Unmet needs of cataract blind children in special schools in Southeast Nigeria

Sir,

The article ‘Benchmarks for outcome indicators in pediatric cataract surgery’, in which 96% of operated children had outcomes of best corrected visual acuity≥20/40,¹ is in stark contrast to what was obtained in some low and middle income countries settings. Herein, we describe the profile of the cataract blind children in special schools in Southeast Nigeria and their unmet needs. This study was done concurrently with research into trends in childhood blindness in which part of the methodology has been reported elsewhere.²

Data regarding onset of blindness, history of cataract surgery, ocular examination, refraction, and low vision assessment were recorded on the WHO/PBL form for childhood blindness and analysed with STATA 12.1 (Statcorp, TX, USA), from which frequency tables, odd-ratios, and P-values were generated. Tests of significance were set at the 95% level. Out of 127 children with childhood blindness in schools for the blind, 42 had lens-related pathologies.

Figure 1 shows the categorization of children with lens-related blindness and Table 1 shows the relevant relationship of correlates between operated and unoperated participants. There were several unmet needs in these cataract blind children. First, the presence of children in the school for the blind with unoperated cataracts is a cause for concern. In addition, the outcome of surgery was poor. Furthermore, none of the children who had undergone surgery had any evidence of intra-ocular lenses (IOLs) or any optical rehabilitation post surgery. One participant’s vision improved from <6/60 to 6/60 in one eye after refraction. There is suggestive evidence that the odds of having surgery in ≤15-year-olds was almost three and a half times greater than in those >15 years. This implies that the rate of cataract surgery in children may have increased over time. However, cataract surgery is not synonymous with good vision. Existing data suggest that many cataract blind or visually impaired children in low and middle income countries have undergone previous surgery, but that their vision has remained poor.³ Several factors affect the outcome of paediatric cataract surgery—these include delay in surgery and inadequate postoperative rehabilitation.⁴ In the absence of medical records on these blind children, there were limited data on the timing of surgery and follow-up period. This was a blind-school survey; therefore, it is likely that the cataract outcomes from this study may not be a true reflection of the outcomes of all paediatric cataract surgeries in the region as only those with poor outcomes will be registered in the schools for the blind. Better outcomes have been reported from a similar east African blind-school study; IOLs were inserted in 65% of the children who underwent surgery and 41% of them had a visual acuity of≥6/60.⁵ Cataract is an increasingly important cause of childhood blindness in Africa. To help improve the capacity for paediatric cataract surgery, there is need to develop the WHO-recommended Child Eye Health Tertiary Facilities in Southeast Nigeria. In addition, it is important for local stakeholders to aggressively pursue strategies to overcome the other barriers that influence poor outcomes.⁴

Figure 1

Categorization of children with lens-related blindness.

Table 1 Relevant relationship of correlates between operated and unoperated participants