What Exactly Is a Cataract?

It is referred to as any opacity or cloudiness of the eye’s natural lens, which is generally transparent. There are numerous kinds of cataracts. Some are considered small and don’t interfere at all with a person’s vision, while others are considered large and can result in significant loss of vision.

Are Cataracts Common in Infants and Children?

Roughly three out of every 10,000 kids have one. This occurrence is variable worldwide.

How Can a Cataract Result in Vision Loss?

Light will enter into the eye and the light is then casted to the retina, which then senses the presence of the light and sends a message to the brain directly. A cataract can keep light from ever making its way to the retina and keep the eye from visualizing. For a child to achieve proper vision, he or she must have clear, vibrant light strike the retina and a pure image be transmitted to the brain. If the light is being blurred by the cataract, the visual development of a child will be limited and cause amblyopia. Swift, and often, instant treatment is needed to avert permanent loss of vision. With adults, cataracts tend to develop after the development of normal vision, allowing the loss of vision to be reversible.

Why Is It That Some Infants Are Born with a Cataract?

Abnormal development of the lens during pregnancy is often the cause of pediatric cataracts. Cataracts may occur from infections, genetic problems, or spontaneously. Malformations of the lens that occur in combination with medical issues tend to be the result of a metabolic or genetic problem. These types of cataracts can exist at birth or develop later during childhood. The majority of pediatric cataracts tend to be isolated issues and aren’t associated with any other irregularities.

Should All Infant and Childhood Cataracts Be Removed?

Not necessarily. Some of these cataracts are small in size or off-center. As a result, they don’t have to be removed since the vision will develop normally, even with the cataract in place.

What Kinds of Cataracts Occur in Infants and Children?

The human lens entails three separate parts, including the nucleus (the center part), the cortex (the outer part), and the capsule that surrounds the cortex. Fogginess can occur in any part of the lens, and even all three at one time:

• Lamellar Cataract – This is when cloudiness occurs between the cortical and nuclear layers of the lens.
• Nuclear Cataract – This is when cloudiness occurs in the center part of the human lens.
• Posterior sub capsular cataract – This is when a thin layer of muddiness that impacts the posterior surface of the lens cortex, right inside of the capsule. This particular form of cataract is often associated with the use of medication like steroids.
• Anterior Polar Cataract – This is when there is a small, typically central opaqueness of the anterior of the lens capsule. These cataracts typically don’t grow throughout childhood and aren’t visually significant. They’re generally managed without the need for surgical intervention.
• Posterior Polar Cataract – This is when there is a central opaqueness at the posterior of the human lens.
• Persistent Fetal Vasculature – This is often related to a pediatric cataract. During eye development, there is a blood vessel that goes from the optic nerve to the in-development lens so that nutrients can be provided to the undeveloped and growing lens. As a general rule, this blood vessel will disappear prior to birth. In the event that the blood vessel doesn’t go away, it may lead to a cataract that is similar to plaque on the posterior of the human lens. Retinal abnormalities may form as well. These cataracts tend to be harder to treat and they have a worse outcome due to the other correlated eye-related irregularities.
• Traumatic Cataract – This is when a penetrating or blunt force causes damage to the lens. This cataract may form shortly following the trauma or possibly even months or years following the injury.

How Old Should an Infant or Child Be for Cataract Removal?

Cataracts that cause interference with vision need to be removed the moment it is safe to do, particularly if it exists at birth. Delaying the removal of the cataract can potentially interfere with the standard development of vision centers within the brain. Small cataracts that aren’t likely to cause interference can be frequently and carefully monitored, but as soon as there is an indication of a vision-related issue, the cataract needs to be removed. If the cataract is off center or small, patching and/or glasses may prove to be beneficial for the development of vision and surgery can often be put off or completely avoided.

How Does Cataract Removal Work in Infants and Children?

A very small cut is made in the eye as well as an opening on the anterior of the lens capsule. The cloudy and soft internal part of the lens will be suctioned out. Smaller children may need an extra incision in the back lens capsule with vitreous gel removal. An intraocular lens (IOL) is often placed inside the vacant lens capsule. This placement generally occurs during this surgical procedure or during a second surgical procedure. As a general rule, the intraocular lens isn’t placed in children under one year old. The wounds are closed with dissolvable stitches.

What Kind of Risks Are There with Cataract Surgery in Babies and Children?

Cataract surgery that is completed by an expert surgeon is typically incredibly safe. However, as with all surgeries, there are risks. These risks can include inflammation, infection, and the detachment of the retina, as well as the development of glaucoma, the intraocular lens, vitreous cloudiness, and capsular cloudiness.

How Will the Eye Focus Properly After the Removal of the Cataract?

The lens focuses light in order for the eye to receive a pure image regardless of whether viewing an object up close or far off. When the lens is removed, the eye is unable to focus light within it. There are numerous approaches that can be taken to restore the eye’s focusing ability. One is to place a permanent IOL. Another is to place a contact lens on the eye’s surface (these will need to be taken out and cleaned on a regular basis. A third is wear glasses that can help concentrate the light rays. These glasses tend to be relatively thick and result in magnification; therefore, they aren’t typically the ideal option if only a single eye is impacted. In addition, the glasses can limit the impacted eye(s) visual field.

If you would like to learn more about cataracts, contact us at Performance Vision today.