What causes the cataract of my child?
What is its incidence?
Is surgery really needed?
How about the postoperative visual outcome?
When shall we come back for follow-ups?
When to implant an intraocular lens?
Fig. 9.1
Preoperative counseling. (a) Disease-based counseling: The physician is explaining the child’s ocular conditions and the proposed treatment plan to his parent; (b) Emotional-based counseling: The physician is communicating with the child via hug or touching; (c) An online platform for physician-patient communication developed by the Cataract Children’s Home in Zhongshan Ophthalmic Center
- 1.
The pros and cons of different surgical timings and strategies.
- 2.
Preoperative preparations, including preoperative medication, preoperative systemic and ophthalmological examinations, pre-anesthesia evaluation, preoperative nursing care, as well as cost and duration of the surgery.
- 3.
Warning signs of postoperative complications, such as eye redness, eye pain, agitation and crying, or other ocular abnormalities.
- 4.
Postoperative visual outcome and its influencing factors (Table 9.2). A well-conducted disease-based counseling can not only demonstrate that the physician is responsible, but also enhance the parents’ trust and cooperation, which is the basis of optimal treatment outcomes.
Table 9.2
Factors associated with a suboptimal visual outcome following pediatric cataract surgery
Long interval from onset of symptoms to surgery
Unilateral cataract
Asymmetric bilateral cataracts
Significant strabismus
Nystagmus
Signs of severe visual impairment (e.g., poor fixation and pursuits)
Juvenile idiopathic arthritis-related cataract or cataract complicated with intermediate uveitis
Developmental abnormalities of the eye
Postoperative complications without timely management
9.1.2 Emotion-Based Counseling
As postoperative recovery may be very slow and the postoperative conditions may become complex and variable, most parents undergo a tough episode of stress. Therefore, in addition to explaining the disease itself, physicians should also show understanding and sympathy for these parents and take time to establish a good rapport or communication with them.
In our clinical practice, the pediatric ophthalmologists interact with the patients and their parents via both direct face-to-face communication and indirect communication on social media. Direct communication includes hugging or touching the child (Fig. 9.1b), gentle verbal communication, giving the child candies or toys as awards, listening to the parents with patience, etc. A good direct communication is the most effective and efficient approach of communication, helping to earn the acceptance and trust of the child and his/her parents, which is associated with enhanced cooperation.
Physicians may also interact with the parents via several indirect ways (e.g., QQ groups, Wechat groups, and websites), disseminating knowledge about pediatric cataract and answering questions from the parents in a timely fashion (Fig. 9.1c). The physicians can also track the patient’s condition and guide the parents to cooperate and comply with the treatment. Meanwhile, owing to the long-term communication, a harmonious, healthy, sincere, and trustful relationship can be established between the physicians and the patients and/or their parents.
9.1.3 Informed Consent
Surgical consent form is an essential legal instrument in the framework of modern healthcare system, which protects both the patients’ right to be informed and the physician’s practice. Before obtaining the informed consent, the physician has to fully explain to the patient’s parents the purpose and methods of the proposed surgery, precautions before and after the surgery, adverse events that may occur during the surgery, etc. According to the applicable laws, children under the age of 18 are considered not competent to make informed consent decisions. As a result, it is their parent(s) or guardian(s) who sign the surgical consent form in person. If this is not possible, there has to be a surrogate with written authorization from the patient, parent(s), or guardian(s) to sign the surgical consent form.
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