By Midhun Mohan

This case report outlines an extremely important treatable global health issue: childhood blindness.

Access to essential paediatric eye surgery in the developing world: a case of congenital cataracts left untreated
Untreated childhood cataracts remain prevalent especially in developing countries. They are a major health burden, not only affecting the individual’s quality of life but also predisposing the individual to becoming a financial burden for the country. This report is of a case of congenital cataracts in a young boy from the Philippines who was left blind since birth.
The mother observed the boy’s vision problems when she noted him bumping into things at the age of 1. When the boy was 2, the health care worker noted opacities on both lenses. The boy was seen at the rural health clinic at the age of 5 and diagnosed with bilateral congenital cataracts and referred to an opthamologist.
Note above the three year delay in getting the boy seen at the rural health clinic. This delay is likely due to:
The poor education of the parents affecting their health seeking behaviours and thus not fully appreciating the seriousness of their child’s condition
Inadequate competency levels of the health care workers. This is could be due to a lack of proper training, which is likely to stem from a lack of funding

Despite being diagnosed, the patient remained untreated for the next 7 years!
What was the reasoning behind such a long gap between diagnosis and treatment? There were two reasons:
The family were not able to afford the treatment
There was a lack of funding from the national health provider

The patient was not able to attend follow up, and three months after surgery, the patient’s visual acuity started to decrease.
There are 3 main factors that that can result in good visual outcomes after cataract surgery:

• Early recognition
• Surgical intervention
• Good follow up after surgery

The report states that:
“Early diagnosis is essential for appropriate and timely intervention and good visual function. Visual outcome is largely dependent on the timing of surgery when dense cataracts are present. Good results have been reported in children undergoing surgery before 6 weeks of age for unilateral cataract and before 10 weeks of age in bilateral cases”

What are the ways in which early diagnosis and intervention can be increased?
It is important to note that any proposed method of increasing early diagnosis has to be economically viable for this developing country. A novel tool that has been recently introduced is the “Portable Eye Examination Kit (PEEK).”

Portable Eye Examination Kit (PEEK)
PEEK is a multifunctional, smartphone based tool which aims to empower eye health workers to diagnose eye diseases and provide a low-cost device for managing and monitoring the treatment of patients.
The modified smartphone contains a series of eye tests in the form of apps that can be used by individuals with little training. Furthermore, because the eyes tests are on a smartphone, it is extremely portable being able to reach the most remotest areas.
One of the app’s it contains is the “Acuity App” which uses a shrinking letter that appears on screen and is used as a basic vision test. It uses the camera’s flash to illuminate the back of the eye to check for disease.
The smartphone is relatively cheap, costing around £300 rather than using bulky eye examination equipment costing in excess of £100,000. The low cost of this device makes it very appealing for developing countries.

Below are useful links to learn more about the Portable Eye Examination Kit (PEEK)
http://www.peekvision.org
http://www.bbc.co.uk/news/health-32914227
http://cehc.lshtm.ac.uk/peek/

Technology has the potential to greatly enhance patient care especially in developing countries. If PEEK was available in this boy’s village, could his blindness have been prevented?