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Dear Readers,
Cataract is one of the most treatable causes of blindness in children. Nearly 200,000 children are bilaterally blind from unoperated cataracts, complications of cataract surgery, or the presence of ocular anomalies associated with the cataracts. Early detection and intervention are recommended to reduce the disability for affected children and their families. In industrialized countries, the visual outcome of surgery for childhood cataract has improved as a result of earlier detection, advances in surgical technique and technology, and a better application of amblyopia management. In contrast, the outcome of pediatric cataract surgery in many developing countries remains poor as a result of late detection, inadequate surgical facilities for children, a lack of pediatric anesthesia, and inadequate follow-up.

Increased capacity for pediatric cataract surgery and care are needed in many areas. In other regions, the facilities and surgical teams are in place but are underutilized, due to a lack of knowledge, monetary constraints, or a negative perception of the surgery owing to poor results from inadequate or poorly timed treatment. Insufficient ophthalmic and anesthesia staff, a lack of surgical instruments, and poor equipment maintenance are also widespread in the developing world. It can also be logistically complex to identify the children who will benefit the most from surgery and reliably transport them to a treatment center.

In this issue of sitenews, we will know about the Prevalence and Magnitude of childhood cataract. We will also try to Understand its problem and discuss about Barriers to improve the outcome for affected children. The burden of preventable cataract blindness can be lifted from the children of the world by adopting effective Strategies and implementing a combination of effective Surgical Interventions.

The organization we are featuring is American Association for Pediatric Ophthalmology and Strabismus and the featured personality is Dr. Marshall M. Parks. You will know more about the history of Paediatric opthalmology. we wish you an experience of learning that is very practical. Your feedback will let us know how we can improve. Please send in your feedback at. We look forward to your feedback.

Thank You. Have a happy reading.

Regards,

Vision 2020 e-resource team
The Issue Features...
CONGENITAL CATARACT
Vol. 6 No.3 March 2010
•   Magnitude
•   Understand the Problem
•   Barriers
•   Strategies
•   Surgical Interventions
•   History of Ophthalmology
•   Featured Personality
•   Featured Organisation
•   Talk to Us
•   Past Issues

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The prevalence of childhood cataracts worldwide has been reported as one to 15/10,000 children. The wide range is because of the assortment of methods, the different age groups, and varying case definitions used in studies as well as true differences between populations. Foster et al estimated that the prevalence of congenital bilateral cataracts in industrialized countries is one to three per 10,000 children. The investigators calculated that approximately four children per 1 million total population per year will be born with bilateral cataracts in industrialized countries, and the figure for developing countries is likely to be 10 children per 1 million total population/year.

The prevalence of blindness from cataracts in children of developing countries is probably one to four per 10,000 compared with approximately less than one per 10,000 children in the industrialized world. Using a standardized classification and coding system, Gilbert et al evaluated 9,293 children examined in 40 countries and reported that the lens is responsible for 12% (range 7% to 20%) of anatomical abnormalities in children.



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A congenital cataract is a condition that a baby is born with, or that develops shortly after birth where the lens of the eye is cloudy instead of perfectly clear. The lens is located at the front of the eye and focuses light and images on the back of the eye on the retina. It is essential for vision, and if it is not transparent, vision will be blurry. If a cataract is present the babys immature nervous system will not receive the visual stimulation that it needs to develop the vision pathways in the brain and permanent vision loss will occur. If the cataract is small it may not affect vision very much, but it can lead to amblyopia, where the brain blocks out the signals of the weaker eye. Over time the optic nerve between the brain and that eye becomes non-functional and there is permanent vision loss. Congenital cataracts can affect one or both eyes, but if both are affected, one eyes cataract might be more severe than the other.



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The main limitations are lack of resources and political will to address cataract blindness as a global public health issue. In many poor rural districts, there is a dramatic lack of eye-care services, and even where they are available, their quality is not always satisfactory.

High-quality low-cost cataract service models are widely used in a number of countries, but their uptake in low-income countries is slow, due to local conditions such as the infl uence of the private sector and the presence of more expensive products on the market. The main barriers to uptake of cataract surgery in poor communities are lack of awareness, poor quality of service, high cost of treatment and limited access.



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The cataract will be surgically removed and vision will be corrected using glasses or contact lenses. Contact lenses can be quite effective with babies and young children who refuse to keep their glasses on; however, families might find it difficult to learn to insert the contact lens in a wiggly, resisting child.

Children may need to have their stronger eye patched for several hours a day so that they are forced to use their weaker eye. This patching (if done in a child under age five years of age) will cause the weaker eyes vision to improve over time. The outlook for children with successfully treated cataracts can be nearnormal vision, if no complications occur and they use their corrective lenses.



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Frank D. Costenbader was an American physician frequently credited as the world's first pediatric ophthalmologist. Costenbader and Marshall M. Parks (his mentee who would later be known to many as "the father of pediatric ophthalmology") began the first ophthalmology fellowship trained program of any subspecialty at the Children's Hospital in Washington, D.C., now known as the Children's National Medical Center. Parks trained many pediatric ophthalmologists during his career and was instrumental in the establishment of the American Association for Pediatric Ophthalmology and Strabismus, a national organization dedicated to improving the quality and management of pediatric ocular disease. Over time, over 30 programs were developed for the training of pediatric ophthalmologists throughout the United States. The American Academy of Pediatric Ophthalmology and Strabismus works with the American Academy of Pediatrics on issues related to pediatric eye disease and vision screening guidelines.

Source: http://en.wikipedia.org/wiki/Pediatric_ophthalmology#History


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Marshall M. Parks - the father of pediatric ophthalmology

Marshall Miller Parks (1918 - July 25, 2005) was an American ophthalmologist known to many as "the father of pediatric ophthalmology".

Parks studied under the guidance of Frank D. Costenbader, the first ophthalmologist to dedicate his practice solely to the care of children. At Children's Hospital in Washington, D.C., now known as the Children's National Medical Center, they began the first ophthalmology fellowship training program of any subspecialty. This evolved from the rotation of Heed Fellowship ophthalmologists who had trained with Costenbader for many years. The first Children's Hospital of Washington fellow was Leonard Apt in 1959.

Parks' scientific contributions include:
  • Elucidation of monofixation syndrome
  • Description and refinement of numerous eye muscle surgical techniques, particularly the fornix incision approach to strabismus surgery
  • Recognition of the benefits of very early strabismus correction (by age 1 year)
  • Innovation in surgical techniques for pediatric cataracts
  • Perhaps Parks' greatest legacy are the 160 fellows he trained in pediatric ophthalmology and strabismus. Many of these former fellows have gone on to leadership positions within the field themselves.
Source: http://en.wikipedia.org/wiki/Marshall_M._Parks


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AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS

AAPOS is the American Association for Pediatric Ophthalmology and Strabismus. The organization's goals are to advance the quality of children's eye care, support the training of pediatric ophthalmologists, support research activities in pediatric ophthalmology, and advance the care of adults with strabismus.

The mission of AAPOS is to advance high quality medical and surgical eye care worldwide for children and for adults with strabismus. AAPOS establishes practice guidelines for pediatric ophthalmology at the highest level of competence and ethics. AAPOS encourages the training of ophthalmologists who are primarily concerned with eye care of children. AAPOS fosters concepts that benefit children's eye health through preventive as well as remedial activities.



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