Your eye lens is crystal clear. When it gets cloudy or any opacity of your eyes is called Cataract. Cataracts are of many types. Some are minor and do not interfere with your vision. However, others can be large and cause vision impairment. If you think that cataracts only affect older adults, you are wrong. Babies are also born with cataracts or children may develop them at a very young age. Such conditions are called Childhood cataracts.
Childhood cataracts are also known as:
- Congenital cataracts – This is when a baby is born with cataract or develops it shortly after birth.
- Developmental or Juvenile cataracts – This is when older children develop a cataract.
Source: http://www.nhs.uk/conditions/Cataracts-childhood/Pages/Introduction.aspx
Classification of Cataract in Children
Cataracts in children depend on a number of factors such as age, causes and forms of cataracts. Depending on these factors, the classification of cataract in children is as follows:
1. The Age of Onset
- Congenital or Infantile Cataract
Lens opacity may be present at birth indicating a congenital onset of cataract but often this may go unrecognised. So, a later diagnosis of lens opacity also falls under this category. Before the cataract is extracted, it is essential to provide a thorough description of the type of the lens opacity. Determination of type is essential to find out whether it is associated with any other disease or not. Morphological categories of cataracts including central foetal nuclear, anterior polar, and posterior polar indicate a congenital cataract. On the other hand, conditions such as Lamellar or cortical cataract can also be associated congenital or a later onset of cataract.
- Juvenile Cataract
This cataract is caused due to an external cause. Many use this term for indicating the onset of cataract after infancy, which may not indicate a non-genetic cause.
Childhood Cataract: Causes
There are several factors for the onset of cataract in children. These include:
- Genetic
Around half of the childhood cataracts are the result of genetic mutations. These genes code for proteins that are responsible for lens structure or clarity. Any metabolic disorders may cause cataracts.
- Trauma
This is one of the primary reasons of acquired cataracts in children. This type of cataract is more common in boys. They may get it due to a penetrating or blunt injury to the eye. Also, the presence of intraocular or intraorbital foreign body may also cause this. So a thorough eye examination is essential.
Secondary Causes
Secondary causes of cataract include:
- Uveitis – Cataracts may develop due to chronic ocular inflammation or due to the chronic use of steroids. Surgery of this type of cataracts is often complicated by postoperative inflammation. So, to avoid pre operative inflammation in the anterior segment of the eye, any usage of pre-, intra-, and postoperative sub conjunctival, topical, intracameral, and other systemic steroids should be avoided. Patients may often have a pupillary membrane covering the lens. This attaches to the iris, thus further complicating the surgery. These membranes can be peeled off of the anterior lens capsule during surgery for facilitating lens removal. Juvenile idiopathic arthritis is yet another cause of anterior uveitis in children. Any other type of uveitis may also cause cataract due to inflammation of by complications created by usage of steroids.
- Intraocular tumours – It is very rare for cataracts to develop as a result of intraocular tumours. However, treatment of such a tumour using radiotherapy may lead to the development of cataract. In this case, the timing of removal of cataract removal needs to be carefully considered.
- Chronic retinal detachment – These cataracts result from injuries or are often associated with Stickler syndrome. If the lens is completely opaque, the eye specialist will perform pre operative ultrasonography to rule out any possibilities of chronic retinal detachment.
- Maternal infection (rubella) – This type of cataract is only seen in some parts of the world where rubella hasn’t been eradicated.
Forms of Cataract
The forms of Childhood Cataract includes:
Diffuse or Total Cataract
This is one of the common types of congenital cataract; however, there is no specific cause of this type of cataracts.
Anterior Cataract
This type of cataract can be further divided into three forms:
- Anterior polar – The opacity appears in the capsule itself and may extend into the anterior chamber as a very tiny mammillation.
- Pyramidal – These are comparatively larger than Anterior polar cataracts and may progress to visual significance. Such type of cataract is pretty difficult to remove using a vitrectomy instrument. It may require removal using forceps.
- Anterior lenticonus – This condition refers to a thinned central anterior capsule with or without any anterior cortical opacity. This condition is a characteristic of Alport syndrome. The lens may get ruptured causing a hydrated total cataract.
Cortical lamellar
This cataract occurs between the adjacent clear lamellae.
Fetal nuclear
This type of cataract occurs in the central part of the lens. They may appear like a dot or may also be dense. This type of cataract usually measure between 2-3.5 mm and is often associated with microphthalmia. It is said to be associated with postoperative glaucoma and may need surgery during early infancy.
Posterior polar
This type of cataract is different from posterior subcapsular cataract. The opacity occurs in the capsule itself.
Posterior lentiglobus (lenticonus)
In this condition, the central and sometimes paracentral posterior capsule thins and may protrude to the rear. This happens where the hyaloid system connects to the eye. This type of distortion may result in a specific area of extreme myopic refraction.
Posterior subcapsular
This type of cataract can be congenital but in most of the cases, is acquired due to any injury or steroid use. The opacity is cortical and does not involve the capsule.
Persistent fetal vasculature (PFV)
The opacity in this type of cataract is generally capsular. It is associated with, thickening, shrinkage, and vascularization of the capsule.
Traumatic disruption of lens
Traumatic anterior lens capsule ruptures quickly in children causing hydrated white cataract.
Source: https://www.aao.org/pediatric-center-detail/pediatric-cataracts-overview
The signs of cataracts
There are several signs indicating your child might be suffering from cataracts. The signs are as follows:
- The child may not look directly towards any object. They may respond to faces or any other large, bright and colourful objects. If you see that your infant cannot locate small objects while he or she is crawling on the floor, then he may have vision problems or is suffering from cataracts.
- When exposed to bright sunlight, the child may excessively squint and scowl, and try to shield his or her eye. This is due to the resulting glare from a cataract.
- Your child’s eyes may not be aligned. They may not focus properly on the same point at a time. This condition is also known as strabismus.
- Instead of a red reflex, you may notice a white reflex in your child’s eye. For instance, in the photograph of the child, one of his/her eyes may appear white while the other has the usual “red eye” look.
- The child may have repetitive wandering movement in the affected eyes. This condition is also known as nystagmus. This sign may appear later when the infant is several months old.
Source: http://www.webmd.com/children/tc/cataracts-in-children-topic-overview#1
Treating Cataracts in Children
The treatment options for cataract in children include:
Surgery
The doctor will perform the surgery on your baby under general anaesthetic. It takes approximately an hour or two. Usually, an ophthalmologist performs this operation. If the child has cataracts are from birth, then you must get it operated as soon as possible. Usually, within a month or two of birth, the operation needs to be carried out. Any negligence or delay may result in vision loss.
Before the operation is performed, the ophthalmologist will apply drops to your baby’s eyes. This is for dilating the pupil of the eye. After that, the doctor makes a very small cut on the surface of the cornea and the removes the cloudy lens. In many cases, the doctor inserts a transparent plastic lens known as an intraocular lens (IOL) or an intraocular implant. This is done during the operation for replacing the cloudy lens that has been removed. This lens is inserted because you cannot focus without a lens. However, many times, the doctor may prescribe the use of external contact lenses or glasses (in case both the eyes are affected) for compensating for the lens removal. These external lenses are fitted a week of two after the operation.
The majority of the ophthalmologists will recommend using contact lenses or glasses in children who are under 12 months old during the time of their eye surgery. This is because babies who have an IOL inserted in their eyes have a higher risk of eye complications or may need further surgery. Once the operation is done, the incision in the eyes of your child will be closed with stitches which eventually dissolve.
Post- Operation
Once the operation is over, the doctor will place a pad or a transparent shield on your child’s eye for protecting it. In most of the cases, the child needs to stay in the hospital overnight so that the doctors may monitor his/her recovery.
If your child has cataracts in both eyes the doctor will operate on both eyes separately. This is done to reduce the risk of any complications that may affect both the eyes. Usually, there is a gap of several days between the two operations. The doctor may perform the second surgery within a week of the first one.
The doctor will provide you eye drops that you need to put in your child’s eye. This drop helps in reducing inflammation, redness and any kind of swelling in the eye. Every two to four hours, you need to put the drops in your child’s eyes. The doctor will show you the method before leaving the hospital.
Further treatment
After undergoing a cataract surgery, most of the children need to wear glasses or contact lenses. This is because the vision is usually blurred in the operated eye and it may not be able to focus on its own. Even if an artificial lens is fitted, the child will need glasses or contact lenses. This helps the child to focus on nearby objects as the artificial lens can only focus on distant objects.
Wearing a patch
For almost all cases of unilateral cataract (where only one eye is affected), the child needs to wear an eye patch. The doctor may also recommend wearing an eye patch of a child with cataracts in both eyes has a weaker vision in one eye. They need to wear the temporary patch on the stronger eye. This is known as occlusion therapy.
Occlusion therapy is used for improving vision in the weaker eye by forcing the brain to identify visual signals from the affected/operated eye. Without this treatment, children with unilateral cataract may not be able to develop good vision in the operated eye.
Orthoptists (often described as the physiotherapists for the eye) assess the visual function. The Orthoptist is the one to guide you about when your child needs to wear the patch and how long they may use it.
Source: http://www.nhs.uk/Conditions/Cataracts-childhood/Pages/Treatment.aspx
A strong vision is essential for a child’s overall physical development including his/her success in school. In babies and young children, the vision system is not fully developed and equal input from both eyes is required for the proper growth of the vision centres of the brain. If your child’s brain doesn’t receive clear images from the eyes, his vision may get affected and become extremely limited in such a way that it cannot be corrected even later in their life. So, it’s extremely crucial to detect eye problems very early in life and treat them at the quickly once they are detected.
Perform a thorough vision checkup after he/she is born. The doctors usually do this. Check the child’s vision again during infancy, preschool and during his/her school years.
How can Disha Eye Hospital help you?
If you are looking for experienced eye specialist for performing a thorough check up of your or your child’s eye, you can book an appointment with our experts. Protecting your and your child’s vision is our first priority. Book an appointment today at http://www.dishaeye.org/appointment.