Descriptive epidemiology of infantile cataracts in metropolitan Atlanta, GA, 1968-1998.

BACKGROUND Infantile cataract is an important cause of childhood visual impairment. Surgery before 6 weeks of age is recommended for optimal visual outcome. Description of the epidemiologic characteristics of cataracts is important for an improved understanding of the condition. OBJECTIVES To identify at-risk populations and facilitate successful treatment of patients with infantile cataracts. METHODS Infants with cataracts diagnosed in the first year of life were identified using the Metropolitan Atlanta Congenital Defects Program, a birth defects surveillance program with active methods of case ascertainment, for the years 1968-1998. Several factors were analyzed, including year of birth, sex, race, maternal age, plurality (single vs multiple gestation), gestational age, birth weight, laterality, seasonality, and age at diagnosis. RESULTS A total of 199 infants with cataracts were identified, for a rate of 2.03 per 10 000 births. In 117 infants (59%), cataracts occurred as an isolated defect; in 43 infants (22%), cataracts occurred as part of a syndrome; and in 39 infants (20%), additional, unrelated, major birth defects were also present. Rates were higher for low-birth-weight infants (those weighing <1500 g; risk ratio [RR], 6.01; 95% confidence interval [CI], 3.83-9.43) and preterm infants (RR, 1.70; 95% CI, 1.21-2.40). Of the cases that occurred as an isolated defect, 38% were diagnosed after 6 weeks. CONCLUSIONS This population-based study provides 31 years of data from a diverse US population and allows identification of risk factors for infantile cataracts. The finding that a number of infants with cataracts continue to have their conditions diagnosed after 6 weeks of age emphasizes the need for direct ophthalmoscopic examination of the red reflex in the newborn period to facilitate early detection and improve outcomes.