Cataracts in infants and children are rare, about 3 in 10,000, and require prompt evaluation and intervention in order to preserve visual development. Within each eye, there is a clear lens focusing images and enabling the brain to obtain a normal view of the world. A cataract is defined as a lens that is not clear. When the lens is clouded, images are not well focused, thereby obscuring visual signals to the brain. The size, location, density of the lens opacity, and age of onset of the cataract, all contribute to reducing visual development.
Many adults develop cataracts as they mature and once the cataract is removed, vision usually returns to normal levels. In young children, however, the visual result depends upon the timing of surgery. The appropriate time to operate is determined by the type of cataract the child has. Therefore, once a cataract is suspected by the family or the pediatrician, rapid referral to the pediatric ophthalmologist who specializes in cataract surgery should be made.
Congenital cataracts are those that develop in children less than 12 months of age, and acquired cataracts occur after age one. The cataract can be in one or both eyes. They can be spontaneous, inherited, or a result of a more significant eye or systemic condition. A complete ophthalmologic examination enables the pediatric ophthalmologist to determine whether visual development is affected, what if any additional evaluation should be done, and whether surgical intervention is necessary. All cataracts that occur in childhood can affect visual development.
Cataract surgery is performed with the use of a microscope. During surgery, the child is asleep and will not feel or remember the surgery. Small incisions are made into the eye enabling removal of the cataract. The small incisions are closed with microscopic sutures. An artificial lens can be implanted if the child meets certain criteria including appropriate age. If the child is not eligible for an artificial lens implant (intraocular lens), a contact lens will be placed on the eye once it is healed. Parents will be instructed on how to insert, remove, and care for the contact lens. Alternatively, the child may be fitted with glasses. Optical correction of any type is necessary in order for the child to develop vision and retain it throughout life.
Once the eye has healed and the proper corrective lens is in place, the child will continue to be followed closely by the pediatric ophthalmologist. The course and prognosis for each child after surgery is variable. Frequent follow up is necessary in order to watch for other conditions including, but not limited to, amblyopia, strabismus, glaucoma, secondary cataract, or retinal detachment. Each of these can occur in any young patient who has undergone cataract surgery. Cataract surgery in infants and children is a safe but highly specialized and complicated procedure: one that requires extensive pre-operative planning, intricate surgical technique, and long term postoperative care.
Gennifer J. Greebel, MD is a pediatric cataract surgeon who completed her pediatric ophthalmology fellowship at the Children’s National Medical Center in Washington, DC. While there, she performed numerous pediatric cataract surgeries on children as young as 4 weeks of age. Since relocating to New York, she continues to perform these surgeries in addition to other pediatric eye surgery.