A cataract is a clouding of the natural lens preventing images to be focused. Thus a patient cannot see. While it is rare, a cataract can be present at birth.
Cataracts are a special problem in children. Since visual pathways do not mature until approximately age 8-10.
Visually impairing congenital cataracts lead to “Lazy Eye” (amblyopia). If left untreated before the age 10, the “Lazy Eye” is permanent and will result in lifelong weak vision.
Treatment for Childhood Cataract
The treatment for childhood cataracts is complex and needs cooperation of more than just the eye surgeons and parents. Consultations with anesthesiologists, pediatricians, low vision rehabilitation specialists and community health workers is important for achieving the best visual outcomes.
It is estimated that 200,000 children have a visual impairment from un-operated congenital cataracts, whether from complications of their surgical management, or from associated vision heath problems that present at the same time as the congenital cataract (such as congenital glaucoma, retinal detachment and other conditions).
Surgery for Cataracts in Children
Timing of the surgery for congenital cataracts is critical. If the cataract is present in one eye only, the child will tend to favor the other heathy eye. This places the cataract eye at risk for Lazy Eye. Surgery should be attempted as soon as the child can be cleared to have general anesthesia, sometimes as early as 6 weeks of age.
If the child has bilateral cataracts, in which case one eye will not necessarily be favored, the surgery could wait a while longer.
Implant vs Contact Lenses vs Eyeglasses
Choosing an intraocular lens implant (IOL) in a child is not the same as in an adult. A child does not have the same size eye as they will have in adulthood. An intraocular lens is of one focusing power and that may be insufficient as the eye grows. If an IOL is selected a second operation may be necessary to replace an IOL later in life
Contact lenses can be used for optical correction after congenital cataract surgery and have the advantage of allowing for the powers to be changed as the eye grows. Parents need to be actively involved in the care and oversight of the contact lenses until the child comes of age and care for the contacts.
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