What Causes Blindness in Children?

Congenital cataract refers to congenital cataract that is present before or after birth, or gradually develops after birth. It is a more common eye disease in children and an important cause of blindness and amblyopia in children.

Congenital cataract in children

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Congenital cataract refers to a cataract that is a congenital genetic or developmental disorder that exists before or after birth, or that gradually develops after birth. It is a more common type of cataract.

Congenital cataract refers to congenital cataract that is present before or after birth, or gradually develops after birth. It is a more common eye disease in children and an important cause of blindness and amblyopia in children.

Most cataract patients develop slowly, progressively decrease their vision, and generally do not feel any discomfort, especially children. They will not report the condition themselves. If parents do not carefully observe the child's every move, it is easy to ignore the child's eye problems. So how can we detect the child's congenital cataract as early as possible? Please see the following introduction:

Congenital cataract is one of the main causes of blindness and visual disability in children. Its incidence in infants and young children is about 0.5%, which seriously affects children's growth and learning. If the treatment is not timely, it will also bring about future work. Negative Effects. Although there are many types of congenital cataracts, the only treatment method is surgery. Due to the rapid proliferation of fibrous tissue after surgery, children with post-onset dysfunction appear within 7-14 days, and need to be operated again or laser treatment.

Experts point out that the internationally recognized safe and effective method is cataract extraction + posterior capsule capsulorhexis + anterior vitrectomy, which can effectively prevent fibrous hyperplasia after cataract surgery in children and keep the visual axis of the pupil area transparent. To achieve once and for all. Another key issue is vision rehabilitation after surgery. The visual development of our normal people is at its peak from 4 months to 6 years of age. At this stage, even if any one of the eyes is blocked for 1 to 2 days, it will affect The visual growth of the obstructed eyes causes imbalanced vision development in both eyes and causes amblyopia. It can be seen that, whether it is monocular cataract or binocular cataract, because the eye does not receive normal optical stimulation after birth, it has different degrees of form-deprivation amblyopia, and it also has the loss of stereo vision and color vision. Success, the visual acuity of the postoperative operation cannot be improved quickly, and long-term amblyopia training is needed, and eventually the visual acuity returns to normal. In addition, in terms of the recovery time of amblyopia, the younger the age, the faster the recovery, the better the effect, so the operation of children with congenital cataract is in principle the sooner the better, and strive to complete within 6 months.

After the cataract is removed, the eye is in aphakic state, so a 10D convex lens should be worn to compensate for the refractive error of the eye. This is very important in the training of amblyopia. Since most children do not cooperate with glasses Some scholars proposed an early implantation of IOL. For example, if the IOL is implanted before the age of 4, then the degree of the IOL should be replaced again in the middle to adapt to the normal development of the eyeball; if the IOL is implanted after the age of 6 , It will remain the same for life as an adult. Modern research proves that the younger the age of treatment for congenital cataracts, the better the prognosis. The visual function of eyes with implanted intraocular lens is better than those with glasses alone.

Congenital cataract is the most serious blinding eye disease in children. Although the cloudy lens (cataract) was removed during surgery, it did not improve vision from the perspective of visual function. Improving vision is the ultimate goal of treating cataracts. Therefore, parents must pay more attention to amblyopia treatment than surgery. Otherwise, even the most successful surgery will lead to lifelong low vision or blindness, which will bring immeasurable family and social burdens.

I. Basic concepts

Difficulties and Solutions of Amblyopia Treatment after Congenital Cataract

Congenital cataract is a common blinding eye disease in children. Because cataracts block vision development, and most of them are accompanied by nystagmus or strabismus, the visual acuity after cataract surgery is almost below 0.1 and it is manifested as severe amblyopia or blindness. Effective treatment of amblyopia will inevitably leave a lifetime of low vision or blindness and become a serious family and social burden.

Personalized, threshold visual target modular treatment scheme is currently the most ideal method for treating severe amblyopia after congenital cataract surgery.

1. Personalized treatment plan: It is the most effective treatment plan based on the patient's specific condition and important conditions related to curative effect. For example: for the vision, complications (eye tremor, strabismus, posterior dysfunction, etc.) of children with cataract, young people do not know the visual chart and other related conditions, use a variety of defibrillation, strategic cover or not cover, preventive or Remedial treatment of impaired treatment, personalized low vision threshold, increased vision target, and other highly targeted treatment options.

2. "Level threshold visual standard" treatment method: that is, the visual acuity detected by the low visual threshold visual acuity chart, or the visual acuity of 0.05 to develop its threshold visual acuity (fineness 0.002 or less) training icon, so that the child can just see, However, the visual target training with a little difficulty (ie, fineness), like climbing a small staircase, gradually improves vision.

3. Modular treatment plan: Combining multiple efficient and complicated treatment methods together to form a simple, "fool-like" operating module, which makes it easy for parents or children to learn to operate and produce the best results. And on this basis, according to the individual characteristics of each case, make corresponding precise adjustments to further improve the efficacy.

1. Extremely poor vision, only 0.1 or below 0.1: Traditional amblyopia treatment instruments cannot provide grade vision standards for high-precision augmentation:

Because the traditional amblyopia treatment instrument can only provide visual enhancement training at a level of 0.1 or higher, and the number of training icons around 0.1 is only a few, it can not be classified and quantified. The child may not be able to see the largest training icon or only a few, so that most of the training icons are in an invalid state that is unclear. The few icons that are clearly visible are easy to remember. Therefore, the augmentation training effect is extremely poor, and it is easy to delay the illness.

2. Visual acuity can not be detected: because of young or poor vision (less than 0.1), visual acuity can not be found at all with ordinary visual acuity chart, or it can only be estimated as 0.02 or 0.04 based on the distance of several hands index: use conventional amblyopia Can not do quantitative augmentation training and delay the illness.

(1) Extremely poor vision: often below 0.1, or no visual acuity.

solution:

1. If the visual acuity can be matched, a high-accuracy threshold visual acuity chart of 0.05 to 0.3 and a fineness of 0.002 to 0.004 can be used to detect the threshold visual acuity, and

According to the inspection results, the threshold icon is customized for high-accuracy amblyopia augmentation training.

2. If you can't find your vision when you are young, you can customize the "threshold icon" according to the visual acuity below 0.05 for fine icon vision training.

3. Additional auxiliary sight glass (limited to 4 ~ 5 generation instruments) to help improve the level of the threshold visual target, thereby increasing the fineness of the "threshold icon"

Degree, reducing the difficulty of improving vision and increasing the effect of increasing vision.

4. Added enhanced vision enhancement function: let the visual target move horizontally and depth of field before and after to stimulate the cells around the fovea to enhance vision enhancement.

(2) Young age and poor coordination:

It is known that the younger the age, the better the vision enhancement effect, but the poorer the coordination degree, which may delay the best time for treatment. The choice of age and treatment timing are as follows:

1) 1 ~ 3.5 years old, unable to cooperate, but this age group is the most sensitive time for vision enhancement training. Parents should pay great attention to it and take the initiative to help the child with treatment.

2) 3.5 ~ 5 years old, able to cooperate, but less sensitive to vision enhancement training. This phase is the easiest to implement precise examination and treatment. We should seize the high degree of coordination during this period and carry out personalized and high-precision intensive amblyopia treatment.

3)> 5 years old, good coordination, but low sensitivity to vision enhancement training. By the age of 7 years, the use of high-precision enhanced amblyopia instruments of more than 4 generations as a remedial treatment still has a certain effect, and the treatment should not be abandoned.

4) Key inspection and treatment items that require the cooperation of children after surgery:

(1) Check threshold vision: Children with vision below 0.1 can not check accurate vision with ordinary visual acuity chart, they must use "low vision threshold visual acuity chart" to check. If they cannot cooperate with the investigation, they shall be treated with vision below 0.05.

(2) Mydriatic retinoscopy: Due to the effects of crystal attachments or residues, hindsight, computer refraction is not reliable, and manual retinoscopy is required. If radiography cannot be performed, the posterior barrier must be removed.

(3) Wearing corrective glasses: Most of the patients have severe refractive errors after surgery. Corrective glasses are required to help focus the focus to see the image clearly. Wearing glasses is the basis for the treatment of amblyopia, and it should be highly valued and persisted. Should be equipped with two pairs of corrective lenses, looking at the telescope and near (such as looking at amblyopia or books, etc.) mirror, it is best to wear glasses for more than 3 hours a day, can improve the efficacy.

(4) Amblyopia treatment device treatment: Due to poor vision, and when the amblyopia device can be used in conjunction with the age, it is appropriate to treat the amblyopia device more than 3 times a day for at least 1 year.

As the number of training targets from 0.1 to 0.3 provided by conventional amblyopia is very small, the precision of the target changes must be low, so that the child cannot see the smallest target or can only see a few, and most of them increase. Visual training targets are in an ineffective state of being unclear, and a few visual targets that can be clearly seen are easily memorized, resulting in extremely poor results and easy delay of illness. Therefore, it is necessary to customize low vision and high precision threshold vision amblyopia (above the fourth generation).

(3) With severe complications: it will increase the difficulty of amblyopia treatment and must be handled properly.

1. Congenital cataract with nystagmus:

Modularized therapy with personalized defibrillation

2. Congenital cataract with strabismus:

The dominant eye (ie, the right eye, which has 2 rows or more higher vision than the squint eye) is preferred, and the principle of balanced visual stimulation treatment is to promote the development of the dominant eye to a useful vision of 0.5 or more, without any special treatment. When the eyes do not have a dominant eye, the upright eye can be covered every other day, so that both eyes will receive the same chance of visual development stimulation, but if covering one eye can aggravate nystagmus, the eye cannot be covered. Due to the extremely poor visual acuity of the upright eye, it is difficult to improve it. For the time being, regardless of squint, the main energy should be used to improve the vision of the upright eye. If the technology is in place, it is advisable to correct strabismus by the way when removing the obstacle, and it is not advisable to specifically correct strabismus to improve vision, because clinically proven that correcting strabismus has no obvious effect on improving vision.

3. Congenital cataract with other eye abnormalities:

Such as small eyeballs, net off. Treatment depends on the condition.

Unless post-disorder prevention measures are added during surgery, post-disorders occur almost 100% after surgery. If the central pupil area is less than 2.0mm, and the light transmittance is less than 80%, those who cannot detect vision or can not perform dilated pupil examination must hinder the augmentation treatment. Therefore, you must laser or re-

(4) Disability and treatment after cataract surgery.

Obstructed after surgery.

Treatment plan:

1. Manage the hidden troubles of posterior dysfunction during the operation (the most advanced posterior capsule and anterior vitrectomy can be used);

2. Postoperative laser or re-operation to deal with severe post-traumatic disorders, keep at least 1.5mm of central area transparent; and transparency is more than 80%;

3. Perform mydriasis examination under sleep as soon as possible about 1 month after surgery to detect the initial refractive status of the lens after surgery. If there is a later onset of obstacles, re-examine the control after removal of the obstacle. , Can use the original inspection results as reference optics;

4. When the threshold visual acuity above 0.05 can be detected, customize the personalized threshold visual standard as soon as possible to perform high-precision amblyopia vision augmentation training. If vision cannot be detected due to young age, quantitative vision augmentation training is performed according to the low vision threshold icon below 0.05.