What is a cataract?
A cataract is a cloudy or opaque area that appears on the lens located directly behind the iris inside the eye. Normally, the lens is clear and allows light entering the eye to clearly focus an image on the retina. When cataracts develop, the light rays become scattered as they pass through the cloudy lens and the retinal image appears blurred and distorted. This problem can often be solved with cataract surgery .
What causes cataracts in children?
Cataracts can be present at birth (congenital) or can develop later in life. It has been estimated that one in every 250 children will develop a cataract. While the exact cause of cataracts found in both eyes (bilateral cataracts) is unknown, some are hereditary. Bilateral cataracts have also been associated with Downs syndrome or other metabolic and genetic disorders. Cataracts found in only one eye (unilateral cataract) are usually not associated with a particular disease.
How will cataracts affect my child's vision?
Many of the cataracts that are discovered in newborns are small and allow for excellent development of vision. Others can lead to vision loss.
What treatment is available for children who have cataracts?
Cataracts that obscure vision should be removed as early as possible, even in the first few days or weeks of life, to allow a clear retinal image. At The Cleveland Clinic Foundation Cole Eye Institute, we utilize state-of-the-art techniques to determine the seriousness of the cataract. Newborns may be treated with bilateral total light occlusion, or patching, as the first step in the treatment process. Patching the eye slows down or stops abnormal brain development caused by a blurred image. Patching of both eyes is a temporary measure, usually lasting no longer than two weeks, used only until cataract surgery can be performed.
In children, cataract surgery involves a microsurgical procedure, done under general anesthesia with an operating microscope. The lens is broken into small pieces with a microsurgical instrument and removed through a small incision. Once the cataract has been removed, focusing power may be restored in one of the following ways:
Extended wear contact lenses — used after cataract surgery for bilateral or unilateral cataracts in children under two years of age. Extended wear lenses are recommended for this age group because the eye and focusing power change rapidly during early infancy. Contact lenses can also be used in older children.
Intraocular lenses — Following cataract surgery, artificial plastic lenses may be implanted to replace natural lenses in children over two to three years of age. This method in children is still under study, but early results have been excellent.
Glasses — used in selected cases when the cataract surgery involves both eyes and contact lenses have failed, or if intraocular lenses are not appropriate.
The final step in the treatment process is to correct ocular dominance; that is, if one eye is stronger than the other, as in the case of a unilateral cataract. In patients with unilateral or asymmetric cataracts (one cataract is more severe than the other), it is necessary to patch the good eye to stimulate vision in the eye that had the cataract surgery.
Why is it so important to operate early?
The critical period for visual development is in the first two months of life when an infant develops vision in response to a clear image. A blurred or distorted vision will cause the brain to set up abnormal visual connections. This abnormal visual development is called amblyopia. Amblyopia can be associated with other disorders such as misalignment of the eye (strabismus) or refractive errors. In children with cataracts, however, the retinal image becomes so distorted that permanent loss of vision may result without treatment.
Children who develop cataracts after the first few months of life have already developed their vision, but amblyopia can still occur because the connections of vision to the brain can deteriorate. Visually, the brain has developed by the time a child is eight or nine years old, so amblyopia is not likely to occur after this age.
What are the advantages and disadvantages of intraocular lens implants?
Intraocular lenses have the potential to reduce the magnification and optical distortion often associated with other methods of restoring focusing power, such as glasses. Intraocular lenses are permanent replacements for the natural lens and, therefore, require less maintenance than contact lenses. Children may prefer an intraocular lens implant because it gives them more freedom to pursue normal childhood activities without the worry of dislodging or losing a contact lens.
Intraocular lenses are not recommended in children under two to three years of age because lens power changes rapidly in early infancy, which would require repeating the surgery. Intraocular lenses are considered in older children because lens power has usually stabilized by age two.
As with any surgical procedure, there are some risks and some special considerations associated with intraocular lens implantation. Major complications are rare. Your doctor will discuss with you any risks or complications that could occur during or after the intraocular lens implant procedure.
Is there any pain associated with cataract surgery?
Children who undergo cataract surgery generally have very little pain or discomfort. Those who receive intraocular lenses cannot feel the lens inside the eye. Children can feel the presence of contact lenses, but usually adapt to them quickly.
Will my child require additional treatment?
Children may develop an "aftercataract" following the primary cataract surgery. An aftercataract is a clouding of the lens capsule, which can often be corrected with laser surgery.
What is the long-term prognosis for children who have had cataract surgery?
Children with congenital cataracts have a good prognosis if treated within the first two months of life. Left untreated, the prognosis is poor. Children whose cataracts develop a few months after birth have a better visual prognosis because some visual development has occurred.
About Pediatric Ophthalmology at the Cleveland Clinic
Because infants and young children are unable to tell us what they can or cannot see clearly, diagnosing vision problems is often difficult. The Cleveland Clinic Cole Eye Institute is one of the few centers with the experience and technology to assess their vision.
The Cleveland Clinic Foundation Cole Eye Institute is part of The Cleveland Clinic Foundation, a multi-specialty, not-for-profit, academic medical center. The multidisciplinary approach to medicine also enables physicians at The Cleveland Clinic Foundation Eye Institute to work closely with colleagues in many other specialties and subspecialties. In pediatric ophthalmology, for example, we can consult with the physicians in the Department of Pediatric Plastic and Reconstructive Surgery to correct vision problems stemming from congenital craniofacial conditions.
Click here to make an appointment now . Or call 216/444-2020 or 1/800-223-2273 Ext. 42020 to schedule an appointment with a Cole Eye Institute ophthalmologist.
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