« RETURN TO FAQs

Cataract

Fig. 1 A cataract is any cloudiness or opacity of the norally clear lens of the eye.

What is a cataract?

A cataract is any cloudiness or opacity of the normally clear lens of the eye. Cataract size ranges from very small to entire lens involvement [See figure 1].

How common are infantile and childhood cataract?

About 3 children per 10,000 children have a cataract. The incidence is variable throughout the world.

How does a cataract cause vision loss?

A cataract causes decreased vision by interfering with the light ray path to the retina (back part of the eye). Abnormal vision development resulting in permanent loss of vision (amblyopia) occurs when a child has a cataract. Prompt and sometimes immediate treatment is necessary to prevent permanent vision loss [See figure 2].

Fig. 2 A cataract interferes with vision because it obstructs the lens of the eye through which light passes, causing light to refract differently than in a healthy eye.

Why are some babies born with a cataract?

Pediatric cataracts often occur because of abnormal lens development during gestation. Lens malformations that occur in conjunction with other findings are often the result of a genetic or metabolic abnormality. These cataracts may be present at birth or develop during childhood. However, most pediatric cataracts are not associated with other abnormalities.

Do all cataracts in babies and children need to be removed?

No. Some cataracts are small and/or off-center in the lens. These cataracts do not need to be removed because vision develops normally, even if the cataract is left in place.

What types of cataracts occur in babies and children?

The human crystalline lens consists of a center part called the nucleus and outer part called the cortex, both contained within a capsule. Cloudiness can occur in one or more parts of the lens:

Fig. 3 Lamellar cataract.

• A lamellar cataract is cloudiness between the nuclear and cortical layers of the lens [See figure 3].
• A nuclear cataract is cloudiness of the center part of the lens.
• A posterior subcapsular cataract is opacity of the lens cortex adjacent to the posterior capsule of the lens [See figure 4].
• An anterior polar cataract is a small, usually central opacity of the front part of the lens capsule. This type of cataract is often shaped like a pyramid. Anterior polar cataracts generally do not grow during childhood and can usually be managed without surgery [See figure 5].
• A posterior polar cataract is a central opacity at the back of the lens [See figure 6].
• Persistent fetal vasculature is often associated with a cataract. During development of the eye a blood vessel extends from the optic nerve (back of the eye) to the developing lens to provide nutrients to the young growing lens. Failure of this blood vessel to regress during development can causen a plaque-like cataract on the back of the lens. The persistent stalk extending from the back of the eye toward the cataract can cause retinal abnormalities.

Fig. 4 Posterior subcapsular cataract.

What is a traumatic cataract?

A traumatic cataract results from either a blunt or penetrating force that damages the lens. The cataract can form shortly after the trauma or months to years after the injury [See figure 7].

At what age should a cataract be removed from an infant or child?

Cataracts that cause significant visual loss are typically removed as soon as is safely possible. The visual part of the brain very actively develops during infancy and childhood. If a cataract causes a blurred picture, the visual part of the brain does not develop normally leading to loss of vision (amblyopia). A visually significant cataract should be removed and vision rehabilitated before the brain reaches visual maturity. This often involves patching an eye.

Fig. 5 Anterior polar cataract.

How is a cataract removed in infants and children?

An incision is made into the eye and an opening is made in the front of the lens capsule. The very soft inner part of the child's lens is suctioned out of the capsule. Younger children may require an additional opening in the posterior lens capsule with some vitreous gel removal. An intraocular lens is then sometimes placed within the lens capsule. Lastly, the incisions are closed.

Fig. 6 Posterior polar cataract.

What are the risks of cataract surgery in infants and children?

Cataract surgery performed by an experienced surgeon is generally very safe. No surgical procedure is without risks however. The risks of pediatric cataract surgery include infection, retinal detachment, development of glaucoma, displacement of the intraocular lens, development of capsular cloudiness and development of vitreous cloudiness.

How does the eye focus once the cataract is removed?

There are several methods to restore focusing ability of the eye: 1) an intraocular lens (Intraocular Lenses (IOLs) in Children) is sometimes placed in the eye at the time of cataract removal. 2) a contact lens can be placed on the surface of the eye. 3) glasses can be used to focus the light rays. Glasses are often very thick and are generally not a good option with unilateral cataracts.

Fig. 7 A traumatic cataract results when either a blunt or penetrating object damages the lens.

How are contact lenses used after cataract surgery?

If an intraocular lens is not placed, a child can wear a contact lens to focus the light rays. Contact lenses are specifically designed for the correction of vision in infants and young children who have had cataract surgery. These lenses are often worn for extended periods. As the eye grows the power of the contact lens can be updated.

Where can I join a support group of families with children with pediatric cataracts?

The Pediatric Glaucoma and Cataract Family Association.
VISIT SITE »