Free Health Dissertations - The Study Was A Cross Sectional Design Study With An Entry Cohort Of Nearly
The study was a cross sectional design study with an entry cohort of nearly 250 children under the age of 15 yrs. The object of the exercise was to ascertain the proportion of these children who were detected and treated at 3 months and I year of age.
The significance of this study is that it highlights either the difficulty of diagnosis (or possibly the inefficiency of the system) as the results were poor by any interpretation. The paper itself is quite detailed and comprehensive, but the results that are relevant to our considerations in this essay are that only 35% of congenital cataracts were diagnosed at the routine new-born examination and only another 12% had been diagnosed by the time of the 6-8 week examination.
Only 57% of the cohort had been seen and assessed by an ophthalmologist by the time they were 3 months old and a further 33% had not been examined or assessed by the time that they were one year old. The authors comment that their study showed that the prime reason for getting an assessment was because of the carer’s concerns in about 40% of all cases. We shall consider the importance of early assessment, accurate diagnosis and appropriate treatment later in this essay, but it is clear from these figures that all three of these eventualities are denied to a very substantial proportion of children and infants with possible adverse consequences for their subsequent visual acuity.
In all areas of medicine, we should ideally work from a rational and verifiable evidence base. (5)
Given the fact that we can point to evidence that shows that a significant proportion of children with one (at least) visual defect are not routinely detected, we should examine the evidence base for the assumption that early detection is important.
For the sake of clarity we will initially confine our considerations to the circumstance of infantile cataract. We do know that infantile cataract is an important and potentially avoidable cause of visual handicap.(6) The resultant stimulus deprivation of the optic tract and visual cortex (7) caused by the inability of the retina to receive normal images, because of the distortion caused by the cataract, produces various degrees of amblyopia.(8) There is a substantial body of evidence to show that in order to optimise the eventual outcome, particularly with the denser forms of cataract, that corrective surgery needs to ideally have been carried out before the age of three months.(9)
Because of the developmental importance of the early visual stimulus it is reasonable to assume that the earlier that corrective treatment can be implemented, the better the result is likely to be (10)
Although we have initially considered the impact of early screening for the condition of infantile cataract, it follows that other conditions can equally well be screened with the same rationale for early treatment.
Dissertations - Free Health Dissertations
