Cataract in Child

What is cataract?

Cataract is a clouding or opacity of the normally transparent lens inside the eye. Cataract is a common cause of poor vision in older adults, but it may also occur uncommonly in infants and children.

What causes cataract in children?

The child may either be born with cataract or may develop cataract early in life after birth. It may be caused due to some disease in mother during pregnancy or due to some problem with child's general health, or injury to the eye. Sometimes it may be hereditary, being passed to the child, usually from a parent who has the same problem. The ophthalmologist or pediatrician generally runs a few tests to find out the cause of cataract. In many cases, though, no cause may be found.

How to know if one's child has a cataract?

The child may have cataract in both the eyes or in only one eye. At birth, each child is examined by the pediatrician to rule out any congenital abnormality, including cataract. If the child has significant cataract in both the eyes, the family members can usually notice that the child does not see well. The child may not be able to recognize mother (normally recognizes by 2 months of age), may not respond to visual stimuli etc. Sometimes when it involves only one eye, it may be difficult to detect, as the child may be seeing normally. The cataract may make the black pupil of the eye look white or gray. Sometimes the eye with cataract may wander out of line causing squint, or may show a jiggling movement (nystagmus). Presence of nystagmus and squint are poor signs in cataract, as they may signify that vision may not return fully after surgery.

Note that the child may have poor vision due to other reasons also besides cataract. Moreover, cataract in child may be associated with other diseases of the eye as well. Therefore it is mandatory to see an ophthalmologist in case you notice the child has any of the above problems.

My child has a cataract. Would he be able to see?

It is very important to treat this condition as soon as possible to get the best results. Most children who are treated for cataract at the right time end up seeing well. Though there might be certain conditions in which the vision is low even with the best possible treatment. Your ophthalmologist will keep you informed about this.

Why is it important to treat childhood cataract early?

The presence of cataract in a child does not let the eye get proper visual stimulus to develop. This prevents the normal development of the eye, especially if the cataract is present in only one eye. This condition is known as amblyopia or lazy eye. Therefore it is important to treat this condition at the earliest to prevent and to treat amblyopia.

What are the methods of treatment for childhood cataract?

The treatment options are:

• • No surgery with periodic follow up
• • Cataract removal without intraocular lens implant
• • Cataract removal with intraocular lens implant

What factors decide the treatment option and the timing of surgery?

The treatment option and the timing of surgery will be decided by the ophthalmologist, based on the following factors:

• • Age of the child
• • Density of cataract
• • Whether cataract involves one eye or both eyes

If the cataract is not very dense and the child is able to see through it, then the surgery may not be required or it may be deferred till the child reaches a age where a cataract surgery with lens implant can be done safely.

Generally the lens implantation is not preferred in a child below 2 years of age because these eyes are still in growing stage, moreover there is a tendency for severe inflammation (uveitis) in these young children and the chances of aftercataract (opacification of the capsule of lens) is almost 100%.

Cataract involving only one eye has to be treated more urgently because the chance of amblyopia is greater in these cases.

What are the complications of surgery?

Cataract surgery is very safe, but as in any surgery, complications are possible. There is a very small risk of serious bleeding or infection after the surgery. If a lens has been implanted, there is a very high chance of aftercataract formation, which may require laser treatment or even a small surgery. Even years after surgery, related eye problems such as retinal detachment can develop and threaten sight. For this reason it is very important to have a regular follow up even after the surgery is done. To examine the eye properly in an uncooperative young child after cataract surgery, the ophthalmologist may occasionally give sedative medicine or even general anesthesia.

What to do after surgery?

The care of the eye after surgery is the most important part of treatment. As we remove the lens of the eye, the refractive power of the same has to be compensated in some form to enable the eye to see properly. Also, because the lens is not there, the eye can not change the power for near work (accommodation). For this reason, the child will require to wear an additional near addition (like in presbyopia) for doing near work. The various options available for this purpose are:

• • Glasses
• • Contact lens
• • Intraocular lens implant

The advantages of glasses are that they are very convenient and simple to use and there is no chance of harming the eye. The disadvantages are that they are very thick and heavy, and the child (especially teenagers) may not like to wear them because of poor appearance and because it hampers in sports. Moreover, they are unsuitable for children who have cataract in only one eye, because the vision from the two eyes cannot be properly combined in the brain, when one eye focuses in the normal way and the other looks through a very strong spectacle lens.

Contact lenses provide both vision and appearance that is normal. But the main disadvantage is that they have to be properly cleaned and maintained, or else there is a small risk of infection. It may be difficult to place them in the eye and to remove them for cleaning especially in small children between 1 to 5 years of age. Also the chances of losing the contact lens is also very high in this age group.

Intraocular lenses are a very good option, as they do not require any maintenance. But these are not preferred in children below 2 years of age. They also have a higher chance of developing aftercataract.

The best form of visual rehabilitation for child is a very complex decision and the ophthalmologist will decide after discussing these issues with the parents.

Amblyopia therapy: In some cases of cataract in children below 5-6 years of age, especially in those where only one eye is involved, the child may have to be treated for amblyopia.