Dr. Anupama Vyas - Children’s Eye Care and Adult Squint Clinic

Paediatric Cataract

Dr. Anupama Vyas provides highly specialized care for children with the most difficult cases of paediatric cataracts. Cataracts in babies and young children are treated urgently because they can have a lasting effect on their vision development.

As the cloudy lens blocks light from getting into the eye, the brain gets no visual experience through that eye, at a time when the eye and brain are working together to learn to see. As a result, a baby or child with an untreated cataract could be slowly going blind, and if cataract surgery is delayed, it might be too late to help.

Causes
Cataracts in a child can be congenital (present at birth) or acquired (develop after birth). Also, some pediatric cataracts may actually be congenital cataracts that simply weren’t identified earlier because the child did not have his or her first eye exam until they were older.

Approximately 50% of childhood cataracts are caused by mutations in genes that code for proteins involved in lens structure or clarity. Metabolic disorders can cause cataracts, which may have particular morphologies that point to the underlying cause.

Congenital infections such as Toxoplasma, rubella, cytomegalovirus, herpes, and syphilis (TORCH) are associated with congenital cataract, with rubella being the most common.

Other causes of childhood cataract in older children include trauma, drug-induced, radiation, uveitis, intraocular tumours and laser therapy for retinopathy of prematurity. Trauma is one of the commonest causes of unilateral cataract in the developing countries.

Bilateral cataracts occur commonly due to the long-term use of topical or systemic steroid.

Symptoms

A pupil that looks white when a flashlight is shined into it

Eyes that aren’t in the right position (misaligned)

Rhythmic eye movements that can’t be controlled (called nystagmus). The eyes may go back and forth, up and down, around, or mixed.

Cloudy or blurry vision

Children’s eyes and brain are still learning to see. This is why distortion can lead to lazy eye or amblyopia in children.

Surgery
Surgical removal of a cataract in an infant or child is done under general anesthesia using an operating microscope. Examination under anesthesia is carried out to record the essential parameters for intraocular lens (IOL) power calculation.

Once the cataract has been removed, focusing power may be restored in one of the following ways:

Intraocular lenses: artificial lenses may also be implanted to replace natural lenses in children. An intraocular lens (IOL) is then sometimes placed within the empty lens capsule either during the same surgery or in a subsequent second surgery. Generally, an IOL is not placed in a patient less than 1 year of age.

Contact lenses: used after surgery for bilateral or unilateral cataracts in children under 2 years of age. A contact lens can be placed on the surface of the eye (contact lenses have to be removed and cleaned regularly.

Glasses: used in selected cases when the cataract surgery involves both eyes and contact lenses have failed, or if intraocular lenses are not appropriate. Once the cataract is removed, glasses are often very thick and cause magnification, so they are generally not a good option when only one eye is affected. They can also limit the visual field of the affected eye.