have access to surgical care when they live in regions where anaesthesia is unavailable. The use of ketamine anaesthesia in a developing region was studied to determine its safety and effectiveness. METHODS: This is a consecutive series of 679 children who had a variety of paediatric eye disorders necessitating a short general anaesthesia. Ketamine was administered intravenously by a paediatrician with training in paediatric resuscitation procedures. Both intraocular and extraocular procedures were performed. The location of treatment was the Tilganga Eye Hospital in Kathmandu, Nepal, a developing region of the world. The study took place over a 5 year period. RESULTS: All procedures were performed without any anaesthetic complications. No child required unanticipated resuscitation or laryngeal intubation. Postoperative dysphoria occurred occasionally and was difficult to measure quantitatively. This side effect of ketamine resolved by the first postoperative day. CONCLUSION: Ketamine is an effective agent for both intraocular and extraocular surgery in the paediatric age group. None of the children in this series needed resuscitation or intubations, and the ophthalmic surgery was carried out safely. Ketamine can be used safely in any ophthalmic procedure of short duration by a person having some training in anaesthetic resuscitation procedures. Because of its simplicity and safety, ketamine may be useful in a simple ophthalmic setup in the developing word.     

Paediatric Low Vision – A Survey

ABSTRACT This paper reports the results of a survey conducted at a paediatric low vision clinic, of all children examined in the eight year period 1974 to 1981. The data provide a unique opportunity to identify the ophthalmic characteristics of children with low vision. The major cause of low vision in these children has been identified, examined and compared with the results of similar studies. Other characteristics studied are distance and near vision, the type of low vision aids used and the nature of primary education undertaken by the children. The results are discussed to provide information to improve paediatric low vision care.     

Paediatric Eye Services: How Much of the Workload Is Amblyopia-Related?

Aims: The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia.

Methods: Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary’s Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance.

Results: Seven hundred and four patients had appointments booked at St Mary’s and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary’s and 9% at Hillingdon; P=0.75). Of the 704 patients, 533 (St Mary’s, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related.

Conclusions: Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits.     

School eye health appraisal

School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.     

Review of guidelines for children's vision screenings

The aim of children's vision screenings is to detect visual problems that are common in this age category through valid and reliable tests. Nevertheless, the cost effectiveness of paediatric vision screenings, the nature of the tests included in the screening batteries and the ideal screening age has been the cause of much debate in Australia and worldwide. Therefore, the purpose of this review is to report on the current practice of children's vision screenings in Australia and other countries, as well as to evaluate the evidence for and against the provision of such screenings. This was undertaken through a detailed investigation of peer‐reviewed publications on this topic. The current review demonstrates that there is no agreed vision screening protocol for children in Australia. This appears to be a result of the lack of strong evidence supporting the benefit of such screenings. While amblyopia, strabismus and, to a lesser extent refractive error, are targeted by many screening programs during pre‐school and at school entry, there is less agreement regarding the value of screening for other visual conditions, such as binocular vision disorders, ocular health problems and refractive errors that are less likely to reduce distance visual acuity. In addition, in Australia, little agreement exists in the frequency and coverage of screening programs between states and territories and the screening programs that are offered are ad hoc and poorly documented. Australian children stand to benefit from improved cohesion and communication between jurisdictions and health professionals to enable an equitable provision of validated vision screening services that have the best chance of early detection and intervention for a range of paediatric visual problems.