Pediatric Cataracts in Children and Babies

Cataracts | Overview

What are cataracts?

A cataract is a cloudy area in the lens of the eye. It can look like a speckle, crystal or stripe. If the cataract is large or dense enough, it can cause blurry vision or block vision. Most cataracts are partial (not involving the whole lens), but they can sometimes be complete (involving the whole lens). A cataract may be in one eye or both eyes.

Although cataracts are most common in older people, they can also affect newborns and children.

What are the symptoms of cataracts?

Most babies are looking around and tracking things with their eyes nicely by the time they’re 3 or 4 months old. If you get the sense that your baby isn’t seeing and responding, that may be a tip off that something is wrong. Jiggling eye movements may also be a sign of a cataract or other eye problem.

Cataracts may also cause:

cloudy or blurry vision
decreased vision
double vision
lights to appear too bright or cause a glare or halo
colors to seem faded

You may also notice a white or grayish area on the eye, but many cataracts can’t be seen with the naked eye because they’re too far back in the lens.

What are the causes of cataracts?

Children may be born with a cataract (congenital), or develop one later (acquired). Congenital cataracts occur when the lens of the eye isn’t formed properly. About 25 percent of the time, congenital cataracts have a genetic cause and may be related to a metabolic, hormonal or chromosomal , such as Down syndrome. In another 25 percent of cases, cataracts are hereditary, which means that the child’s mom or dad also had a cataract in childhood.

Acquired cataracts are caused by abnormal interactions among the proteins that make up the lens. Over time, these abnormal interactions cause clumping, specks or cloudy areas to form.

Some possible causes of acquired cataracts are:

trauma to the eye
diabetes or another metabolic disease
steroid use
complications from other eye diseases
complications from treatment of other childhood diseases, like rheumatoid arthritis
radiation therapy after cancer

Many cataracts are idiopathic, which means they occur for no known reason.

How we care for cataracts

Babies and children with cataracts need highly specialized care. Our Pediatric Cataract Service offers the expertise, child-modified equipment and advanced technology to diagnose and treat cataracts in even our tiniest patients. Babies and children with cataracts are referred to us from all over the country.

Our pediatric ophthalmologists are very experienced in treating kids with cataracts and have removed cataracts in newborn babies. Our team uses specialized tools and equipment, including customized software that predicts the growth of your child’s eye, allowing us to choose the best lens to serve your child through adulthood. Our team has successfully implanted intraocular lenses in babies as young as 1 month old.

Cataracts | Diagnosis & Treatments

How are cataracts diagnosed?

To diagnose a cataract, your child’s doctor will perform an eye exam any may run some tests, including:

dilating your child’s pupils with eye drops to examine the back of the eye
an ultrasound to look in the back of the eye

What are the treatment options for cataracts?

Depending on the size of the cataract, treatment may involve patching the eye or surgery. Each child and cataract is different, but a general rule is that the older the child, the less urgent it is that the surgery be done right away. This means that some cataracts can be managed without surgery for months or years.

Children born with a dense cataract will need surgery to remove it as soon as possible. If the cataract isn’t removed, it can block light from getting to the retina (the back of the eye) and prevent the retina from sending visual information to the brain. If this happens during the development of sight, the brain may never learn to see, even after the cataract is removed.

Patching

If the cataract is only a tiny dot on the lens, the lens may not need to be removed. Instead, the doctor may recommend simply placing a patch over the “good” eye, and possibly having your child wear glasses or contact lenses. Patching the unaffected eye forces the eye with the cataract to develop better vision.

A patch is an adhesive covering that completely blocks the eye. They are available in fun, kid-friendly designs. Typically, the patch is worn anywhere from one hour a day to fifty percent of waking hours.

Patches are also commonly used after cataract surgery, to help the eye that had the cataract “catch up” to the other one. Your child’s doctor will determine if this is necessary.

Surgery

During surgery, a small incision is made in the eye and the cloudy lens is removed with a special instrument.

Your child may have the lens replaced with a clear, plastic permanent lens, called an intraocular lens, during the surgery. But this type of lens isn't always an option for children. This is because lens implants in young children are more likely to cause complications and it can be hard to determine the best lens power to use in a young child's eye that will also serve them best as an adult.

Most children who don’t have a lens implanted during surgery are fitted with specialty contact lenses a few days later. In some cases, this is a temporary solution used until it's time for intraocular implants. In other cases, the contact lenses work great and there's no need for more surgery.

Cataracts | Frequently Asked Questions

Why must my baby's cataract be treated right away?

An eye with a cataract can’t provide visual information to the brain. If this occurs while the brain is “learning to see,” it may learn to ignore that eye. And since vision occurs when the brain and the eye work together, your child may never be able to see with that eye, even if the cataract is eventually removed.

Do all cataracts need to be removed?

No, in some cases, the cataract may be just a dot in the middle of the lens that doesn't have to be removed because there’s room for light to get around it. Sometimes figuring out whether a cataract needs to be removed requires lots of experience and expertise, so it’s crucial that your child be evaluated by an eye doctor who sees many babies and children with cataracts.

Will my child require ultrasonography to break up her lens before it can be removed?

Probably not. Ultrasounds are used in cataract surgery for adults to break up hard lenses that are usually caused by aging. Most children don’t need ultrasound because their lenses are soft.

Do all cataracts affect vision?

No – sometimes a cataract may be so small that your child perceives no blurriness at all. But one thing to keep in mind is that unlike your circulatory or respiratory system, your experience of your visual system completely depends on how you use it.

Will my child’s cataract get worse?

This is hard to predict – some cataracts progress, and some don’t. And sometimes a child’s vision might seem like it’s starting to worsen because their visual needs are changing, even if the cataract itself isn’t changing.

Can cataracts be prevented?

Not really, although it’s important that kids wear eye protection when playing sports to lessen the chance of eye injury.

Are intraocular lenses noticeable?

Most often, the implant is invisible. Some parents say that the eye with the implant seems to have a “sparkle” or “glint” if light catches it just right, but that certainly doesn't cause any problems for your child.

Will my child need to wear glasses?

Most children will need to wear glasses after intraocular lens implants. Natural lenses can shift focus from far to near, but intraocular lenses can only focus on one place. Once children can sit up, they may need bifocals to help them focus up close and far away. If your child has been prescribed reading glasses or bifocals, they might not need to wear them all the time.

Cataracts