Pediatric Cataracts
What is a cataract?
It is a clouding of the lens used to focus light onto the retina. Usually the lens of an eye is completely clear just like a window should be. For different reasons, the lens become opacified at varying levels which causes a decrease in a patient’s vision.
Can cataracts occur in children?
Yes, the incidence of cataracts in children is approximately 3-4 / 10,000 births. Even though it is far more common in adults, it does occur in children.
When and what causes cataracts in children?
There are a number of reasons for cataracts in children. They can be inherited in which a large number of family members have been diagnosed and treated for cataracts at a young age. Often, these are diagnosed at birth or within the first few months of life. They can be caused by various infections, metabolic disorders, injuries, inflammation of the eye, or use of steroids. These cataracts can occur at birth or develop later in life.
How are cataracts diagnosed in children?
They can be diagnosed at birth or later at a check up at the pediatrician’s office by noting a poor red reflex in the eye. The pediatrician plays a vital role in diagnosing these problems because the pediatrician is the physician that screen babies for any abnormalities at birth or later in life. Once a child is diagnosed with a cataract, he or she should be scheduled immediately with an ophthalmologist trained in treating children with cataracts.
Why should surgery be performed in children?
Surgery should be performed if the cataract is large enough to block the child’s vision and cause a decrease in vision. Some types of cataracts are small and do not interfere with the child’s vision or just require the child to be placed in glasses. Any lesion greater that 3mm is felt to be visually significant.
When should surgery be performed in children?
If the child is born with a cataract, the surgery should be performed within the first month of life. If the surgery is delayed after this, the brain has often switched all of its receptors to the other eye and cannot learn to use the eye in which the cataract was present. If it is a delayed cataract which develops later in life, it should be removed within a couple weeks of diagnosis if the child is still in an amblyopic age range. This would generally include children of the age less than 9 years. If it develops later from such occurrences as injury, steroid use, or inflammation, the surgery can be delayed for a few weeks until the inflammation in the eye is controlled. It is still better to have the surgery earlier than later, because if the child is without use of this eye for too long he or she can develop strabismus or lose the ability to have good stereo vision (see three dimensional).
What type of treatments are needed for pediatric cataracts?
If the cataract is small, they only need to be observed. Sometimes they are small but cause a refractive error requiring glasses only and not surgery. If they are large enough, they require surgical removal. This involves making a small incision 3.2mm or less into the eye and using a device which aspirates out the cataract. If a child is less than 6 months, they will generally be left without a lens and require a contact lens to wear full time. If they are greater than 6 months, the majority of the time an acrylic lens is placed inside the eye in place of the patient’s native lens which developed the cataract. These are the same type of lens which are placed in adults after cataract surgeries. These patients often will require glasses afterwards. This is especially true for the babies, because the lens power has been chosen to make the child far sighted. The reason for this is that a child’s eye grows with time, and if they are given a power lens which would require no glasses, they would become near sighted with time and sometimes require very thick glasses. Even when the surgery is over and everything looks like it should, the treatment for the child’s cataract is just beginning. The child will need to be treated for amblyopia (lazy eye). The reason for this is that the brain has switched its receptors to the other eye, and now has to be trained to use the eye in which the cataract was removed. This will require extensive patching over the normal eye. Lastly, children develop a great deal more of inflammation of the eyes after cataract surgery in comparison to adults. This can often lead to membranes forming blocking the child’s vision or lead to constriction of the pupil. If these entities occur, the child may require multiple surgeries in order to clear the child’s visual axis to allow him or her to see. The good news is that with proper timing, good surgical technique and proper care of the patient’s amblyopia, a child can develop great vision in an eye in which a cataract has been diagnosed.
