Do we indeed have enough data already to help answer some questions about pediatric cataract management? Maybe so but to develop RWD that leads to RWE the clinical question that we want to ask must be framed appropriately.Ĭonsider that several authors from the Indian subcontinent, USA and Asia have published studies that counter the findings of IATS, and that the only individual patient meta-analysis contradicts other aspects of IATS. If we look at the numerous papers published on the subject of pediatric cataract, we begin to see that there have been numerous retrospective papers, survey data, one or two randomized control trials, some meta-analysis studies, and a Delphi consensus paper.
#Aao bcsc questions trial#
Conducting a randomized control trial to answer a question that could be answered with existing data is wasteful both of resources and investigator effort and exposes human subjects to unnecessary risks and costs. More and more the concept of real world data (RWD) defined as data derived from a number of sources that are associated with outcomes in a heterogeneous patient population, is becoming increasingly favorable. In cases of bilateral cataracts, the eyes are often more normal in size. Why should this be ? Well most cases of unilateral cataracts are due to some form of PHPV with an eye that is usually smaller than the unaffected eye. It is, in fact, the bilateral dense cataracts in children that are of greater developmental concern evidence from a large longitudinal cohort study from the UK suggests that bilateral pseudophakia may result in better visual outcomes. Moreover, if a child has a unilateral cataract, he or she is still likely to have a normal life as long as the unaffected eye remains healthy and normal. A true comparison for real world evidence (RWE) in India would be to compare unilateral intraocular lens (IOL) to unilateral aphakic correction. Quoting the IATS as a reason not to implant under the age of 2 years becomes less relevant. It is noteworthy that the Infant Aphakia Treatment Study (IATS) compared the best correction (contact lens) with pseudophakia and not aphakic spectacle correction with pseudophakia. The socioeconomic status of a large proportion of children with cataracts in India precludes reliable rehabilitation with contact lenses for aphakia. In developing countries like India, 7.4%–15.3% of childhood blindness is due to cataract. Pediatric cataracts are responsible for more than 1 million childhood blindness in Asia. Extrapolating results from studies in other parts of the world may not be relevant or appropriate. Should the practices of pediatric ophthalmologists in India be comparable to those of other parts of the world? Only if the circumstances of the environment are similar. Their conclusions based on this study were that “The management of lens anomalies by pediatric ophthalmologists in India varies with laterality and appears to be comparable to that followed worldwide.” They contacted members of the Indian Strabismus and Paediatric Ophthalmology Society and sent surveys out with a return of approximately 20%. describe an E-Survey assessing the management patterns of Indian pediatric ophthalmologists for pediatric cataract and ectopia lentis. There is a renewed sense that while cataract surgery in adults appears to be evolving at a furious pace that pediatric cataract surgery is perhaps lagging in our understanding of the basic physiological and anatomical issues that play a role in a successful outcome. Pediatric cataract management has gained tremendous focus in the past decade.
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