Many parents have heard of cataracts, but don’t realize they can occur in children as well as adults. While age-related cataracts are the most common, cataracts can also affect newborns and children.
By Dr. Kimberly Yen, Pediatric Ophthalmologist at Texas Children’s Hospital
A cataract is a clouding or opacity in the lens of the eye. Normally, the lens is crystal clear. There are many types of cataracts in children; some are small and do not affect vision, while others are large and can cause severe vision loss. Some cataracts may be present from birth or are inherited while others develop later in childhood. Some even occur as a result of medication side effects, due to a medical condition or because of trauma.
Cataracts affect vision because they stop light and images that enter the eye from reaching the retina (which is like the film of a camera in the back of the eye). In order for a child to develop good vision, the light and images that hit the retina must be clear so the brain receives a clear image from the retina. If a cataract blurs the light and images, it can limit the development of vision because the vision centers in the brain do not develop properly; this causes a condition called amblyopia. Treatment of the cataract may be needed to prevent permanent vision loss.
Cataracts in children that interfere with vision require surgery. If the cataract is not removed, it can prevent normal development of the vision centers in the brain. Tiny cataracts that do not seem likely to interfere with vision may be carefully monitored, but may need surgery if signs of a vision problem develop. If a cataract is very small or off-center, glasses and/or patching may be helpful for visual development and surgery can be delayed or avoided completely. A pediatric ophthalmologist can assess the cataract by using special lights and instruments to check the child’s eyes.
Approximately three out of 10,000 children have a cataract. In children, cataracts can present in different ways. Sometimes, a cloudy or white spot can be seen in the middle of the pupil, which is the dark round circle in the center of the colored portion of the eye (iris). Some patients present with a misaligned or drifting eye (strabismus) or shaking of the eyes (nystagmus). Pediatricians will check the light reflex of children’s eyes to look for a cloud in the pupil. If any of these findings are seen in a child, then they need to see a pediatric ophthalmologist.
In children, cataract surgery is performed under general anesthesia. To remove a cataract, a few small incisions are made in the eye. An opening is made in the front of the lens capsule. The soft and cloudy inner part of the child’s lens is suctioned out of the capsule. Younger children may require an additional opening in the posterior lens capsule with some vitreous gel removal (called a vitrectomy). An intraocular lens is then sometimes placed within the empty lens capsule. Dissolvable stitches are used to close the wounds and the eye is generally patched overnight.
The lens inside the eye focuses light and images so the eye can receive a clear image whether viewing something in the distance or up close. Once the lens is removed the eye can no longer focus light inside the eye the same way. There are several ways to restore this focusing ability: 1) a permanent intraocular lens implant is sometimes placed inside the eye at the time of cataract surgery, 2) a contact lens can be placed on the surface of the eye (contact lenses have to be removed and cleaned regularly), 3) glasses can be used to focus the light rays.
Most children will need glasses after cataract surgery, even if an intraocular lens implant is placed, and most children will also need to wear bifocals to improve focusing up close. The method of correction required will depend on the child’s age and the type of cataract the child has.