What is a cataract?
A cataract is a cloudy or opaque area in 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 becomes blurred and distorted.
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 either prior to birth or during childhood. While the exact cause of
some cataracts found in both eyes (bilateral cataracts) is unknown, many are
hereditary. Bilateral cataracts have also been associated with a number of
genetic disorders.
Cataracts found in only one eye (unilateral cataract) are
usually not associated with a particular disease. Trauma is another cause of
unilateral cataract.
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. More extensive ones can lead to
severe loss of vision.
What treatment is available for children who have cataracts?
Cataracts that obscure vision should be removed as early as
possible, even in the first weeks of life, to allow a clear retinal image.
Surgical removal of a cataract is done under general anesthesia using 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:
- Contact lenses — used after surgery for bilateral or unilateral
cataracts in children under two years of age. Contact 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 — artificial lenses may also be implanted to
replace natural lenses in children. This method is still under study for
infants, 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 treat amblyopia
that develops 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. All patients who
undergo cataract surgery also require bifocal glasses to correct the residual
error of refraction and to allow focusing at distance and near.
Why is it so important to operate early?
The critical period for visual development is in the first few
months of life when an infant’s brain develops vision in response to a clear
image. 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 visual cortical connections can deteriorate. Vision is fully 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.
As with any surgical procedure, there are risks and 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 "after cataract" following the primary
cataract surgery. An after cataract is a clouding of the lens capsule, which can
often be corrected with laser surgery, but may require an additional surgical intervention.
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.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/16/2009…#14416
