Cataracts in children are caused by malnutrition, low birth weight, neonatal complications such as hypoglycemia and hypophosphatemia, intrauterine infections such as rubella, and genetic variations. If you look closely, all these entities are common in the Indian scenario. The average birth weight of a child in India is about 2.8 kg, compared to 3.5 kg in the developed world. Low birth weight babies are more likely to have complications in the early neonatal period. This can result in cataract formation. Similarly, in children, recurrent episodes of diarrhea or other systemic diseases can lead to developmental cataracts. Although maternal infections are less common during pregnancy, they remain a major cause of cataracts in children. Genetic causes of cataracts are also common in India due to the presence of consanguinity and local reproduction among different populations,” says Dr. Shailja Tibrewal, Senior Consultant, Department of Pediatric Ophthalmology, Strabismus, and Ocular Genetics, Dr. Shroff’s Charity Eye Hospital, New Delhi.
Causes of cataract in children
Dr. Tibrewal notes that he shares the causes of cataracts in a child:
- Genetic variations (mutations) in the genes involved in lens formation, resulting in defective proteins and subsequent clouding of the lens.
- Infections in the mother during pregnancy, especially in the first three months. The TORCH group of infections is one of these (toxoplasma, rubella, cytomegalovirus and herpes). During pregnancy, they manifest as a fever with or without a rash.
- Injury to the lens of the eye caused by blunt or penetrating trauma is also common in children and in most cases results in traumatic cataracts.
- Down syndrome, Lowe’s syndrome, galactosemia, hypocalcemia, juvenile rheumatoid arthritis, and diabetes are all linked to infant cataracts.
- Cataracts in children can be seen in conjunction with other ocular developmental abnormalities such as persistent fetal vasculature, aniridia, and anterior segment dysgenesis where it is part of a larger developmental anomaly.
- Prolonged indiscriminate use of some eye drops (steroids) can lead to cataracts.
- Low birth weight is also associated with an increased risk of cataracts in children.
Some symptoms parents should watch out for?
Cataracts in children can occur at birth or develop at any time during childhood. When a child is very young and unable to communicate his or her vision problems, detection of the problem is often delayed. “Cataracts that are extremely dense can be seen as a whitish reflex in the center of the eye (pupil). When a dense cataract is present from birth, the eyes may not be able to remain stable and begin to twitch, resulting in abnormal eye movement. An observant mother will notice that the child cannot make eye contact or smile while looking at the mother’s face, which is normal after 2-3 months of age,” adds Dr Tibrewal.
Decreased vision in an older child can cause problems walking, getting close to watch television, and bringing objects closer to the face to see. Children often cannot express their visual problems. Some children may withdraw from social activities, avoid playing with friends, and become frightened or uncomfortable in unfamiliar surroundings due to poor eyesight. Cataracts can be discovered in school-age children during eye health screening activities. Older children may inform their parents about their reduced vision or difficulties with school work, which should not be ignored, and professional help should be sought immediately.
How is cataract detected in children?
A cataract can be detected by an ophthalmologist or eye care professional using several tests. The Arclight or direct ophthalmoscope is a simple screening tool that can detect any obstruction of light entering the eye. “A reduction in the red glow produced by the normal retina indicates such an obstruction (back of the eye). To confirm the presence of a cataract, the doctor dilates the pupil with eye drops and carefully examines the patient with a slit-lamp biomicroscope,” says Dr Tibrewal.
How is cataract in children different from cataract in adults?
Pediatric cataracts differ from adult cataracts in terms of etiology, impact on patients’ lives, consequences of non-treatment, and treatment strategies. As mentioned earlier, events during the birth and development of the child are closely related to the formation of cataracts. Better nutrition and health of mother and child can reduce the prevalence of cataracts in children in general. Dr. Tibrewal thinks that childhood cataracts may be associated with other systemic problems that also require referral and treatment. Most cataracts in adults are caused by the aging process. Compared to adult cataracts, childhood cataracts add many years of disability. If the child is not treated, the disease will haunt him or her for the rest of his life.
Blindness and untreated visual impairment negatively impact a child’s overall motor and social development. It also has an impact on their education, occupation and productivity, resulting in a greater socio-economic impact. “Long-term untreated pediatric cataracts can lead to amblyopia (lazy eye). When the developing retina and brain are deprived of high-quality images, the eye-brain connection does not develop properly. This results in amblyopia or lazy eye. Once this happens, no cataract surgery will fully restore vision,” says Dr Tibrewal. Amblyopia can be reversed with appropriate therapy in children as young as 10 years old. However, as people age, their response to treatment decreases. Therefore, it is crucial to treat infant cataracts as soon as possible.
In terms of treatment, child cataract surgery requires additional steps to prevent recurrence (following cataracts or clouding of the visual axis). If these extra steps are not taken by trained surgeons, clouding of the visual axis will occur in 100% of cases. Unlike adults, children always need glasses after surgery. This is because the child’s growing eye will change in size as he or she gets older. As a result, despite the insertion of an intraocular lens, the child may need small glasses to achieve the clearest possible vision. As mentioned earlier, amblyopia may need treatment after surgery. Therefore, repeated checkups and evaluations are necessary for years after surgery to maintain good vision quality.
How is cataracts treated in children?
Currently, the only treatment option for cataracts in children is surgery. Micro-incision surgery is used to remove the cataract lens. To replace the cataract, an intraocular lens is implanted. Despite microincision cataract surgery, stitches may be required for safety. To avoid complications, the intraocular lens is sometimes not implanted in the eye if the eyeball is small. In such cases, the child will need power glasses after the operation. When the eye has reached the correct size, the intraocular lens can be implanted. Regular follow-up is required to ensure the best possible outcome.
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