What Causes Cataract in Childhood?
How can I Detect if my Child has a Cataract?
How does a Cataract affect Vision?
How is Cataract Surgery Performed on Children?
What are the Risks?
Will patching be required?
How is the focusing power if the eye restored?
Are Intraocular Lenses Safe in Children?
also read "Cataract" for more info on Cataract Surgery
Cataracts are a common cause of poor vision in older adults, but also occur uncommonly in infants and children.
WHAT CAUSES CATARACT in CHILDHOOD?
Cataract in childhood may be caused by injury to the eye, or associated with the child's general health. Sometimes cataracts are hereditary. In these cases, brothers and sisters may also be affected and require a screening examination. If no family members have cataracts, certain blood tests may be obtained to help find out why the child has cataract. In most cases, though, no cause can be found.
HOW CANT I DETECT IF MY CHILD HAS A CATARACT?
When cataracts are present in both eyes, family members can usually tell that there is a problem with vision. When only one eye is affected, the child most often seems to function normally, thus making detection difficult. A cataract may make the black pupil of the eye look white or gray. Sometimes an eye with a cataract will wander out of line, or show jiggling movements (nystagmus). Often, though, the child's eyes look perfectly normal to family members.
HOW DOES A CATARACT AFFECT VISION?
When a cataract is present, vision is impaired because light cannot reach the back of the eye properly. In some cases, vision is so good no treatment is necessary. Usually, though, the cloudy lens must be removed through surgery before the eye can see well.
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HOW IS CATARACT SURGERY PERFORMED?
Cataract surgery is a major eye operation that must be done with the child asleep under general anesthesia. It can be performed at any age. The lens is removed using delicate surgical instruments (not a laser) through a small incision near the outer corner of the eye.
Usually the child feels little or no pain, and goes home a few hours after surgery. The eye needs to be examined in the office within one day, and several more times during the next few weeks. Eye drops are given several times per day during the early weeks after surgery to prevent infection and to promote healing.
WHAT ARE THE RISKS?
Cataract surgery is generally safe, but complications can occur that may harm the eye or worsen vision. There is a very small risk of serious bleeding or infection. Even years after surgery, related eye problems such as glaucoma or retinal detachment can develop and threaten sight. For this reason it is important for the child to continue having regular eye examinations.
Cataract surgery permanently removes most of the lens from the eye, but a small part of it is left behind called the posterior capsule. This capsule holds the implant in place if an implant is used. In most pediatric cases this capsule later becomes cloudy and has to be removed with another operation. An office laser can be used for this purpose in cooperative children.
WILL PATCHING BE REQUIRED?
Many children, especially if they have had a cataract in only one eye need treatment for amblyopia ("lazy eye") after surgery. Usually this involves placing a patch over the unoperated eye for at least a few hours a day, forcing the child to use the operated eye.
Children often object strongly to wearing a patch, but unless this treatment is effectively done, vision may never recover from the harm caused by the cataract. The first few months after surgery are the most important time for treating amblyopia, but usually some amount of patching must be continued up to about age 10 years. In some cases, even with the best possible treatment vision stays low.
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HOW IS THE FOCUSING POWER OF THE EYE RESTORED?
During cataract surgery, the lens of the eye is removed. After surgery, it is necessary to provide some other means of focusing the light that enters the eye. There are three ways to provide the eye with the necessary focusing power:
1) GLASSES must be quite thick because after lens removal, the eye loses 2/3 of its focusing power. The main advantages of glasses after cataract surgery are that they carry little risk of harming the eye, and they are very convenient and simple to use. The main disadvantages are that they may limit side vision, and older children (mostly teenagers) may object to their appearance and may find it difficult to play sports in them. Also, if cataract surgery is performed on only one eye, the vision will be unbalanced between the two eyes.
2) CONTACT LENSES usually provide both vision and appearance that is very natural. They can be used after cataract surgery on one or both eyes. Children of all ages usually are quite comfortable wearing contact lenses. Lenses are available that can be worn continuously for about a week at a time. It is important, though, to remove them regularly for cleaning.
The main disadvantages of contact lenses after cataract surgery are that in young children (especially between about 1 and 5 years of age), placing them in the eye and removing them for cleaning can be difficult. They can be lost when the child rubs the eye. Although safe when cared for properly, contacts can cause serious eye infections if care instructions are not followed. Some children wear contact lenses part of the time and glasses part of the time, depending on their particular needs or wants.
3) INTRAOCULAR LENS (IOL) is a thin acrylic disc that is placed permanently inside the eye, usually during the same operation in which the cataract is removed
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An intraocular lens (IOL) implant
IOLs, like contact lenses, provide vision and appearance that is natural. Their main advantages over contact lenses are that once in place usually the only attention they need is regular check-ups by the ophthalmologist, and they cannot be lost or broken.
The main disadvantage of IOL implantation is that once the lens is inside the eye, it is difficult to remove or replace. This is important, especially for younger children, because as the eye grows, the focusing power it needs for sharp vision can change. Mainly for this reason, the child who has had IOL surgery may still need to wear thin glasses or contact lenses at certain ages.
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ARE INTRAOCULAR LENSES SAFE IN CHILDREN?
IOLs have been used in millions of adults who have had cataract surgery within the past 15-20 years, and have been found to be safe and effective. IOL implantation in children has become popular only within the past few years, and there is still a good deal to be learned about how well it will work and how safe it will be over a long lifetime.
The risk of a surgical complication that might harm the child's eye is slightly higher when an IOL is implanted. A child who has cataract surgery now without an IOL may be able to have one placed in the future with a second operation, but there are some extra risks and disadvantages to this staged plan.
One of the jobs of the natural lens is to adjust the eye's focus from distance to near. None of the three kinds of corrective lenses described above does this as well as the natural lens in a child's eye. To make up for loss of focusing adjustment, it is often necessary to provide the child with additional refractive correction for seeing up close. This is usually done by means of bifocal or progressively blended glasses, which may be needed even if contact lens wear or IOL implantation has been chosen.
The specific condition of your child's eyes and general health, and the specific concerns and wishes of your family are very important in making the decision about whether glasses, contact lenses, or IOL implantation should be used in your child.
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