Congenital Cataract

Category Pediatric Ophthalmology

What is a Cataract?
Cataracts occur when changes in the natural lens of the eye cause it to become less transparent (clear). This results in clouded or misty vision. The lens is the transparent structure located just behind the pupil (the black circle in the center of the eye). It allows light to reach the retina in the back of the eye to allow image formation.

What is the cause of cataracts in children?
Childhood cataracts maybe
Congenital Cataracts – cataracts that are present when a baby is born or shortly afterward. This category is the reason behind the majority of cataracts in children. Developmental, infantile, or juvenile cataracts-cataracts diagnosed in older babies or children.

Causes of congenital cataracts are
A genetic fault inherited from the child’s parents caused the lens to develop abnormally Certain genetic conditions like Down’s syndrome & Turner's syndrome. Certain infections affect the mother during pregnancy

Cause of Acquired/ juvenile cataracts
Galactosaemia, Galactokinase deficiency, Lowe’s Syndrome & Mannosidosis.
Eye trauma – as a result of an injury to the eye or eye surgery Use of eye drops containing steroids. 

If you see the following things in your child you must opt for an eye examination and rule out any eye abnormality including CATARACT:-

  1. If the child is lean & tall, short-statured or short and stocky, one should seek a pediatrician’s opinion and also see an ophthalmologist to rule out cataracts due to Marfan’s syndrome, Down’s syndrome, Lowe’s syndrome, Weil Marchesani Syndrome
  2. If you see Skeletal abnormalities like Sternal deformity, Rickets, a Wide chest with widely separated nipples, Scoliosis see an ophthalmologist rule out cataracts.
  3. If you see Hand, Joint, Muscular, and teeth abnormalities like Small broad stubby hands with curved little fingers Broad hands with broad hands and fingers Decreased joint mobility Excessively flexible with increased joint mobility Hypotonicity Hypertonicity with difficulty in releasing the handgrip Muscle wasting Dental hypoplasia Notched and barrel-shaped central incisors.

How does a cataract cause vision loss?
Light enters the eye and is projected to the retina (inner surface of the back of the eye) which senses the light and transmits the visual signal to the brain. A cataract may stop light from reaching the retina and prevent the eye from seeing. A clear image forming in the retina is essential for the stimulation of the visual cortex and the development of proper vision in children. If there is a cataract preventing the penetration of light and stimulating the retina, it may result in amblyopia. Prompt and sometimes immediate treatment is necessary to prevent permanent vision loss. In adults, cataracts develop after normal visual development so the vision loss can be reversed.

How is cataract different in Children?
Pediatric cataracts can

  • occur in one eye (unilateral) or both eyes (bilateral).
  • be complete or partial
  • be present at birth or occur sometime after birth.
  • partial at birth and later progress to become visually significant.

Unlike adult cataracts, cataracts in children are treated on an urgent basis depending upon the density and location of cataracts. This is to try and ensure that they do not develop squint and irreversible loss of vision due to lazy eye or amblyopia.

What is the Visual prognosis of childhood cataracts?
The prognosis in children is worse with an earlier onset, denser, and longer duration of cataracts.
But there is hope!
Advances in medicine, new techniques, and materials have made the prognosis better. Now, we are able to operate as early as the first few weeks of life and visually rehabilitate the child with either glasses or contact lenses. While we do everything we can for all children visiting us, ultimately it is the resolve of the caregivers to follow post-operative management that decides the visual success for the child.
Children with acquired progressive cataracts have less amblyopia and a much better visual prognosis than children with cataracts that obstruct the visual axis since birth. Generally, monocular congenital cataracts have a relatively good prognosis if surgery and optical correction are provided by two months of age. Beyond this age, there is a possibility of having dense amblyopia in the operated eye.
Dense bilateral congenital cataracts require urgent surgery and visual rehabilitation. In general, bilateral cataracts operated prior to two months of age have a good visual prognosis with approximately 80% achieving the vision of 20/50 or better.

What are the other problems children with cataracts might face?
Children born with cataracts are also at risk of developing:

  • Glaucoma
  • Strabismus
  • Nystagmus
  • Amblyopia

This complicates successful cataract surgery in children.

Can you prevent cataracts in children?
It's not usually possible to prevent cataracts, particularly those that are inherited (run in the family). If you have previously had a baby with childhood cataracts and are planning another pregnancy, please talk to your obstetrician. They may advise genetic counseling to reduce the risk of your next child developing a cataract or vaccination to prevent infections in pregnancy.

How is cataract surgery in children done?
Cataract Surgery in children is done under general anesthesia. It involves the removal of the cataractous (opaque) crystalline lens. This is often accompanied by surgical measures (primary posterior capsulorhexis and anterior vitrectomy) to ensure the clarity of the central visual axis after the surgery- which can otherwise get obscured by the ‘after cataract’ (collection of inflammatory cells and fibrous tissue) formation.

Are Intraocular lenses used in children?
An IOL is preferred for children over one year of age. We currently consider IOL implantation in patients who are one year or older where appropriate and IOL implantation is the procedure of choice in children 2 years and older. The use of aphakic glasses or contact lenses continues to be the treatment of choice for congenital cataracts in neonates.

WhatsApp Us
Get Direction