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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 173-174

Comments on: Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care centre in central rural India


1 Community Eye Care Foundation, Dr. Gogate's Eye Clinic; Department of Ophthalmology, D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India
2 Vivekananda Mission Ashram Netra Niramay Niketan, West Bengal, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Parikshit M Gogate
Community Eye Care Foundation, Dr. Gogate's Eye Clinic, 102-202, Kumar Garima, Tadiwala Road, Pune - 411 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_845_20

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How to cite this article:
Gogate PM, Sil AK. Comments on: Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care centre in central rural India. Indian J Ophthalmol 2021;69:173-4

How to cite this URL:
Gogate PM, Sil AK. Comments on: Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care centre in central rural India. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 16];69:173-4. Available from: https://www.ijo.in/text.asp?2021/69/1/173/303350



Dear Editor,

Dr. Sen et al. need to be congratulated for their work on causes of delayed presentation of pediatric cataracts in India.[1] There have been studies about how delayed presenting cataracts in children fare after pediatric cataract surgery, but none on the exact causes of delay from India.[2] While lack of awareness was the cause between detection by a family member (mostly mother) and presenting to the hospital (delay 1 as per author), like studies from China, South Africa, Zambia[3],[4],[5]; cost was the major factor for delay in posting for surgery (delay 2). In their questionnaire, the authors should have asked what the primary health care providers told the parents. Studies from South Africa and Zambia showed that on numerous occasions, local nurses, general practitioners, and paediatricians advised the parents to wait, rather than undergo early surgery.[4],[5] Fear of anaesthesia and sub-optimal visual results were contributing factors for health care providers. Many health care personnel were not aware of amblyopia and the narrow window of opportunity. Dr. Sen should have explored whether such barriers existed in rural central India, as they are amenable to correction by continual medical education. Another study from India and China about delay in presentation for pediatric cataracts had found the delay to be more in India, as the mothers were less likely to be literate and visiting a doctor later, than in China.[6]

Cost was a barrier as pediatric cataract surgery needs more inputs like hydrophobic acrylic intraocular lenses, automated vitrectors, general anaesthesia and longer post-operative care and costs more than adult cataract surgery.[7] Many children come from poor families. Institution, non-government organisations (NGOs), international non-government development organisations (INGDOs) and philanthropist must step in to bridge the gap so that children who need surgery, do not have to wait for it, if their parents cannot immediately afford it. Neighbouring Bangladesh has had one of the world's most successful pediatric cataract- programme by using the novel approach of key informants to detect cataracts in children and then launching an INGDO supported nation-wide program.[8] Dr. Sen et al. report only 34.3% visual outcome <0.48 logMAR units (≥6/18) visual acuity. But that was at a one month follow-up. The vision would improve as the children's visual system adapts to its new clearer status, and a 6 or 12-month follow-up would have more encouraging vision. Studies from Pune and Miraj have shown that delayed presenting cataracts also have a significant visual impairment, unlike the study from China.[2],[3],[9] Just a good follow-up has been shown to improve postoperative vision after pediatric cataract surgery.[9] Factors which kept the child away from early surgery also conspire to keep the child away from proper follow-up, refraction, and amblyopic treatment.[10] Schools for the blind in India still have children who underwent anatomically successful cataract surgery, but faltered on the physiologic development of vision.[11] We surgeons are rightly proud of our surgical prowess, but early identification, timely surgical treatment, and proper follow-up of pediatric cataracts needs a team approach with a community orientation, as propounded by Orbis International in Chitrakoot, Zambia, and other parts of India.[1],[5],[9],[12],[13]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sen P, Gupta N, Mohan A, Shah C, Sen A, Jain E. Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India. Indian J Ophthalmol 2020;68:603-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gogate PM, Khandekar R, Shrishrimal M, Dole KD, Taras S, Kulkarni SR, et al. Cataracts with delayed presentation. Are they worth operating upon? Ophthalmic Epidemiol 2010;17:25-33.  Back to cited text no. 2
    
3.
You C, Wu X, Zhang Y, Dai Y, Huang Y, Xie L. Visual impairment and delay in presentation for surgery in Chinese pediatric patients with cataract. Ophthalmology 2011;118:17-23.  Back to cited text no. 3
    
4.
Gogate P, Parbhoo D, Ramson P, Budhoo R, Øverland L, Mkhize N, et al. Surgery for sight: Outcomes of congenital and developmental cataracts operated in Durban, South Africa. Eye 2016;30:406-12.  Back to cited text no. 4
    
5.
Mboni C, Gogate P, Phiri A, Seneadza A, Ramson P, Manolakos-Tsehisi H, et al. Outcome of pediatric cataract surgery in Copper belt province of Zambia. J Pediatric Ophthalmol Strabismus 2016;53:311-7.  Back to cited text no. 5
    
6.
Wang J, Jin L, Lu Q, Borah RR, Ali R, Li J, et al. Barriers, costs, and attitudes toward pediatric cataract surgery at two large facilities in China and India. Ophthalmic Epidemiol 2019;26:47-54.  Back to cited text no. 6
    
7.
Gogate P, Dole K, Ranade S, Deshpande M. Cost of pediatric cataract in Maharashtra, India. Int J Ophthalmol 2010;10:1248-52.  Back to cited text no. 7
    
8.
Muhit MA, Shah SP, Gilbert CE, Hartley SD, Foster A. The key informant method: A novel means of ascertaining blind children in Bangladesh. Br J Ophthalmol 2007;91:995-9.  Back to cited text no. 8
    
9.
Gogate PM, Sahasrabudhe M, Shah M, Patil S, Kulkarni AN, Trivedi R, et al. Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III. Indian J Ophthalmol 2014;62:186-95.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Gogate P, Kulkarni A, Mahadik A, Mane R, Borah R, Patil S, et al. Barriers to follow-up for pediatric cataract surgery in Maharashtra, India: How regular follow-up is important for good outcome. The Miraj pediatric cataract study II. Indian J Ophthalmol 2014;62:327-32.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Gogate PM, Chottopadhyay T, Kaur H, Narayandas S, Phadke S, Kharat M, et al. Making blind children see: The impact of correcting moderate and severe visual impairment in schools for the blind. Middle East Afr J Ophthalmol 2020;26:216-22.  Back to cited text no. 11
    
12.
Khokhar SK, Pillay G, Dhull C, Agarwal E, Mahabir M. Pediatric cataract. Indian J Ophthalmol 2017;65:1340-9.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Ali R. Pediatric eye care team: A comprehensive approach. Community Eye Health 2018;31:S3-4.  Back to cited text no. 13
    




 

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