Every eye has a lens that helps to focus light. A cataract is an opacity or cloudiness of that lens which should be clear and transparent. In a child, a cataract blurs the vision and may disrupt normal visual development in the eye. Vision is a learned function and if you don’t use it, you will lose it, so timing of removal of cataract is vital in children to prevent permanent visual loss.
Although uncommon, children of all ages, including babies can get cataracts. A cataract that is present at birth is called a congenital cataract. It can occur in one eye (unilateral) or both eyes (bilateral). Congenital cataracts can result from chromosomal problems, infections during pregnancy, trauma during birth, exposure to radiation, or as part of a systemic syndrome. Young children can also develop cataracts due to metabolic diseases like diabetes, inflammation in the eye, exposure to certain medications such as steroids, radiation exposure, and eye injuries. Occasionally, no cause can be found.
Some cataracts can be seen by your pediatrician using the “red reflex test.” The red reflex is essentially the reflection of light from the retina which can sometimes be seen in photographs taken with a flash as a “red eye.” If there is any difference in the color of the reflex between the two eyes or a white reflex is seen, your child should see a pediatric ophthalmologist for further evaluation and treatment. If you have family history of childhood cataracts, you should ask to be seen by a pediatric ophthalmologist even if the red reflex is normal.
Your child's eye doctor will take a detailed history, including family history of eye diseases, assessment of your child's growth, development, and any systemic diseases.
They will assess vision using different age-appropriate vision tests, and examine the eyes using a microscope. It may be necessary to put dilating eye-drops to enlarge the pupil for a better assessment of the size, shape and extent of the cataract, as well as to examine the other structures of the eye.
If the cataract obstructs view to the structures behind the lens, they may recommend an ultrasound of the eye. Some blood tests may be ordered if cataracts are in both eyes (bilateral).
Your eye doctor will determine whether the cataract is effecting the vision If it is very small, or away from the center of the lens, it may not blur the vision, and only close follow-up checking for growth or need for glasses would be recommended. If the cataract is obstructing the path of light, it is causing vision loss and will need to be removed surgically. The urgency of surgery is greater in younger children still going through visual development. A cataract in a baby needs to be removed within weeks of birth. In an older child, the decision may be based upon their visual needs. In some children, a plastic lens will be placed in the eye to replace the cataract, but in others, no lens is placed due to the risks of scarring.
No. After surgery, additional treatment with glasses or contact lenses, and patching is likely necessary. Unlike in adults, a child's brain is still developing, hence without these post-operative treatments, the vision loss due to cataract can be permanent. Cataract surgery also puts your child at risk of developing glaucoma, or retinal detachment later in life. Frequent follow-ups with the pediatric ophthalmologist are important for early detection and management of these potential complications.