Congenital and Pediatric Cataracts
When you hear the term cataracts, you assume it is associated with a person over the age of 50. But in a small number of newborns, about 0.4 percent, congenital cataracts are found at birth or develop soon afterward. Pediatric cataracts are not present at birth, but develop later. While there are concerns about cataract surgery on an infant, many times the cataract will need to be removed so as not to hamper the vision development of the child. We perform this surgery at the Eye Institute at the Medical Center Clinic.
What is a congenital cataract?
A congenital cataract is the same as an adult cataract — it means that the child’s natural lens in the eye is cloudy instead of clear. In adults, this cloudiness develops over time as proteins in the eye clump together and cloud a small area of the lens. Over time the clouding grows, impacting vision. In congenital cataracts, the child’s lens is cloudy either from birth or develops shortly thereafter.
Just as with adult cataracts, there is no cure for congenital or pediatric cataracts. Some congenital cataracts may not require surgery — if the central vision remains unimpeded, for instance. But many cases of congenital cataracts require surgery to allow normal development of the child’s vision system.
What causes congenital and pediatric cataracts?
Just as in adult cataracts, it is thought that abnormalities in the formation of proteins in the eye are responsible for clouding of the usually transparent lens. Congenital cataracts occur in newborns for many reasons: inherited tendencies, infection, metabolic problems, diabetes, trauma, inflammation, or drug reactions.
A baby can be born with cataracts if the mother developed infections such as measles or rubella, chicken pox, cytomegalovirus, herpes simplex, herpes zoster, poliomyelitis, influenza, Epstein-Barr virus, syphilis, and toxoplasmosis. Even certain antibiotics such as tetracycline, when used to treat an infection in a pregnant woman, can lead to congenital cataracts in the newborn.
While congenital cataracts and pediatric cataracts both involve cataracts in children, technically, pediatric cataracts weren’t present at birth. Older children who develop cataracts often had one of the infections listed above.
But the cause behind 40 percent of pediatric cataracts is trauma, such as a blow to the eye. It’s also thought that around one third of “pediatric cataracts” cases were actually congenital cataracts that were not diagnosed earlier.
What are the types of congenital cataracts?
- Anterior polar cataracts — These cataracts are well defined and located in the front part of the lens, but are often thought to be too small to require removal of the lens. They are associated with inherited traits.
- Posterior polar cataracts — These are also well defined, but they appear in the back portion of the eye’s lens.
- Nuclear cataracts — These are the most common form of congenital cataracts and appear in the central part of the lens.
- Cerulean cataracts — Cerulean cataracts are distinguished as small, bluish dots in the lens. They usually occur in both eyes and are linked to inherited traits, but don’t usually cause vision problems.
When it is time for a child to have cataract surgery?
Cataract surgery on an infant is far more difficult than on adult patients. This is because complications can occur such as high intraocular eye pressure, which can lead to glaucoma. Also, anesthesia and infants can be challenging.
But the alternative is the possible impingement of the child’s vision development. The vision needs to be clear enough to allow normal development, and cataract-clouded lenses won’t allow for this. It is thought the time to remove a visually impairing cataract from an infant’s eye is between the ages of 6 weeks and 3 months. In cases of pediatric cataracts that develop later, each situation is unique.
Do you correct the vision once the cataract is removed?
It’s critical to correct the vision after removal of the cataract. This can be done with an intraocular lens, just as is done with adult cataract patients. Or it can be done with contact lenses or eyeglasses. Without some sort of vision correction following cataract surgery, normal vision development will be impeded.
When considering the options, we’ll discuss the pros and cons of all vision correction options with you.