Pediatric cataracts

Many people believe that cataracts only affect older people. However, children can also suffer them. Both the pediatrict cataract and the one that derives from aging, consist of a clounding of the natural crystalline lens of the eye, which can cause blurred vision and even blindness.

In adults, cataracts usually appear many years after the correct development of vision so, after eliminating the cataract, most adults can have a good vision. Due to the fact that vision in children is still ideveloping and that this process does not end until they are 8 or 10 years, if the cataract is not treated, it can cause long-term vision problems.  For this reason, early detection and treatment can prevent permanent vision loss in children with cataracts.

Main types of childhood cataracts:

• Congenital They are present at birth.
• Acquired They develop after birth.
• Unilateral They affect only one eye.
• Bi-lateral They affect both eyes, and can be symmetrical or asymmetrical (one of the cataracts is more severe than the other).

Main causes of pediatric cataracts:

Cataracts can appear in different areas of the lens and can range from small lesions (spots) to large clouding.

They can be caused by genetic predisposition, metabolic disorders, or trauma to the eye that damage the lens. Sometimes, they appear spontaneously.

• An eye’s lens must be clear to focus the images that reach the retina and that are subsequently sent to be processed at the brain level. The clouding of the eye’s lens (cataract) can prevent light from reaching the retina or that the light rays are scattered when passing through the cloudiness, which leads to a distortion of the retinal image.
• In children, the eyes and the brain are still learning to see, so the distortion can cause “lazy eye” (amblyopia). If not treated properly, pediatric cataracts can cause abnormal connections between the brain and the eye that can be irreversible.
• Most cataracts in children are detected when they are examinated at bith, before they even leave the hospital. Many more are detected by pediatricians in periodic exams and, in some cases, it is the parents who notice them. They are usually detected by means of red reflex tests performed by the pediatrician (which consists of watching them under a retinoscope) or it can be noticed by a white reflex that appears in photographs taken with flash to the child and even thanks to a stranger white reflex that covers the pupil and can be seen in photographs of the child. If that happens, you should go to the ophthalmologist urgently, since it could also be a more serious illness.
• Acquired cataracts are usually diagnosed at vision screeanings or after an eye injury.

The treatment of pediatrict cataracts may vary depending on the type and severity of the cataract. In some cases surgery to remove the cataract is required. Unlike adults with already developed and full-sized eyes, children require specialized surgical instrumentation and techniques, therefore, the intervention must be performed by a specialist surgeon.

For many children, surgery is only the first step to complete eye rehabilitation. Ongoing treatment must repair the connections between the brain and the eye, which involves teaching the eye to focus correctly.

After surgery, children usually need a combination of contact lenses, intraocular lenses implanted in the eye and / or glasses. If the cataract has caused amblyopia, it is possible that the child may need to perform occlusions with an eye patch that covers the vision of the good eye to stimulate the vision of the weaker eye.

The prognosis will be better in those children who receive the treatment on time and make a good follow-up. For a good final result, years of individualized visual rehabilitation may be necessary.