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Congenital Cataract

More about kids eye problems

What is a congenital cataract?

A cataract is the clouding on the clear natural lens of the eye. When this clouding is present at birth, it is known as a congenital cataract. The condition can be inherited or can occur randomly during pregnancy. It may also be associated with other ocular problems, such as microphthalmia (small eyes), anophthalmia (absence of the eye) and coloboma (a hole in the eye). A doctor usually detects congenital cataracts early on, but sometimes they are not found until later when the child starts school. Generally speaking, cataract surgery is not an emergency, but pediatric cataracts must be operated on as soon as possible.

How Are Congenital Cataracts Diagnosed?

The parents may notice that the child cannot see as well as other children. However, the most common way congenital cataracts are diagnosed is during a routine eye examination. Naturally, the news comes as a big shock to the parents, but this congenital cataract must be operated upon as soon as possible.

Symptoms of congenital cataract

Children don't know what normal vision is supposed to be. Thus if the child has a cataract in only one eye or a unilateral cataract, they may not complain of having poor vision. Parents or other family members notice congenital cataracts.  If, however, the child has bilateral cataracts, then the parents do notice that the child does not see well compared to other children.

Here are the symptoms of congenital cataracts:

  1. Blurred vision
  2. Child moving closer to the TV
  3. White reflex in the pupillary area
  4. White reflex in photographs - which means instead of sometimes seeing red-eye, one sees a white eye
  5. Development of nystagmus or 'wobbling eyes'
  6. The child has wandering eye movements where they don't look at anything particular
  7. Parents notice the child is not looking at them
  8. One eye starts developing a squint
  9. Child bangs to objects because of blurry vision

Causes of congenital cataract

Congenital cataracts can occur in newborns for many reasons. Some causes include:

  • Inherited tendency
  • Intrauterine Infection - measles or rubella (the most common cause), rubeola, chickenpox, cytomegalovirus, herpes simplex, herpes zoster, poliomyelitis, influenza, Epstein-Barr virus, syphilis and toxoplasma
  • Metabolic disorders
  • Diabetes
  • Trauma
  • Inflammation
  • Drug reaction - tetracycline antibiotics used to treat infections in pregnant women have been shown to cause cataracts in newborn babies.
  • Retinopathy of prematurity

Congenital cataract treatment

Cataract surgery is not usually an emergency. However, pediatric cataract surgery is an emergency. Vision development occurs in the first 8-10 years of life. Nothing must hamper this vision development. The first few years are critical in the child's visual development. If there is some defect in this development, it's known as a lazy eye or amblyopia. 

Depending on the cataract, surgery remains the primary treatment for pediatric cataracts. When we see a newborn child with a cataract, we have to wait till the child is six weeks old to perform the cataract surgery. The child may need surgery in one or both eyes. These surgeries may be done at the same sitting or in two sittings.

We always place a lens in the eye when performing adult cataract surgeries. However, we don't put a lens inside children's eyes until the child is two years old. We leave the child aphakic or without a lens. A week or so after surgery, the child would need to start wearing glasses or contact lenses to see. These glasses or contact lenses have a high plus number if the child is left aphakic. Usually, if one eye has undergone surgery, we use contact lenses, and if both eyes have undergone surgery, we use glasses. 

Pro Tip: The child obviously cannot wear contact lenses independently. We teach the mother how to put on and take off the lenses.

Cataracts in children older than six weeks are operated on right away. Again, implanting a lens inside the eye or not would depend on the child's age. Your doctor would choose the power of the lens to be implanted in the eye depending on the child's age. Children who have a lens inside their eye would need glasses too. We expect the power of these glasses to reduce over the next few years.

What Other Problems Can Happen?

Congenital cataracts may be present without any other problems in the eyes or the rest of the body. However, some conditions could be current, along with the congenital cataract.

  1. Aniridia
  2. Microphthalmos and
  3. persistent hyperplastic primary vitreous
  4. Retinopathy
  5. Deafness
  6. Central nervous system defects
  7. Glaucoma

What happens if the congenital cataract is not treated

The first 8 -10 years of life is when visual development happens. If this development is affected, we get a condition known as Amblyopia or Lazy eye. Traditionally lazy eyes could be treated only till 8-10 years of age. Post 10 years treatment of lazy eye was not effective. There is a new treatment that can treat Lazy eye even in older kids to a great extent. 

This does not mean that we wait till the child is older for cataract surgery. The cataract, once diagnosed, should be operated upon as soon as possible.

Does my child need cataract surgery?

Congenital cataracts can be of a few different types. Some occupy the entire material of the lens, and some don't. The whole idea of operating on a child who has a cataract enables light to enter the eye to see. If the cataract is situated in the periphery and does not obstruct light from entering the eye, then there is a possibility that the cataract need not be removed. Your doctor would be able to decide whether your child's cataract needs surgery or not.

Pediatric Cataract Treatment in Mumbai

Pediatric cataract surgery is a little different from adult cataract surgery. It is thus essential that a pediatric ophthalmologist performs the surgery. Dr Deepak Garg performs all the pediatric cataract surgeries at Eye Solutions in Mumbai.

 

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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