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Congenital Cataract

More about kids eye problems

Congenital Cataract

A cataract is a lens clouding in the middle of the eye. Infant cataracts occur because of a malformation of the lens during early intrauterine life and are hereditary in about 20% of cases. Cataracts in older children can occur due to a less severe malformation or following eye trauma. Vision will range from slightly to severely impaired. Your cataract specialist must remove severe cataracts occurring near the time of birth within weeks, or vision can fail to develop normally, and the eye will become legally blind (the medical term is "amblyopia").

Congenital Cataract removal

Your cataract specialist may initially treat less severe cataracts with patching therapy, dilating eye drops, or glasses. We perform pediatric cataract surgery under general anaesthesia. With modern instrumentation and techniques, cataract surgery performed by a pediatric ophthalmologist is considered safe and effective.

From a more technical standpoint, cataract surgery in children is different in the following ways.

  1. The sclera is the white part of the eye. This sclera is more rigid in adults and less in children. This scleral rigidity helps in adult cataract surgeries being sutureless. Because the sclera is less stiff in children, we take sutures and close the wound when operating on children.
  2. The Lens Capsule is very elastic in children.   This capsule is like a bag that contains the lens material. When we perform cataract surgery in adults, the capsule behaves differently. However, when we perform the same surgery in children, the capsule behaves differently. This difference in capsular behaviour is essential for your surgeon to be aware of so that your cataract surgeon can alter surgical steps.
  3. Finally, one of the cataract complications is PCO, which happens because of whitening of the back part or posterior capsule. In adults, PCO is treated by performing Yag Caps. Yag caps laser is a procedure that requires cooperation from an adult. Eye doctors may not get that cooperation from a child. Thus, it is vital to prevent PCO formation, which we do by adding another step to pediatric cataract surgery. Here the skilled cataract surgeon will remove a part of the posterior capsule while doing the surgery. After this removal, another procedure called vitrectomy is performed and only then is the lens placed in the eye.

Vision Correction after cataract removal

The lens inside the eye typically focuses light rays to a sharp point on the retina (in the back of the eye). After removing this lens, the focusing power will need to be replaced with either a lens implant (inside the eye), a contact lens (outside the eye), or eyeglasses.

Lens Implants

Recommended for toddlers and older children, implants or IOLs are designed to remain in the eye permanently. Implants avoid the magnification of cataract glasses and the need to insert, remove, and replace contact lenses. Pediatric implant surgery is more complex because of the unique characteristics of young eyes. The implant's power depends on your child's eye size at the time of surgery and estimates of future eye growth, and we will choose the power to focus on either near or distant targets. We may prescribe standard thickness bifocal glasses later to fine-tune your child's vision.

As mentioned earlier, this is usually done after two years of age. Sometimes IOLs can be implanted even when the child turns two years. Usually, Monofocal Lenses are implanted, and with the new monofocal IOL called Eyhance lens, it's even better. Very rarely Multifocal IOLs are implanted.

Contact lenses

Contact lenses are the preferred method for infants who have had cataracts removed from only one eye. They are sometimes even used if we perform cataract surgery in both eyes but don't place a lens in the eyes.

Contacts make it easier to use both eyes together because they produce less image magnification than glasses. They are also aesthetically more appealing than glasses. We fit these lenses within one to three weeks after surgery, and initial instructions typically require one or two office visits. You can use both soft and rigid lenses. Soft lenses are available in 3 forms: daily disposable contact lenses, biweekly contact lenses and monthly disposable contact lenses.

Eye Glasses

We recommend glasses when we remove cataracts from both eyes. As mentioned earlier, the lens power in the eye is calculated based on the child's age. Sometimes, right after surgery, the child may have an eye power that may appear to be high. We expect this high eye power to reduce gradually as the child grows older. 

However, cataract glasses are very thick and magnify the appearance of the eyes. When the child is older, we can prescribe bifocal cataract glasses to focus on near and far distances. Later on, one can replace the glasses with contact lenses or implanted lenses.

Frequently Asked Questions ?

What is a Cataract ?
A cataract is clouding of the lens. Usually, the lens is located directly behind the iris and focuses light on the retina, which is the light-sensitive area of the retina. On clouding of the lens, this light now cannot travel through the lens, and there is visual impairment.
What causes Cataracts in children ?
Usually, we see cataracts in older individuals. However, children too can develop cataracts.

Sometimes, an infant is born with a cataract, which could occur because of an infection the mother had during her pregnancy, like German Measles. In a small percentage of cases, it could also be genetic. Most of the time, it is impossible to determine the exact cause of the development of cataracts.

Cataracts can develop in childhood too often due to eye injury or disease states in the other parts of the body. It can also occur because of prolonged ingestion of steroids.
How is the Cataract going to be treated ?
Some childhood cataracts may only be partial and thus not interfere with vision. These small cataracts usually do not require treatment but should be observed regularly to look for progression. Moderate cataracts may require treatment with glasses or amblyopia (lazy eye). We operate on more significant cataracts which impair vision.

The surgery in children is done under general anaesthesia and require an incision in the eye. Depending on the child's age, your doctor will decide whether to implant a lens in the eye or not.
How is the vision going to be corrected after Cataract Surgery ?
After cataract surgery, your doctor will prescribe your child glasses. Whether we implant a lens or not, your child may have low or high power. The decision whether to implant the lens or not is made by your child's eye doctor, depending on your child's age.

Your doctor may also prescribe contact lenses for your child, which we usually do if the power of the glasses is high, and therefore contact lenses become a better option. Very young children too can wear contact lenses so, please do not get worried about how your child will wear contact lenses. Your optometrist will educate you on how to make your child wear the lenses.

If your child has amblyopia (lazy eye), they may also require patching the better eye to stimulate the weaker eye to read. Read the brochure on 'Amblyopia' to understand more about this condition.
What is Abmlyopia ?
Amblyopia is a condition in which, on examination, your child’s eye is completely normal however the vision is less than usual in that eye. This decrease in vision could be due to multiple reasons. One of the reasons is cataracts. To treat amblyopia, you will have to patch the good eye, which forces the use of the eye with poor vision, and gradually there is a chance of the vision improving. Please read ‘Amblyopia’ to understand more about this condition.
What is Strabismus ?
Strabismus is another name for squint. Here one of your child’s eyes has deviated. There are various types of strabismus, and one can learn more about this condition. We treat this condition by eye muscle surgery, in which we realign the eyes. You would be able to see some pictures of patients who have undergone squint surgery here.
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