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September 26, 2024
It is a common belief that cataracts happen in older people. But do you know it can occur in children too? Surprising but true. One of the eye-related issues faced by children is cataracts.
Let’s explore more in this article.
Cataract is the clouding of the lens of the eye, which is otherwise clear or transparent. Cataracts prevent light rays from passing through the lens and focusing on the retina. This creates vision problems for your child. The protein that makes the lens of the eye becomes cloudy due to cataracts.
While cataracts are rare in children, it is not uncommon. They can be unilateral (affect one eye) or bilateral (affect both eyes). Sometimes paediatric cataracts are small and do not cause any vision issues. But sometimes they can be progressive and cause vision issues.
Children’s cataracts can be of different types including:
So why do cataracts develop in certain children? There can be several reasons and sometimes it can be difficult to establish the exact cause. Some of the possible causes include:
Congenital cataracts are usually caused by a faulty gene that is passed on to the child from their parents. This fault leads to the lens not developing properly. A family history of congenital cataracts increases the risk of the child developing it.
Paediatric cataracts have also been linked to certain chromosome conditions such as Down’s syndrome.
Congenital cataracts are also caused by the mother getting certain infections during pregnancy such as rubella, chickenpox, cytomegalovirus, toxoplasmosis and others.
Secondary cataracts can be caused by:
So which children are more likely to develop cataracts? The risk rises when a child:
Different children experience different kinds of symptoms of cataracts. The most common symptoms include:
Symptoms of cataracts in children may look like other vision issues. So it can be a good idea to get a checkup with an ophthalmologist if your child is facing any of the other issues.
It is important to diagnose cataracts in children as early as possible. Early detection reduces the risk of vision as much as possible.
You will be offered a physical screening of your newborn baby within 72 hours of birth and again when the baby is six to eight weeks old. One of the primary reasons for this screening is to detect childhood cataracts early. This screening involves checking the general appearance of the eyes and how they move. If the eyes look cloudy, your doctor may conduct other tests to look for signs of cataracts.
One of the important parts of this check is to look for the ‘red reflex’ using a bright light. The red reflex is similar to the red-eye effect that can sometimes be seen in flash photography. It is the reflection from the back of the eye. No red reflex or a weak red reflex may mean that the lens is cloudy.
Diagnosis of cataracts in children starts with your healthcare provider asking you about your child’s health history. While your doctor may ask you primarily about your child’s vision-related issues, they may also ask you questions to determine the overall health of your child.
Additionally, your child conducts the following tests:
In general, you should take your child for an eye examination at regular intervals. There’s no harm in being cautious. Regular checkups can help detect any eye-related issue at an early stage.
The most common treatment for cataracts is surgery. However, whether your child needs surgery will mostly depend on the effect to which their vision is affected. If the cataract is not causing any vision issues, it may not need any immediate treatment. However, your child will need regular check-ups to monitor the vision.
If vision is affected, then your child may need surgery to remove the cloudy lenses. The surgery is usually followed by long-term use of glasses or contact lenses. Since paediatric cataracts are rare it is not easy to predict how much improvement will be achieved by vision treatment. Some children have reduced vision in the affected eye even after receiving treatment, although most experience significant improvement in vision.
Cataract surgery for children is generally done under general anaesthetic. Your child will be unconscious during the surgery. The surgery usually takes one to two hours and is carried out by an experienced ophthalmologist.
If the cataracts are diagnosed during the eye test done within 72 hours of birth, the surgery will be carried out within the first or second month after birth. Eye drops are given to the eye to dilate the pupil before the surgery.
The surgery involves making a small cut in the cornea, the surface at the front of the eye through which the cloudy lens is removed. In some cases, a clear plastic lens called an intraocular implant or intraocular lens is inserted to replace the lens that is removed. Why? Because the eye cannot focus without a lens.
However, babies and young children, below the age of one are usually given glasses or external contact lenses instead of implanting lenses in the eye. These are fitted a week or two after the surgery and are done to avoid the higher risk of complications and avoid further surgery.
After the surgery, the incision in the child’s eye is closed with stitches that gradually dissolve.
A transparent shield pad is placed over your child’s eye to protect it after the surgery. Usually, children are asked to stay overnight at the hospital so they can be monitored.
If your child has cataracts in both eyes, usually your ophthalmologist will operate one eye at a time, to reduce the complications. You can go home with your child between the two surgeries. The second surgery usually takes place within a week of the first surgery.
The doctor will prescribe eyedrops to be put in your child’s eyes at home. The drops will reduce redness and swelling in the eye. You will need to put the drops every two to four hours. Don’t worry, you will be shown how to do it before you leave the hospital.
Most children will be asked to wear glasses or contact lenses after the cataract surgery. Since their eyes will be blurred post-surgery, they will not be able to focus properly at least for some time after the surgery.
Your child will also need glasses or contact lenses if an artificial lens has been fitted, to enable them to focus on closer objects. Why? Because the artificial lens can focus on distant objects only. These glasses or contact lenses are usually fitted a few weeks after the surgery by the optometrist. They will teach you and your child how to wear the contact lenses, how to replace them and how often.
Your child will have to go for regular check-ups after the surgery so that the doctor can monitor their vision. As your child grows, the strength of the contact lenses or glasses will be adjusted.
In case one eye is affected by the cataract, usually known as unilateral cataract, or has weaker vision in one eye, the optometrist will give a temporary eye patch over the stronger eye. This is known as occlusion therapy.
Occlusion therapy is done to improve the vision of the weaker eye by forcing the brain to recognise the visual signs from that eye that the brain has been ignoring earlier. It is difficult for children to develop vision in the weaker eye in case of unilateral cataracts without treatment. The vision will also be assessed by Orthoptists, and specialist physiotherapists for the eye. The orthoptist will guide you on how to wear the eye patch and for how long. It can vary from one person to another and is largely based on how weak the vision is.
In most cases, the surgery is quite successful. However, some children face complications such as:
This is not the cataract coming back, it is caused by cells growing back over the artificial lens capsule. PCO usually develops four to twelve months after the cataract surgery. If your child develops this condition, another surgery may be required to correct it.
This can be done through laser eye surgery during which the lens capsule is removed, leaving only enough to keep the artificial lens in place. This procedure takes only about fifteen minutes. Vision usually improves immediately or within a few days.
While cataracts in children can be a daunting diagnosis to obtain as a parent, the outlook is not bleak. With proper and timely treatment vision loss can be fully averted.
The long-term prognosis largely depends on how fast the treatment is given. The treatment can be highly successful if the parents and children stick to the treatment plan.
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