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Friday, 5 February, 1999, 11:34 GMT
Screening misses babies' cataracts
19:00 04-02-99 ac
GPs are increasingly involved in the early examinations of babies
Almost a third of cataracts in newborn babies are missed, despite recommendations to perform routine checks on infants.

The cataracts could lead to blindness if not diagnosed early.

Researchers at the Institute of Child Health, London, said infant cataract management has improved considerably in recent decades with increased recognition of the importance of early diagnosis and treatment.

However, their study, published in the British Medical Journal, found the diagnosis was missed in 29% of cases.

Blurred vision

A cataract is a clouding of the lens of the eye. Vision becomes blurred or dim because light cannot reach the retina at the back of the eye properly.

They cannot cause permanent blindness in adults, but can become thick enough to completely obscure vision.

19:00 04-02-99 ac
The earlier a cataract is found, the better the potential outcome
However, in infancy they can cause amblyopia, or lazy eye. Amblyopia occurs because the retina is deprived of visual stimuli at a crucial developmental stage.

Vision improves in newborn babies as they use their eyes during the first months of life.

During early childhood years, the visual system changes quickly and sight continues to develop.

But if a child cannot use his or her eyes normally, vision cannot develop properly. After nine years of life, the visual system is usually fully developed and cannot be changed.

"That is why early diagnosis, if it's a dense cataract, to allow treatment in the first three months of life is so important," said Dr Jugnoo Rahi, who led the research.

Early intervention

"The problem with missing a dense cataract is you'll never get the same potential outcome as if you'd got it early," Dr Rahi said.

She said the study highlighted a need for better training to improve the screening process.

The routine tests check the red eye reflex, which is often caught in flash photography, using an opthalmoscope.

"This test has been national practice in this country for 30 years, yet no one has studied how this test performs or whether it always picks up cataracts," Dr Rahi said.

For this reason it was difficult to tell whether the process itself was to blame for missed diagnoses.

"People have concerns because they know training is not necessarily good throughout the country, but this is the first time we've suggested there really is room for improvement."

Better co-ordination between paediatric, primary care and ophthalmic health professionals is also needed to enable early diagnosis, the study said.

Recommendations

Royal College of Paediatrics and Child Health and the Royal College of Ophthalmologist guidelines recommend routine eye examinations for infants at birth and at six to eight weeks.

The BMJ study looked at 235 cases of congenital or infantile cataract diagnosed between October 1995 and September 1996.

Of these, 35% were detected at the first routine check and 12% at the six to eight week exam.

However, while 57% of children were assessed within three months of birth, 33% were not examined until after their first birthday.

Dr Rahi said the study is a good starting point for a review of current procedures.

"It raises the whole question of how we train paediatricians and GPs to perform the newborn examination," she said.

See also:

21 Jul 98 | Health
13 Oct 98 | Health
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