By Eyecare NG

Overview   |  Signs & Symptoms   |   Causes   |  Treatment   |   Complications   |   Prevention 

Overview

Cataract is a condition whereby the usually transparent crystalline lens in the eye becomes cloudy.

Normal Eye Versus Eye with Cataract

The lens is located behind the pupil and helps in focusing light on the light-sensitive tissue inside the eye called retina. When the lens becomes cloudy, it prevents light from reaching the retina resulting in poor vision.

Cataract mostly affects old people because as we age, the lens undergoes changes that cause it to gradually become cloudy. Children can also have cataract. While some are born with it (congenital cataract), others develop it in infancy or early childhood (infantile, developmental or acquired cataract).

Though not quite common, cataract is a major cause of preventable blindness in children.  It can affect one or both eyes and should be removed as soon as possible to avoid vision development problems.

Signs and symptoms of cataract in children

It may be difficult to spot cataract in a child especially at the early stages but here are some signs and symptoms that may indicate that your child has cataract:

  • White pupil: If your child’s pupil is white instead of the usual black, it is possible he/she has cataract. That aside, there are other conditions that can cause white pupil in a child; so an eye examination is necessary to determine why your child’s pupil is white.
  • Poor vision: If your child is not attracted to light or bright colours or does not follow people or objects with the eyes, he/she may have poor vision due to cataract. Cataract causes poor vision because it reduces the amount of light that gets to the retina and as the clouding of the lens thickens, vision gets worse.
  • Wobbling eyes: If your child has wobbling eyes, a condition known as nystagmus, he/she needs to be examined.
  • Squint: Cataract can cause misalignment of the eyes. The affected eye could turn in, out, up or down due to lack of use or poor visual development.
  •  Glare: Cataract can cause scattering of light, resulting in glare.

Causes of cataract in children

Genetics: The major causes of congenital cataracts are inherited genes and genetic conditions. Faulty genes that cause clouding of the lens or prevents it from developing properly may be inherited from either or both parents.  Also, some genetic disorders like Down’s syndrome can cause cataract. Cataracts due to genetics are usually bilateral (affects the two eyes).

Maternal infections and conditions: If a mother develops some infections during pregnancy, it may lead to cataract in the unborn baby. Some maternal infections that can cause cataract in an unborn child include German measles (rubella), herpes zoster, toxoplasmosis, influenza, syphilis, cytomegalovirus infection and chicken pox.  Other maternal conditions such as diabetes and the use of certain drugs during pregnancy can cause cataract.

Eye injury: Eye injury is a major cause of acquired cataract in children. Trauma to the eye can cause abnormal reaction of the proteins that make up the lens causing it to become cloudy.

Other causes: Other causes of cataract in children include juvenile diabetes, prolonged steroid treatment and complications from other eye conditions.

Treatment of cataract

Cataract is usually treated through surgical extraction of the cloudy lens. The need for surgery is dependent on whether the cataract interferes with vision or not.

If the clouding of the lens occurs away from the centre and does not affect vision, immediate surgery may not be required. However, the child’s vision should be monitored closely.

Cataracts that interfere with vision should be removed as soon as possible to allow for normal vision development and reduce the risk of the child developing long term vision problems.

During cataract surgery in children, the cloudy lens is removed and may be replaced with an intraocular lens depending on the age of the child and how stable the eye is. However, due to the frequent changes in the refractive status of children, some eye surgeons may decide not to insert an intraocular lens immediately; particularly if the child is less than 2 years old.  In these cases, eyeglasses or contact lenses are prescribed to make vision clear in the operated eye until the child is old enough or the eye is more stable to have an intraocular lens inserted into it. To ensure normal vision development, it is important that the child wears the eyeglasses or contact lenses most of the time after surgery.

Complications of cataract surgery

Cataract surgery in children is usually successful and the risk of complications very low. However, some complications may occur following surgery.

The posterior capsule of the lens may get cloudy after cataract surgery resulting in poor vision. During cataract surgery, the posterior capsule of the lens is usually left in the eye to hold the artificial intraocular lens in place. Sometimes the back of this lens may thicken and become cloudy.  This condition can be cleared through laser surgery.

The intraocular pressure may increase after cataract surgery leading to glaucoma. This occurs if there is bleeding, inflammation or the filtration system in the eye is compromised during cataract surgery. The condition can be treated using eye drops or through surgery, depending on the cause.

Other complications like endophthalmitis may occur.

It is important that treatment for complications that threaten vision are initiated promptly to prevent permanent vision loss in the affected eye.

Prevention of cataract in children

Inherited cataracts cannot be prevented but there may be to counsel parents who are at risk of transferring genetic or inherited conditions to their children.

Pregnant women and all women who plan to get pregnant should avoid infections that may put their babies at risk of cataract. One way to do this is to get vaccinated against certain diseases like German measles.

Children should use safety eye wears while play or performing sports that puts the eyes at risk for injuries.

Conclusion

To identify vision-threatening conditions like cataract early, it is important that children undergo regular eye examination starting from birth.  With early detection and treatment of cataract, the risk of vision development problems is minimized and children go on to lead normal lives. If cataract is not detected and treated early, permanent vision loss may occur.

Parents and guardian should ensure that children who undergo cataract surgery continue to go for eye checks and that any post-surgery complication is treated promptly.