Assessing the impact of a program for late surgical intervention in early-blind children

Abstract

Objective Many blind children in the developing world are unable to obtain timely treatment due to lack of financial and medical resources. Can public health programs that identify and treat such children several years after the onset of blindness enhance their quality of life? The notion that visual development is subject to an early ‘critical period’ argues against this possibility. However, there are inadequate empirical data from humans on this issue. To address this need, we examined the quality of life of children living in India and who were treated for early-onset blindness (before one year of age), due to cataracts or corneal opacities. Study Design Survey study. Methods As part of an ongoing scientific effort named Project Prakash, we screened over 40,000 children in rural northern India to identify those suffering from early onset blindness. They were provided eye surgeries in a tertiary care ophthalmic center in New Delhi. We subsequently surveyed sixty-four Prakash children, ranging in age from 5 to 22 years, and obtained their responses on a multi-dimensional Quality of Life questionnaire. Results Nearly all of the subjects indicated that their quality of life had improved after treatment. Children reported marked enhancement in their mobility, independence and safety, as also in social integration. Surprisingly, we found no significant correlations between quality of life metrics and factors such as age at treatment, gender, time since treatment, and pre- and post- surgery acuity. Conclusions A key question for public health policy makers is whether a program of surgical intervention for older blind children is likely to be beneficial, or if the resources are better spent on rehabilitation via vocational training and assistive devices. The marked improvements in quality of life we find in our data strongly argue for the provision of surgical care regardless of a child’s age.

Understanding the development of amblyopia using macaque monkey models

“…Programs such as Project Prakash (45) have provided a mechanism through which many children have been treated at older ages. The degree of plasticity that remains in these children is heartening, but functional visual recovery remains limited (46)(47)(48). Recent prospective studies of amblyopia treatment in children show results that are consistent with animal studies of critical periods and treatment strategies, in which intervention and treatment at young ages produce the best visual outcomes in cases of unilateral vision loss [see Holmes et al (49) and Koo et al (50)].…”

Artificial intelligence manages congenital cataract with individualized prediction and telehealth computing

“…Presently, conventional follow-up plans scheduled by clinicians are one-size-fits-all and are primarily based on personal experience or limited clinical evidence, resulting in the delayed detection of complications 11 . Furthermore, among developing countries, only a few specialized care centers are capable of effective examinations and accurate interventions 12 , 13 . The sparse distribution of these specialized centers creates significant difficulty and economic pressure for patients, resulting in low follow-up rates 14 .…”

Pediatric cataract

“…Delayed presentation in adulthood is also being frequently noted because of delayed diagnosis, ignorance, and lack of facilities. [ 54 ] The developmental cataract has a better prognosis than congenital cataract. [ 55 ] Homocystinuria can be managed using methionine-restricted diet.…”