The Effects of Cataract Surgery on Children’s Vision: A Systematic Review

Author: Albaqami FM, Alotaibi MA, Alrabie WK, Albaqami MM, Alfadli FM, Alobaylan HA, Althbaiti MA, Alosaimi AS, Alharthi F, Althomali TA.

Geographical coverage: the United States, Israel, India, Ireland, Finland and the Netherlands

Sector: Cataract surgery

Sub–sector: Visual acuity

Equity focus: Not reported

Study population: Paediatric patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background: Cataract‑related blindness affected approximately 10.8 million people worldwide in 2010. In Saudi Arabia, cataract is the leading cause of blindness, accounting for about 55 % of all cases. Childhood cataract disrupts early visual development and may cause cognitive, academic and emotional difficulties. Although early surgery can restore sight, its broader developmental ramifications remain unclear. Childhood blindness also hampers education and later employment, imposing considerable socio‑economic burdens. Timely surgical intervention, appropriate rehabilitation and regular follow‑up are therefore essential. This systematic review assessed the effectiveness of cataract surgery in improving visual acuity in children, taking into account factors such as amblyopia, timing of surgery and lens implantation.

Objective: To measure the improvement in visual acuity following cataract surgery in children.

Main findings: Seven high‑quality studies were included. Two were conducted in the United States and one each in Israel, India, Ireland, Finland and the Netherlands. Most reported better outcomes in children with bilateral cataracts than in those with unilateral disease. Both aphakic (without an intra‑ocular lens) and pseudophakic (with an intra‑ocular lens) patients demonstrated visual improvement, although younger children tolerated contact lenses less well. Some studies found no statistically significant difference in visual acuity between these two groups. Post‑operative outcomes were influenced by co‑existing glaucoma, uveitis and other complications.

Methodology:  The searches of PubMed, MEDLINE, Embase, PsycINFO and Google Scholar identified published and unpublished retrospective studies that reported visual‑acuity outcomes after paediatric cataract surgery. Studies of children and adolescents aged under 18 years, published from database inception to March 2022, were eligible. A single reviewer screened titles and abstracts, extracted data and critically appraised study quality. Findings were synthesised narratively.

Applicability/external validity: The review did not explicitly address external validity.

Although the review included studies from diverse regions, only seven studies met the eligibility criteria and sample sizes ranged from seven to 37 participants. Wide variability in patient age (infants to adolescents) and cataract type (unilateral or bilateral) limits generalisability. Moreover, most studies had a high risk of bias, potentially skewing the results.

Geographic focus: No geographical limits were applied. The included studies were conducted in the United States, Israel, India, Ireland, Finland and the Netherlands.

Summary of quality assessment: Overall, there is medium confidence in the review’s conclusions. Searches covered multiple databases; inclusion and exclusion criteria were clearly stated; study quality was assessed and results reported. A list of included studies was provided, and study characteristics were presented. However, no list of excluded studies was supplied; reference lists were not searched, authors were not contacted, language limits were not specified, and only one reviewer performed screening and data extraction. Risk‑of‑bias findings were not stratified by study quality.