Pediatric Cataracts

By John Hinrichsen, M.D. Cataracts are a condition of the eye, caused when the lens becomes opaque. Most people associate this condition with adults, but a significant number of children are born with or develop cataracts. Cataracts can be inherited from a parent. This cataract can be seen at birth or may develop in the first years of life. If there is a family history of cataracts at a young age, children should be checked within the first week of their life for a cataract and then followed closely. There are more than 50 conditions that may be associated with cataracts. These include metabolic disorders such as diabetes, low calcium, low blood glucose or galactosemia (inability to metabolize a specific sugar found in milk). In some cases, the metabolic disorder can be treated and the cataract will resolve, but often the child will require cataract surgery. Other common causes are infection during pregnancy, trauma, chromosomal disorders such as Downs syndrome, multisystem diseases such as Lowes syndrome and Alport syndrome. Cataracts in children are diagnosed by a good medical history and physical exam. Every child should have their eyes checked in the nursery and at well baby checks for what is known as a red reflex. This is checked by shining a light in the childs eyes. If the reflex is not normal, the child should be seen by an ophthalmologist immediately. If a cataract is discovered, treatment must be started. A small cataract which does not block the childs vision, may require only observation and placement of glasses if needed, but if the cataract is blocking the childs vision, surgery will be required to remove it. A cataract present at birth needs to be removed within the first 3 to 4 weeks. If the child is older than 6 months and especially if he or she is older than 1 year, a replacement lens can be placed at the time of the surgery. This is generally an acrylic lens, the same type that is used for adult cataracts, made to remain in the childs eye for life. If the child is younger than 6 months, he or she will not have a lens replaced at the time of the cataract removal. Instead the child will wear a contact lens. Lens replacement is not performed on younger children because of a much greater inflammatory reaction in the eyes after surgery. The surgery itself requires 2 small incisions. Once the cataract is removed and the lens placed, a couple of small absorbable sutures are used to close the incisions and a patch is placed over the eye for a day or two. Because cataract surgery on a childs eye is much different than on an adults eye, it is better to have an ophthalmologist who is trained in dealing with pediatric cataracts. While adults can generally see well immediately after surgery and only have to use eye drops for a few weeks, this is only a first step for children, who often have what is called amblyopia due to the cataract. This means that the brain has turned this eye off. As a result, the childs brain must be forced to use the eye. This is performed by patching the childs unaffected eye and placing the child in contacts or glasses as needed. If a child is older and develops a cataract

due to trauma, this may not be necessary, but a child younger than 8 will need patching of the unaffected eye for years. If not, even the best surgery will not improve the childs vision significantly. Steroid eye drops will be needed for a longer time period than adults and sometimes children must take oral steroids for inflammation. Even with this, children will often require more than one surgery for their cataract. It used to be if a child was diagnosed with a cataract at birth, he or she would likely end up legally blind in that eye. But today, with improved surgical techniques and a better understanding of pediatric cataracts, children can obtain significant improvement --even approaching a vision of 20/20. (Dr. Hinrichsen is in practice with Highland Clinic and on the active staff at CHRISTUS Schumpert Health System.)