Monitoring and Morphologic Classification of Pediatric Cataract Using Slit-Lamp-Adapted Photography

Abstract

Purpose: To investigate the feasibility of pediatric cataract monitoring and morphologic classification using slit lamp-adapted anterior segmental photography in a large cohort that included uncooperative children.

Methods: Patients registered in the Childhood Cataract Program of the Chinese Ministry of Health were prospectively selected. Eligible patients underwent slit-lamp adapted anterior segmental photography to record and monitor the morphology of their cataractous lenses. A set of assistance techniques for slit lamp-adapted photography was developed to instruct the parents of uncooperative children how to help maintain the child's head position and keep the eyes open after sleep aid administration.

Results: Briefly, slit lamp-adapted photography was completed for all 438 children, including 260 (59.4%) uncooperative children with our assistance techniques. All 746 images of 438 patients successfully confirmed the diagnoses and classifications. Considering the lesion location, pediatric cataract morphologies could be objectively classified into the seven following types: total; nuclear; polar, including two subtypes (anterior and posterior); lamellar; nuclear combined with cortical, including three subtypes (coral-like, dust-like, and blue-dot); cortical; and Y suture. The top three types of unilateral cataracts were polar (55, 42.3%), total (42, 32.3%), and nuclear (23, 17.7%); and the top three types of bilateral cataracts were nuclear (110, 35.8%), total (102, 33.2%), and lamellar (34, 11.1%).

Conclusions: Slit lamp-adapted anterior segmental photography is applicable for monitoring and classifying the morphologies of pediatric cataracts and is even safe and feasible for uncooperative children with assistance techniques and sleep aid administration.

Translational relevance: This study proposes a novel strategy for the preoperative evaluation and evidence-based management of pediatric ophthalmology (Clinical Trials.gov, NCT02748031).

Keywords: Pediatric cataract monitoring; morphologic classification; preoperative evaluation.

Figures

Figure 1

Assistance techniques and equipment for slit-lamp-adapted photography among uncooperative children. (A, B) An infant with an immature spine and low weight (mostly under 1 year and less than 10 kg) was held up by his mother with one hand on the haunch and another hand on the abdomen, and the head position was adjusted by a technician. (C, D) Straps were used for a heavier child with a mature spine and moderate weight (from 1–2 years and less than 20 kg), and the head position was adjusted by a technician. (E, F) If a child was too heavy to be held up by his parents, even with straps (mostly older than 2 years and more than 20 kg), a transformable bed (our patented product) was used to support the child, and a technician helped adjust the head position (notes: permissions have been received to use patient likeness in the figure).

Figure 2

Flow chart of patient selection, examination and analysis. A total of 438 patients diagnosed with pediatric cataracts were finally included, containing 260 (59.4%, 260/438) uncooperative children with our assistance techniques and equipment, after sleep aid administration. Specifically, the assistance techniques were used in the following proportions: flying-baby posture (141, 54.2%), strap technique (97, 37.4%), and special transformable bed (22, 8.4%). All 746 slit-lamp images of the 438 pediatric patients were successfully diagnosed and classified.

Figure 3

Representative slit-lamp images of 10 types and subtypes of congenital cataract morphologies. Considering the lesion locations, the pediatric cataract morphologies could be objectively classified into seven types (or 10 subtypes): total; nuclear; polar, including two subtypes (anterior and posterior); lamellar; nuclear combined with cortical, including three subtypes (coral-like, dust-like, and blue-dot); cortical; and Y suture.

Figure 4

Histogram of the seven cataract types in all included patients with bilateral cataracts or unilateral cataracts. The top three types of unilateral cataracts were polar (55, 42.3%), total (42, 32.3%), and nuclear (23, 17.7%); the top three types of bilateral cataracts were nuclear (110, 35.8%), total (102, 33.2%), and lamellar (34, 11.1%). The polar type of cataract (both anterior and posterior subtypes) was mostly likely to be categorized as unilateral, while the most likely laterality categorization of other types or subtypes of cataract was bilateral. Nu + co, nuclear complicated with cortical cataracts.