About Pediatric or
Congenital Cataracts

A cataract is an opacification or clouding of the normal crystalline lens.  Cataracts can occur at different ages in children. The diagnosis of a congenital cataract which is present at birth can be made on the first day of life if a red reflex is not obtained in the newborn nursery. Early diagnosis and referral are important since irreversible damage can occur if a congenital cataract is not treated in the first few months of life. congenital cataracts can result from problems with the eye itself or from systemic disorders.  Because of this a thorough ocular and systemic evaluation should be performed in any child who presents with a cataract. A genetic evaluation may be indicated in some cases as well.

Treatment of Pediatric Cataracts

If the cataract is determined to be visually significant, surgery is indicated to remove the involved lens. Once the visual axis is cleared, the child will require optical correction to allow visual rehabilitation. This may include the use of glasses, a contact lens or an intraocular lens implant. Because of the small size of the infant eye, a high power optical correction is necessary, which often cannot be obtained by the use of glasses alone.

Glasses may also not be appropriate in a child following unilateral cataract extraction because of their magnification effect.  This can result in difficulty with clarity of vision as well as problems with the development of binocular vision. Because of these factors a contact lens is sometimes used.  These contact lenses should not be thought of as a substitute for glasses as they may be in adult patients. They are an absolute necessity for infants with cataracts or an older child with a unilateral Cataract. In some patients an intraocular lens can be implanted. Because of concerns regarding the immaturity and future growth of the infant eye, some surgeons prefer not to implant an intraocular lens in a very young child.  Amblyopia is a major obstacle to the development of good vision in these children. Amblyopia therapy is an important issue in the management of childhood cataracts. A good visual outcome is highly dependent on the compliance with amblyopia treatment.