Successful immunization and vitamin A supplementation programs have seen the prevalence of childhood blindness in Sub Saharan Africa (SSA) fall and have also seen cataract become the leading cause of childhood blindness.
Causation of most congenital cataracts is unclear; some clinical evidence for the importance of congenital rubella has been reported in developing countries and there are no rubella vaccination programs in SSA or any facilities for serological testing for evidence of congenital rubella.
Management of congenital cataracts in SSA remains a challenge and a team of professionals is required. The same principles apply as elsewhere: early surgery, early optical rehabilitation, and maintaining a clear visual axis. However these can be more difficult to achieve in SSA. In the absence of screening programs, and with long distances to travel to specialist centers, children are likely to present late with leukocoria, poor vision or nystagmus. In addition, contact lenses are not a feasible option for optical rehabilitation leaving a choice of intraocular lenses or glasses and follow-up is often poor. Surgical techniques are modified slightly to account for these problems. Recruiting a dedicated childhood blindness coordinator to provide special counselling and to track families and use mobile phone reminders has been shown to improve follow-up rates. Despite all these problems reasonable visual results have been reported from some specialist centres.
There are considerable health economic benefits to operating on children with cataract. Childhood blindness is second to adult cataract among the five priority conditions of Vision 2020 in terms of the burden of blind person years.