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