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

Abstract

Background:Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery.Aim:To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up.Subjects:262 children (393 cataracts) who underwent cataract surgery in 2004-8.Materials and Methods:The children were identified and examined in their homes and a “barriers to follow-up” questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed.Statistical Analysis:SPSS version 19.Results:Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group (P < 0.001), less education of mother (P = 0.012), father's occupation (P = 0.031), how much money spent on travel (P = 0.033) and was it paid or free surgery (P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up.Conclusion:Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.

Follow-up patterns and associated risk factors after paediatric cataract surgery: observation over a 5-year period

“…The follow-up rates are variable in different parts of the globe ranging from a mean follow-up of 3.5 months in Mexico13 to 98.3% of patients attending at least one follow-up, 66.9% patients attending 2 weeks of follow-up and 42.9% attending 10 weeks of follow-up in Tanzania 14. Gogate et al reported only 20.6% patients followed up regularly 15. These studies included children up to late teens undergoing surgery for all types of cataract including traumatic cataract whereas we focused particularly on children less than 5 years of age operated for either congenital or developmental cataract, which are more prone to permanent visual loss.…”

Unilateral Congenital and Developmental Cataracts in Children in India

“…5,14,15 The children in our series were operated on after infancy, and their follow-up and amblyopia treatment were irregular. 7 A study from California of 15 children with nontraumatic unilateral cataracts treated with contact lenses had 7 (46.7%) eyes attaining excellent Snellen visual acuity (defined as 20/50 or better). 16 Early cataract extraction, good to moderate patching compliance, and aggressive early contact lens management were associated with better outcomes.…”

“…Although preoperative vision, type of surgery, and IOL details were taken from patient charts, the rest of the data was prospectively collected. 7 Despite house visits and counseling, some children did not visit the pediatric eye center. A detailed program was made for additional home visits of these children, and a pediatric ophthalmologist along with an optometrist and community worker visited them with the required equipment such as portable visual acuity charts, portable slit lamp, keratometer, and A-scan for examination.…”

“…A 1-year study was conducted to trace, visit, and examine the children. 7 As these children had been treated under the Orbis India Childhood Blindness Initiative, their detailed records had been maintained. The children had undergone cataract surgery with intraocular lens (IOL) implantation after a detailed ophthalmic and pediatric evaluation that included visual acuity assessment.…”

“…The children were to have 6 weeks, 6 months, and then at least an annual follow-up. 7 Those with a history of trauma, injury, suspected injury, or foreign body were excluded because they were considered traumatic cataracts. Bilateral congenital or developmental cataracts were not considered for this series.…”