A cataract is a clouding of the lens in the middle of the eye. Infant cataracts are usually caused by a malformation of the lens during early intrauterine life and are hereditary in about 20% of cases. Cataracts in older children can occur as the result of a less severe malformation or following eye trauma. Vision will range from slightly to severely impaired. Severe cataracts occurring near the time of birth must be removed within weeks or vision can fail to develop normally and the eye will become legally blind (the medical term is “amblyopia”).
Less severe cataracts may initially be treated with patching therapy, dilating eye drops, and/or glasses. Pediatric cataract surgery is performed under general anesthesia. With modern instrumentation and techniques, cataract surgery performed by a pediatric ophthalmologist is considered safe and effective.
The lens inside the eye normally focuses light rays to a sharp point on the retina (in the back of the eye). After this lens is removed, the focusing power will need to be replaced with either a lens implant (inside the eye), a contact lens (outside the eye), or eyeglasses
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 special characteristics of young eyes; the power of the implant depends on the size of your child’s eye at the time of surgery and estimates of future eye growth and will be chosen to focus at an either near or distant target. Normal thickness bifocal glasses may be prescribed later to fine-tune your child’s vision.
Contact lenses are the preferred method for infants who have had cataracts removed from only one eye. 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. Fitting is usually done within one to three weeks after surgery, and initial instruction normally requires one or two office visits.
Glasses are sometimes recommended when cataracts have been removed from both eyes. 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 provide focusing at both near and far distances. Later on, the glasses can be replaced with contact lenses or implanted lenses.