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Al-Bakri M, Skovgaard AM, Bach-Holm D, Larsen DA, Siersma V, Kessel L. School performances in children with cataract: results from a population-based cohort study. BMJ Open 2023; 13:e072984. [PMID: 37532485 PMCID: PMC10401207 DOI: 10.1136/bmjopen-2023-072984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Childhood cataract is a chronic condition that may interfere with the child's learning capacities. We aimed to investigate whether childhood cataract influences academic development by comparing school performance in reading and mathematics in children with cataract to a matched control group. DESIGN Nationwide registry-based cohort study. SETTINGS Two surgical centres that perform all treatments for childhood cataract in Denmark. PARTICIPANTS Children born between 2000 and 2009 diagnosed with cataract before 10 years of age (n=275) and an age-matched and sex-matched control group (n=2473). MAIN OUTCOME MEASURES School performance was assessed as test scores in national tests performed at regular intervals from grade 2 to grade 8 in reading and mathematics. Analyses were corrected for birth origin, child somatic and mental disorder and parental socioeconomic status and mental disorders. RESULTS Of 275 children, 85 (30.9%) were operated for bilateral cataract, 79 (28.7%) unilateral cataract and 111 (40,4%) were not operated. We found that children with cataract have lower participation rate in the tests (62.5%) compared with the control cohort (77.2%) (p value=0.0001). After adjusting the pooled analyses for birth origin, somatic and mental disease in the child and parental socioeconomic status and mental disorders, we found that the children with cataract scored significantly lower in mathematics compared with those without cataract (mean difference=-4.78, 95% CI: -8.18 to -1.38, p value=0.006), whereas no difference was found regarding scores in reading (p=0.576). The lower score in mathematics was driven by children who had been operated for bilateral cataract (p-value=0.004). CONCLUSION Children with cataract without somatic or neurodevelopmental comorbidities or psychosocial adversities seem to do well in school, whereas children operated for bilateral cataract have higher frequencies of difficulties in mathematical tasks.
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Affiliation(s)
- Moug Al-Bakri
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Milde N, Rasmussen A, Nissen K, Kessel L. Support needs around the time of diagnosis of parents caring for an infant with visual impairment or blindness in Denmark: a qualitative study. BMJ Open 2023; 13:e067805. [PMID: 36810175 PMCID: PMC9945031 DOI: 10.1136/bmjopen-2022-067805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE The whole family is affected when an infant is diagnosed with visual impairment or blindness. We aimed to describe the support needs of parents around the time of diagnosis. DESIGN We used a descriptive qualitative method based on the theory of critical psychology and conducted five semistructured interviews with a total of eight parents of children under the age of 2 years who had been diagnosed with blindness or visual impairment before the age of 1 year. Thematic analysis was used to extract primary themes. SETTING The study was initiated by a tertiary hospital centre specialised in the ophthalmic management of children and adults with visual impairment. PARTICIPANTS Eight parents representing five families caring for a child under the age of 2 years with visual impairment or blindness participated in the study. The parents were recruited from the Department of Ophthalmology at Rigshospitalet, Denmark in relation to appointments in the clinic or by phone or email. RESULTS We identified three themes: (1) recognition and reactions during the time of diagnosis; (2) family, network and struggles; and (3) interaction with healthcare professionals. CONCLUSION The main lesson for healthcare professionals is to bring hope at a time when all hope may seem to be lost. Second, a need to direct attention to families with no or sparse supportive networks. Third, coordinating appointments between hospital departments and at-home therapies and reducing the number of appointments to allow parents time to establish a family relation with their child. Parents respond well to competent healthcare professionals who keep them informed and who see their child as an individual rather than as a diagnosis.
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Affiliation(s)
- Nina Milde
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Annette Rasmussen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Kamilla Nissen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet - KennedyCenter, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rasul A, Roos L, Groth K, Riise P, Bach-Holm D, Kessel L. Epidemiology of ectopia lentis and outcomes after surgery in a Danish population. J Cataract Refract Surg 2022; 48:1394-1402. [PMID: 36449672 DOI: 10.1097/j.jcrs.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the causes of ectopia lentis (EL) and the outcomes after surgery in a Danish population. SETTING The Eye Clinic Rigshospitalet and Kennedy Center in Copenhagen. DESIGN Retrospective cohort study. METHODS Medical records of patients with nontraumatic EL born after 1980 and seen at the Eye Clinic Rigshospitalet and Kennedy Center from 1983 to 2019 were reviewed. Clinical information regarding family history, comorbidities, genetic workup, ophthalmological examinations, and surgical history was retrieved. RESULTS 72 patients (38 males), of whom 68 had bilateral EL (94.4%) were identified. Marfan syndrome (MFS) was found in 34 (47.2%) and biallelic variants in ADAMTSL4 in 4 (5.6%). Surgery was performed in 38 (52.8%) patients, 66 eyes, with a median age at the time of first eye surgery of 8.4 years (range 0.8 to 39.0 years) and a follow-up of 2.3 years (range 0 to 25.7 years). Intraocular lenses were implanted in 9 (23.7%) (11 eyes). Corrected distance visual acuity improved from 0.7 to 0.2 logMAR (median) in right eyes and from 0.7 to 0.3 logMAR in left eyes postoperatively. 21 patients (56.8%), 42 eyes, did not experience any surgery-related complications. 3 patients (3 eyes) experienced a perioperative tear in the posterior capsule. Temporary postoperative ocular hypertension was reported in 3 patients (7.9%) (3 eyes), and 2 patients (5.4%) (2 eyes) developed persistent ocular hypertension. There were no cases of postoperative retinal detachment. CONCLUSIONS The main reason for EL was MFS. Surgery improved visual acuity, and postoperative ocular hypertension was the most common complication, whereas retinal detachment was not observed.
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Affiliation(s)
- Asrin Rasul
- From the Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark (Rasul, Riise, Bach-Holm, Kessel); Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark (Roos); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (Groth); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Bach-Holm, Kessel)
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Hansen MM, Bach-Holm D, Kessel L. Biometry and corneal aberrations after cataract surgery in childhood. Clin Exp Ophthalmol 2022; 50:590-597. [PMID: 35524701 PMCID: PMC9546075 DOI: 10.1111/ceo.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/20/2023]
Abstract
Background To report long‐term biometric and refractive outcomes in a group of Danish children after surgery for childhood cataract. Methods Children between 7 and 18 years who had undergone uni‐ or bilateral cataract surgery at the Department of Ophthalmology, Rigshospitalet, Denmark, were examined in this cross‐sectional study. Swept source optical coherence tomography (OCT) based optical biometry (IOLmaster 700) and anterior tomography (Pentacam) was performed. Healthy fellow eyes from those with unilateral cataract were used as controls. Results We included 56 children in the study with a median age at surgery of 43.8 months (1.6–137.6). The amount of higher order aberrations was significantly increased in operated eyes (median root mean square 0.461 μm [range 0.264–1.484]) compared with non‐operated eyes (median root mean square 0.337 μm [range 0.162–0.498], p < 0.001). Younger age at surgery was positively associated with more higher order aberrations at follow‐up (p < 0.001), but we found no significant associations between the amount of higher order aberrations and visual acuity or contrast vision. Longer axial length was associated to glaucoma while shorter axial length was associated to strabismus (p < 0.001). Conclusions Eyes operated for childhood cataract have higher order aberrations compared with non‐operated eyes. Higher order aberrations are complex refractive errors that cannot be corrected by normal lenses and may contribute to poor visual outcomes for the children. We found an association between young age at surgery and higher order aberrations.
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Affiliation(s)
- Mathias Møller Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Al-Bakri M, Skovgaard AM, Bach-Holm D, Larsen DA, Siersma V, Kessel L. Increased Incidence of Mental Disorders in Children with Cataract: Findings from a Population-based Study. Am J Ophthalmol 2022; 236:204-211. [PMID: 34648774 DOI: 10.1016/j.ajo.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the incidence of mental disorders in children with cataract compared with children without cataract. DESIGN Nationwide cohort study based on entries in comprehensive national databases. METHODS The incidence of mental disorders in children born between 2000 and 2017 diagnosed with cataract before 10 years of age (n = 485) was compared with sex- and age-matched controls (n = 4358). Analyses were corrected to somatic disease in the child and parental socioeconomic status and psychiatric morbidity. The study was conducted as 2 university hospitals in Denmark managing children 6 years of age our younger with cataract. RESULTS The incidence of mental disorders was nearly doubled in children with cataract compared with controls (odds ratio [OR], 1.83; 95% CI, 1.28-3.63). The risk of anxiety disorders was quadrupled (OR, 4.10; 95% CI, 1.90-8.84) and the risk of developmental delay was doubled (OR, 2.66; 95% CI, 1.45-4.90). The risk of mental disorders was significantly higher in children diagnosed with cataract in the first 3 years of life compared with controls (OR, 2.36; 95% CI, 1.53-3.64), whereas those diagnosed with cataract later in childhood did not have an increased risk (OR, 1.24; 95% CI, 0.66-2.30). CONCLUSIONS The risk of mental disorders, in particular anxiety and neurodevelopmental delay, is markedly increased in children with cataract and even more so in those diagnosed within the first 3 years of life. Psychiatric screening instruments may be integrated in the management of these children.
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Affiliation(s)
- Moug Al-Bakri
- From the Department of Ophthalmology, Rigshospitalet (M.A.-L., D.B.-HH, L.K.).
| | | | - Daniella Bach-Holm
- From the Department of Ophthalmology, Rigshospitalet (M.A.-L., D.B.-HH, L.K.); Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen (V.S.), Copenhagen, Denmark
| | - Line Kessel
- From the Department of Ophthalmology, Rigshospitalet (M.A.-L., D.B.-HH, L.K.); Department of Clinical Medicine, University of Copenhagen, Copenhagen
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Al‐Bakri M, Bach‐Holm D, Larsen DA, Siersma V, Kessel L. Socio-economic status in families affected by childhood cataract. Acta Ophthalmol 2022; 100:183-188. [PMID: 33666374 DOI: 10.1111/aos.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the socio-economic status of families affected by childhood cataract and to assess how the socio-economic status is affected by cataract diagnosis. MATERIALS AND METHODS Children born between 2000 and 2017, seen between the age 0 and 10 years in the same period at Rigshospitalet or Aarhus University Hospital for cataract (N = 485), were included and compared to a matched children group without cataract (N = 4358). Socio-economic status was evaluated by the parents' income, employment, education, marital status and family structure. RESULTS Parents of children with cataract were more likely to have a low yearly income (OR = 1.60, 95% CI (1.12-2.27)), be out of work (OR = 1.74, 95% CI (1.34-2.26)) and have basic education as the highest attained education (OR = 1.64, 95% CI (1.27-2.13)) prior to diagnosis. This social gradient was not affected by the diagnosis. In addition, a higher number of children with cataract lived in multi-family residencies (13.8% versus 8% in group of children without cataract) and they had a greater number of siblings (6.2% had ≥4 siblings versus 2.1% in group of children without cataract). CONCLUSION Families affected by childhood cataract have a lower socio-economic status and educational background even before cataract is diagnosed but the diagnosis does not aggravate the differences between these families and the background population. The lower socio-economic status and parental educational background should be taken into consideration in the management of these families.
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Affiliation(s)
- Moug Al‐Bakri
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Line Kessel
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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De Lima S, Kugelberg M, Jirwe M. Swedish Parents' Experiences and Their Need for Support When Having a Child with Congenital Cataract: A Qualitative Study. J Pediatr Nurs 2021; 60:109-115. [PMID: 33930621 DOI: 10.1016/j.pedn.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/26/2021] [Accepted: 04/21/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support. DESIGN AND METHOD A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development. CONCLUSION The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made. CLINICAL IMPLICATIONS The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.
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Affiliation(s)
- Sara De Lima
- St. Erik Eye Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
| | - Maria Kugelberg
- St. Erik Eye Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Sweden.
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Chen W, He S, Hu L, Zhu J, Xie W, Xiang D. Ultrasound biomicroscopy for the assessment of postoperative complications after congenital cataract surgery. Quant Imaging Med Surg 2021; 11:1483-1489. [PMID: 33816184 DOI: 10.21037/qims-20-185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background The aim of the present study was to investigate the role of ultrasound biomicroscopy (UBM) in the evaluation of postoperative complications in children with congenital cataracts. Methods A retrospective study was conducted between September 2012 and December 2016 at Guangzhou Women and Children's Medical Center. Red reflex test and high-resolution bag/balloon UBM were performed to evaluate postoperative congenital cataracts. The red reflex test results were recorded, and UBM imaging results were recorded and analyzed. Different postoperative complications were classified based on the UBM imaging features, and a second procedure was performed accordingly. The UBM images were compared with the images captured from the intraoperative videos. Results In total, we looked at 120 eyes in 96 patients (65 males and 31 females) in the present study. The age of the cohort was 3-76 months. A total of 51 eyes with poor red reflex were included. There were complications in 46 eyes after congenital cataract surgery, as detected by UBM, including posterior capsular opacification (n=29 eyes), pupil block (n=8 eyes), synechia (n=5 eyes), hyphema (n=1 eye), and abnormal intraocular lens (IOL) placement (n=3 eyes). UBM images showed specific features of postoperative complications. Conclusions UBM is a valuable tool for the early evaluation of postoperative complications of congenital cataracts, especially for those with media opacities or when pupil dilation is not possible.
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Affiliation(s)
- Wensi Chen
- Department of Pediatric Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shiping He
- Department of Cataract, Aier Eye Hospital of Zhongshan Xiaolan, Zhongshan, China
| | - Lanxiang Hu
- Department of Pediatric Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jie Zhu
- Department of Pediatric Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wanhua Xie
- Department of Pediatric Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Daoman Xiang
- Department of Pediatric Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Molecular genetics of congenital cataracts. Exp Eye Res 2019; 191:107872. [PMID: 31770519 DOI: 10.1016/j.exer.2019.107872] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Congenital cataracts, the most common cause of visual impairment and blindness in children worldwide, have diverse etiologies. According to statistics analysis, about one quarter of congenital cataracts caused by genetic defects. Various mutations of more than one hundred genes have been identified in hereditary cataracts so far. In this review, we briefly summarize recent developments about the genetics, molecular mechanisms, and treatments of congenital cataracts. The studies of these pathogenic mutations and molecular genetics is making it possible for us to comprehend the underlying mechanisms of cataractogenesis and providing new insights into the preventive, diagnostic and therapeutic approaches of cataracts.
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