|Year : 1988 | Volume
| Issue : 3 | Page : 123-125
Vision in childhood aphakia
S Shrivastva, RB Vajpayee, YR Sharma
Deptt. of ophthalmology, Gandhi Medical College and Associated Hamidia Hospital Bhopal - 462 001, India
Deptt. of ophthalmology, Gandhi Medical College and Associated Hamidia Hospital Bhopal - 462 001
The poor visual results of the present series especially in monocular congenital infantile and juvenile cataracts suggest that a comprehensive eye health education programme including an aggressive anti amblyopia therapy must be undertaken for congenital and juvenile cataract.
Routine ophthalmic checkup should be done by a paediatrician or by vaccinators for early detection of cataracts and for early appropriate referral.
The surgery should be performed at the earliest and the optical correction and anti amblyopia therapy must be given in the early post-operative period compulsively. Ideally, continuos wear contact lens should be used but at times the method of optical correction which is suitable and possible for the patient may be selected on an individual basis. The role of ' IOL in children remains disputable in the present time but definitely needs more attention and follow-up.
|How to cite this article:|
Shrivastva S, Vajpayee R B, Sharma Y R. Vision in childhood aphakia. Indian J Ophthalmol 1988;36:123-5
| Introduction|| |
Inspite of the many advances in surgical management of cataracts the optical correction of aphakia especially, in children still remains a formidable challenge and is often a frustrating experience for the ophthalmologist. Problems of monocular congenital and infantile cataracts have been often regarded as insurmountable, uniform poor visual results have often dictated total surgical inaction ,,. Many of the routinely employed methods for optical correction of aphakia are suitable for aphakic children even for uniocular aphakic patients but still the significant number of patients of childhood aphakia seen after a variable period of time after surgery show poor vision . Recent studies have, however, reported good visual results even in microphthalmic eyes with monocular cataract . We, thus under took to review the visual results in children operated for cataract before the age of 14 years.
The study was undertaken to relate the visual status to various factors operative in determining the final visual outcome.
| Material and Methods|| |
The patients records were obtained from the hospital data and patients contacted for ophthalmic checkup. Seventy such patients were examined.
Detailed ophthalmic examination was carried out. A detailed inquiry was made about the post-surgical efforts at visual rehabilitation. Patient compliance was noted. The socio-economic and educational status of the patient and family members was also considered. Visual acuity was recorded without and with optical correction which the patient was using and also repeat refraction was done to note the best obtainable vision. Binocular vision was checked with Worth four dot test and on synoptophore. The data obtained was analysed to study the effect of various factors on final visual outcome.
| Observations|| |
The age of our patients varied from 4 years to 48 at the time of the study. There were 62 (88.57%) males and 8 (11.43%) females. Of these 33 patients (47.14%) belonged to rural areas and the remaining 37 (52.86%) to urban and suburban areas. Only 2 cases (4.76%) were operated upon before the age of one year. Only one case (1.43%) had anterior chamber lens implantation done. 14 cases (20%) were using contact lens; all of them had unilateral aphakia. 19 cases (27.14%) were using spectacle correction. Of these 10 cases were having binocular aphakia. Interestingly 36 cases (51.42%) were not using any optical correction.
In 68 eyes (78.16%) the corrected vision was less than 6/9. Amblyopia was the predominant cause of reduced vision in 42 eyes. (62.67%). 36 amblyopic eyes (85.71%) were operated on after the age of 3 years. Amblyopia occured more frequently in unilateral aphakic eyes. 33 amblyopic eyes (78.57%) belonged to unilateral aphakia group. In these eyes the amblyopia was more dense. Binocular vision with all 3 grades was present only in 2 cases (2.86%), both of them were using contact lens for uniocular aphakia. 57 cases (81.43%) had uniocular vision with fellow phakic or one of the aphakic eyes. It was also observed that visual acuity does not always correlate linearly with binocular function. In the present series only 14 cases (20%) were using optical correction regularly, 15 cases (21.43%) were not prescribed optical correction, 21 cases (30%) were unaware of the fact that optical correction is needed after operation and they did not attend hospital for optical correction or. followup. The remaining 20 cases (28.57%) were not using it regularly because of intolerance. The factor of unawareness and non-compliance was more common in the uneducated rural than the urban and suburban patients. Other causes for not using optical correction were cost of optical correction and nonavailability of suitable optical correction.
| Discussion|| |
The visual results are usually poor in cases of cataract during infancy and childhood primarily because of the frequency of concomitant ocular defects.
Contact lenses are far less visually disabling than aphakic spectacles. Good visual results in aphakic children in the age range of I week to 10 years with silicone polymer extended wear contact lens
have been reported ,.But such lenses are not suitable for our patients due to cost factor, nonavailability, and inadequate hygienic conditions of our patients. In our series amblyopia was the major cause for visual loss (87.94%)-16.18% of these had strabismus also; other causes included corneal scars and after- cataracts. It is illuminating
that more than 50 patients received no postoperative correction and more than half of those prescribed optical correction used it irregularly because of intolerance. Of the 36 patients using no post-surgical optical correction, 21 cases were totally unaware than such correction is needed. This suggests that better preoperative counselling of the family is needed. In the management of congenital and juvenile cataracts a proper physician-family contact and long term followup remain imperative. Good visual results with intraocular lens implants in children have been reported. This needs further study.
| References|| |
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|2.||Park, M.M., Amer J. Ophthalmol, 94:441-449, 1982. |
|3.||Duke Elder, S., System of Ophthalmology Vol. VI, Henry Kimptin, London, 295-297, 1973. |
|4.||Sheppard, R.W. and Crouford J.S. The treatment of congential cataracts surv. Ophth. 17, 340-347, 1973. |
|5.||Hoyt, C.S. and Nickel, B.L., Bilson F.A. : Review: opthalmological examination of Infant. Surv. Ophthal, 26: 177-192, 1982. |
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[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]