BMJ 1999;318:362-365 ( 6 February )

Papers

National cross sectional study of detection of congenital and infantile cataract in the United Kingdom: role of childhood screening and surveillance

Jugnoo S Rahi, Medical Research Council clinical training fellow,  Carol Dezateux, senior lecturer in paediatric epidemiology, 

Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH

Correspondence to: Dr J S Rahi j.rahi{at}ich.ucl.ac.uk

Objectives: To determine the mode of detection and timing of ophthalmic assessment of a nationally representative group of children with congenital and infantile cataract.
Design: Cross sectional study.
Setting: United Kingdom.
Subjects: All children born in the United Kingdom and aged 15 years or under in whom congenital or infantile cataract was newly diagnosed between October 1995 and September 1996.
Main outcome measures: Proportion of cases detected through routine ocular examination and proportion assessed by an ophthalmologist by 3 months and 1 year of age.
Results: Data were complete for 235 (95%) of 248 children identified. Of these, 83 (35%) were detected at the routine newborn examination and 30 (12%) at the 6-8 week examination; 82 children presented symptomatically. 137 (57%) children had been assessed by an ophthalmologist by the age of 3 months but 78 (33%) were not examined until after 1 year of age. In 91 cases the child's carers suspected an eye defect before cataract was diagnosed.
Conclusions: A substantial proportion of children with congenital and infantile cataract are not diagnosed by 3 months of age, although routine ocular examination of all newborn and young infants is recommended nationally. Strategies to achieve earlier detection through screening and surveillance are required.


Key messages

  • Cataract in infancy is an important preventable cause of visual impairment and blindness in childhood

  • Research suggests surgical treatment of dense cataracts is needed within the first 3 months of life

  • In the United Kingdom routine ocular examination is recommended for all infants at birth and at 6-8 weeks

  • In this national study, 47% of children newly diagnosed with congenital or infantile cataract were detected through these examinations

  • 57% had been examined by an ophthalmologist by 3 months of age, but 33% were not assessed until after their first birthday

  • Strategies are required to achieve earlier diagnosis and increase the proportion of cases detected through screening in the first 3 months of life




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Rapid Responses:

Read all Rapid Responses

An even more specific screening test is needed
Stephen Morgan
bmj.com, 16 Feb 1999 [Full text]
Pupils should be dilated prior to examination
G G W Adams
bmj.com, 23 Mar 1999 [Full text]
Late diagnostic - a very important issue
Antonio Jordao
bmj.com, 1 Apr 1999 [Full text]
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