Cataract in Children
Cataract in Children
“It's not what you look at that matters, it's what you see.” – Henry David Thoreau
But there are times when your vision is clouded by more than just your perception… A cloudy lens can also be at fault! …
Any cloudiness of the normally transparent lens is referred to as a cataract. Although it occurs naturally as an ageing process in adults it is not uncommon for children to have cataract.
Cataract can be present at birth which is called ‘congenital cataract’ or it may develop later in life. It may be inherited or may occur as a result of infection, inflammation, injury or as a developmental abnormality. It may be seen in one or both the eyes.
Our eye can be likened to a camera. The retina (the back part of the eye) is like the film. In a normal eye light passes through the front part of the eye (cornea) and lens which then gets focussed on the retina. The retina sends signals via the optic nerve to the brain which enables us to see.
In order that a clear image is projected on the retina it is essential that the media allowing the passage of light have to be clear. Any opacity in the media as in cataract hampers the projection of clear image on the film of the camera and hence affects vision.
In babies vision starts developing from the day they are born, stimulating the areas of vision in the brain. Any obstacle to the development of vision especially in the formative years can lead to permanent diminution of vision or even blindness.
When a cataract is present the baby’s immature nervous system will not receive the visual stimulation that it needs to develop the vision pathways in the brain and permanent vision loss may occur. If the cataract is small it may not affect vision very much, but it can lead to amblyopia, where the brain blocks out the signals of the weaker eye. Over time the optic nerve between the brain and that eye becomes non-functional and there is permanent vision loss.
The following could be indicators to your child having a cataract:
• White spot in the pupillary area (central black hole seen in normal eyes)
• Squint or misaligned eyes especially in cataract in one eye
• Nystagmus i.e. shaky wobbly eyes
• Child complaining of defective vision
• Squinting of eyes
• Holding books close to face
Treatment involves surgical removal of cataract and correction either by implantation of an intraocular lens, glasses or contact lenses as deemed appropriate by the treating doctor. The surgery should be done as soon as possible to remove the barrier to the passage of light and stimulate normal development of vision.
An important aspect to emphasise regarding management of cataract is that ‘no child is too young enough to undergo cataract surgery’.
Also a child’s eye is not a miniaturised adult eye. Hence cataract surgery is slightly more complex in children as compared to adults and should be performed by those having adequate experience and specialised training to handle the same.
Cataract surgery is the first step in the long term journey towards providing good vision to a child. After surgery the child needs regular follow ups to monitor vision, glass power, eye pressure and retina as advised by the treating doctor.
Complications of surgery include-
• Visual axis opacification (Posterior capsule opacification)- There occurs whitening of the remnant capsule on which the lens is implanted. This occurs to a large extent in children who undergo cataract surgery; lower the age at which child is operated higher is the chance of this complication occurring. Certain modifications carried out during the primary surgical procedure can reduce the rate of this complication significantly.
• Glaucoma- This refers to optic nerve damage due to raised eye pressures. It is seen in up to 12 to 25% of children undergoing congenital cataract surgery. Often it can be controlled with medicine and eye drops but may, in some infants, require further surgery.
• Amblyopia- This is commonly referred to as lazy eye. This can occur if the vision in one eye is stronger than in the other. The brain learns to ignore the vision it receives from the weak eye, causing varying degrees of visual loss in that eye. Occlusion therapy (patching) will be started which involves your child wearing a ‘patch’ over the strong eye to try and improve the vision of the weak eye.
• Squint- This refers to misalignment of the operated eye as a result of vision being weak in the operated eye and is more common in unilateral cataracts. It may require further surgery to straighten the eye.
• Endophthalmitis- This refers to severe infection of the operated eye which can lead to dire consequences. Management involves diagnosis and aggressive treatment in the postoperative period.
If your child remains undiagnosed and untreated, your child will miss out on the joy of viewing this beautiful world. It is important that the child be treated on time when vision and brain development occur in the early formative years of life.