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LETTER TO THE EDITOR
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2325

Eureka moments in pediatric cataract screening


Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication23-Sep-2020

Correspondence Address:
Dr. Yogita Gupta
Room No 486, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1125_20

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How to cite this article:
Khokhar S, Gupta Y, Dhull C. Eureka moments in pediatric cataract screening. Indian J Ophthalmol 2020;68:2325

How to cite this URL:
Khokhar S, Gupta Y, Dhull C. Eureka moments in pediatric cataract screening. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 24];68:2325. Available from: https://www.ijo.in/text.asp?2020/68/10/2325/295658



Dear Editor:

Birch et al.[1],[2] have established the role of early diagnosis and intervention in minimizing deprivation amblyopia in unilateral or bilateral pediatric cataract. This has led ophthalmologists to refine their examination methods for a more reliable screening of cataract. Pediatric ocular examination has been described with intranasal dexmedetomidine,[3] oral chloral hydrate,[4] etc. A parent's lap is often described ideal for eye-testing purposes by ophthalmologists.[5] We wish to share a few tips for examination of preverbal children with pediatric cataract that have proved to be useful in our clinical experience as pediatric ophthalmologists.

1. A child in parent's shoulder hold

The examiner instructs the parent to gently lift the child and rest them onto their shoulder, while supporting the back and neck of child with both their hands. The parent should then turn their back toward the examiner, ensuring the child faces the doctor [Figure 1]a. This position increases body contact of the child with parent. This tends to relax the child and improves their cooperation. Red reflex can be easily tested in this posture
Figure 1: Examination technique in pediatric cataract screening (a) with positioning child in shoulder hold of the parent, where he/she is well supported by parent's hands, while examiner performs ophthalmoscopy at same eye level as child's eye. (b) A case of total intumescent cataract with nucleus sinking in dependent position while child is in left lateral position and while child is in (c) sitting position. (d) Examiner performing ophthalmoscopy over glasses in a child with aphakia while testing for red reflex

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2. Test of cortex liquefaction

A total intumescent cataract can be tested for liquefied cortex and nucleus sinking in dependent position, as in Morgagnian cataracts. Child's eye is tested in sitting, lateral, and supine positions to look for shift in the position of nucleus [Figure 1]b and [Figure 1]c. Surgeons should use a heavy viscoelastic substance for achieving a circular anterior capsulorhhexis in such cases

3. Examination over glasses

Children with postoperative aphakia should be periodically tested for visual axis opacity (VAO). A good method for this can be checking the red reflex while the child has worn glasses [Figure 1]d. Red reflex is dull in cases of high refractive error. Refractive correction and magnification of reflex by aphakic glasses can be exploited for detecting VAO early without examination under anesthesia.

Unlike adult patients, a detailed ophthalmic examination in preverbal children is often very challenging. It is quite likely possible that few ocular details like cataract (if not too dense) may be missed initially if child does not cooperate well for examination. These simple examination tips provided by authors may prove to be of great benefits to pediatric ophthalmologists, when screening preverbal children for cataract or VAO and in preoperative planning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Birch EE, Stager D, Leffler J, Weakley D. Early treatment of congenital unilateral cataract minimizes unequal competition. Invest Ophthalmol Vis Sci 1998;39:1560-6.  Back to cited text no. 1
    
2.
Birch EE, Cheng C, Stager DR, Weakley DR, Stager DR. The critical period for surgical treatment of dense congenital bilateral cataracts. J Aapos 2009;13:67-71.  Back to cited text no. 2
    
3.
Chen C, You M, Li Z, Nie L, Zhao Y, Chen G. Study of feasibility and safety of higher-dose dexmedetomidine in special outpatient examination of pediatric ophthalmology. J Ophthalmol 2019;2019:2560453. doi: 10.1155/2019/2560453.  Back to cited text no. 3
    
4.
Karaoui M, Varadaraj V, Munoz B, Collins ME, Aljasim LA, Al Naji E, et al. Chloral hydrate administered by a dedicated sedation service can be used safely and effectively for pediatric ophthalmic examination. Am J Ophthalmol 2018;192:39-46.  Back to cited text no. 4
    
5.
Committee on Practice and Ambulatory Medicine Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians: organizational principles to guide and define the child health care system and/or improve the health of all children. Ophthalmology 2003;110:860-5.  Back to cited text no. 5
    


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