Gerald Msukwa, Margaret Njuguna, Cillasy Tumwesigye, Bernadeth Shilio, Paul Courtright, Susan Lewallen

Cataract in children attending schools for the blind and resource centers in eastern Africa

publication date
2009 May
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Objective: The aim of this study was to describe results of a representative sample of children who have undergone cataract surgery in schools for the blind in 4 African countries.

Design: Cross-sectional study.

Participants: Children enrolled at schools for the blind in Kenya, Malawi, Tanzania, and Uganda.

Methods: We used a population-proportional-to-size methodology to select a representative sample of schools for the blind and annexes and included all the children attending the selected schools. Trained teams using standardized examination methods and a modified World Health Organization form examined the children. The form was modified specifically to collect information on outcomes of cataract surgery.


Results: Of 1062 children examined, 196 (18%) had undergone cataract surgery or had cataract as the major cause of visual impairment; 140 (71%) had bilateral surgery, 24 (12%) had unilateral surgery, and 32 (16%) had not had surgery. Of operated eyes, 118 (41%) had visual acuity > or =20/200. Intraocular lenses were implanted in 65% of the operated eyes. Eyes with intraocular lens were more likely to have better vision than those without (P for trend = 0.04). Amblyopia was the most common cause of poor visual acuity in children who had undergone cataract surgery.

Conclusions: The number of children in the schools who receive cataract surgery has increased greatly since 1995. The high rate of amblyopia highlights the critical need for programs to find children earlier and to ensure adequate follow-up after surgery. Without such programs, the value of training pediatric surgeons will not be fully realized.

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