Clinical characteristics, course, and visual prognosis of partial cataracts that seem to be visually insignificant in children

Treatment of Amblyopia and Amblyopia Risk Factors Based on Current Evidence

PURPOSE

Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential risk factors for amblyopia.

METHODS

Literature review of the management of amblyopia and risk factors for amblyopia.

RESULTS

Common amblyopia risk factors include anisometropic or high refractive error, strabismus, cataract, and ptosis. Often a conservative approach with spectacles is enough to prevent amblyopia. However, surgery may be necessary to clear the visual axis or align the eyes.

CONCLUSION

Amblyopia risk factors should be managed early. Though amblyopia treatment is more likely to be successful at a younger age, those who are older but treatment-naïve may still respond to treatment. Promoting binocular or dichoptic experiences may be the future direction of amblyopia management.

Pediatric cataract: challenges and future directions

Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.

Systemic steroid-induced cataracts in children: long-term changes in morphology and visual acuity

PURPOSE

To report the long-term visual prognosis and surgical rates of steroid-induced cataracts in children.

METHODS

The medical records of children diagnosed with steroid-induced cataracts who were followed up for more than 5 years were retrospectively reviewed. Children over 3 years of age who cooperated with the initial visual acuity test (Snellen chart) were included. The following data were evaluated: best-corrected visual acuity at the time of diagnosis and at final follow-up, morphologic changes in the cataract, and surgical outcomes and associated systemic diseases that required steroid treatment.

RESULTS

A total of 59 eyes of 30 patients with posterior subcapsular cataracts were included. The mean follow-up period after diagnosis was 7.6 ± 2.9 years (range, 5-14.5 years). Cataracts were graded on the basis of the size of lens opacity. Cataract progression was defined as widening of the lens opacity. Cataracts progressed in 20 eyes (34%) and remained unchanged in 39 eyes (66%). Three patients underwent bilateral cataract surgery because of cataract progression and significant loss of visual acuity. Of the 53 eyes of 27 children (90%) who did not undergo surgery, best-corrected visual acuity did not change significantly during the follow-up period.

CONCLUSIONS

In this study cohort, cataract progressed in 34% of the eyes with steroid-induced cataract; however, surgery was required in only 10% of the children, and in these patients the postoperative visual outcome was favorable.