What Exactly Is a Cataract?

The lens of the eye is generally crystal clear, but when a cataract has formed, the lens of the eye becomes cloudy or opaque. There are several different kinds of cataracts. Some can be small and don’t hinder your vision, while others are larger and can result in severe loss of vision.

How Widespread Are Cataracts in Infants and Children?

Cataracts occur in three out of every 10,000 children. The occurrence is inconsistent worldwide.

How Do Cataracts Cause Loss of Vision?

Light enters into the eye and is then projected to the inner surface of the back of the eye (aka the retina) which then senses the presence of the light and transmits a special signal to the brain. If there is a cataract, the light may not ever reach the retina, preventing the eye from seeing properly.

For good vision to develop in a child, he or she must have clear light strike the retina and a clear image be received by the brain. If the light is being blurred by a cataract, then the child’s visual development is limited and amblyopia is the result. To prevent permanent loss of vision, prompt and immediate treatment is often necessary.

With adults, cataract tends to develop after typical development of vision; therefore, the loss of vision can be reversed.

Why Is It That Some Babies Are Born with Cataracts?

Pediatric cataracts tend to occur as a result of abnormal eye lens development during the mother’s pregnancy. They can result from infections, genetic issues, or simply occur suddenly. Malformations of the eye lens that occur in combination with medical issues tend to be a direct result of a metabolic or genetic problem. These types of cataracts can be present when the baby is born or they may develop later during childhood. Generally, pediatric cataracts are isolated and aren’t associated with any other kind of abnormalities.

Do All Pediatric Cataracts Need to Be Removed?

No, they do not. In some instances, the cataracts are small or off center of the natural eye lens. These kinds of cataracts will not need to be removed since the vision can develop normally—even with the cataract left in place.

What Kinds of Cataracts Occur in Infants and Children?

The human eye lens contains three different parts: nucleus (center), cortex (outer), and a capsule that surrounds the cortex. Cloudiness can occur in any one or more of these parts. Here is a look at some of the different types of cataracts:

• Lamellar Cataract – This type of cataract is characterized by the cloudiness between the nucleus and the cortex.
• Nuclear Cataract – This type of cataract is distinguished by the cloudiness of the lens’ center.
• Posterior Sub Capsular Cataract – This kind of cataract is characterized by a thin layer of cloudiness that impacts the back part of cortex, which is located just inside of the capsule. It tends to be associated with the use of medication like steroids.
• Anterior Polar Cataract – This is a small cataract that typically has central opacity at the front of the capsule of the lens. These cataracts don’t normally grow during childhood and aren’t visually significant. They can generally be managed without surgical intervention.
• Posterior Polar Cataract – This type of cataract has central opacity at the back of the natural lens.
• Pediatric Cataract – With this particular type of cataract, there is often persistent fetal vasculature. While the eye is in development, there is a blood vessel that extends from the back of the eye (optic nerve) to the developing lens so that nutrients can be provided to the growing lens. Generally, this blood vessel will disappear prior to birth. If it does not, it may lead to the development of a plaque-like cataract on the back of the lens. Retinal abnormalities can also occur as a result of the persistent stalk that extends toward the cataract from the back of the eye. These types of cataracts can be harder to treat and have a worse prognosis due to the eye abnormalities associated with them.
• Traumatic Cataract – This type of cataract is a result of penetrating or blunt force that results in damage to the natural lens. It can form shortly after the trauma takes place or months or even years following the injury.

How Old Should an Infant or Child Be for a Cataract to Be Removed?

Cataracts that are hindering an infant or child’s vision need to be removed as soon as it is safe to do so. This is particularly true if the cataract is present at birth. If the removal of the cataract is delayed, it can hinder the normal and appropriate development of the vision centers within the brain. Small cataracts that don’t seem like they will interfere with vision can be frequently and carefully monitored, but it is important that the cataracts are moved as soon as a vision issue is recognized. If the cataract is off center o very small, it may be beneficial for the visual development to opt for patching and/or glasses, allowing for surgical intervention to be delayed or possibly avoided altogether.

How Does Cataract Removal Work in Infants and Children?

A small incision is made into the child’s eye, along with an opening at the front of the lens capsule. The soft, cloudy inner section of the lens is then suctioned out of the capsule. Smaller children could require an extra opening in the posterior capsule with vitreous gel removal—a process known as vitrectomy. An intraocular lens (IOL, for short) may then often be placed within an empty lens capsule during this same surgery or a second surgery. As a general rule, an IOL isn’t placed in a child under one year old. To close the wounds, dissolvable stitches will be utilized.

What Types of Risks Are Involved with Cataract Surgery in Infants and Children?

As long as an experienced surgeon performs cataract surgery, the surgery is usually very safe. However, there is always risk when a surgical procedure is taking place. With pediatric cataract surgery, the risk may include inflammation, infection, retinal detachment, development of capsular cloudiness, development of vitreous cloudiness, displacement of the intraocular lens, and development of glaucoma.

How Is the Eye Able to Focus After Cataract Removal?

The eye lens focuses light so that the eye is able to obtain a clear image regardless of whether it is viewing the image up close or from a distance. As soon as the lens is removed, it is unable to focus light within the eye any longer. There are a few different methods that can be used to restore the eye’s ability to focus again:

• A permanent IOL can be placed within the eye
• A content lens can be placed on the eye’s surface (these will need to be regularly removed and cleaned)
• Glasses can be used to help focus the rays of light. After the cataract is removed, glasses tend to be thick and result in magnification, so they may not be a good option if only one of the eyes is affected. In addition, glasses can hinder the field of vision of the affected eye(s).

For more information about cataracts or if you believe that you or your loved one may be suffering, contact the experts at Performance Vision as soon as possible to schedule an appointment.