We understand that you may have a lot of questions when your child is diagnosed with a cataract:
- What is it?
- What does it mean?
- How will it affect my child?
We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and options fully.
Background: How we see
The structure of our eyes is complex, but put simply: light enters the eye through the pupil and travel to the lens, which gathers and focuses the light on the tissue lining the back of the eye, called the retina. The retina converts the light into nerve impulses, which travel through the optic nerve up to the brain. Read more about the different parts of the eye.
What is a cataract?
A cataract is a cloudiness in the lens, similar to a smudged window or a window with a speck in it. Just as you can’t see through a window that’s sufficiently smudged, light can’t get through a cataract. But unlike a window, a cataract can’t be “cleaned” – the whole lens needs to be taken out and replaced, with a contact lens (for infants and very young children), or a clear plastic lens (for children who are older).
A cataract can be partial (not involving the whole lens) or complete, but they’re usually partial. They can look like speckles, crystals, stripes or plaques.
How common are cataracts in children?
Around one in 5,000 children are born with a cataract. Taken together, congenital and acquired (developing later in life) cataracts occur in about .4 percent of children.
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. Here’s what we mean:
Say you’re using a magnifying glass to read some small print, and it works perfectly. Now say someone gives you something else to read, in much smaller print. The magnifying glass hasn’t changed, but it might not work quite so well for this new task. A child’s vision can be like that. Her eyesight might be perfectly fine for playing with her friends, but when it comes time to learn to read, you may discover that she needs glasses. Physiologically, her vision hasn’t changed (in all likelihood), but as her “visual demands” change, how she experiences vision might change, too.
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 her visual needs are changing, even if the cataract itself isn’t changing.
If my child is born with a cataract, when should it be removed?
If your child is born with a dense cataract, we like to remove within first two months, and definitely by four months. Often, the sooner we take the cataract out, the better the vision your child will be able to develop afterwards.
What are the complications of cataracts?
Cataracts can cause poor vision, and that means that the eye is more likely to wander, too. If this happens, we perform surgery on the eye muscles, or sometimes use Botox injections. Kids with cataracts also have a higher risk of developing high pressure in the eye (glaucoma), sometimes years later. Glaucoma may be treated with surgery or, in some cases, medicine.
Can cataracts be prevented?
Not really, although it’s important that kids wear eye protection when playing sports to lessen the chance of injury to the eye. Learn more about how to prevent eye injuries.
What causes a cataract?
Congenital (present at birth) cataracts occur when the lens didn’t form properly. Acquired cataracts are caused by abnormal interactions among the proteins that make up the lens. Over time, these abnormal interactions cause clumping, specks, opacities and/or cloudy areas to form.
About 25 percent of the time, congenital cataracts have a genetic cause, and may accompany a metabolic, hormonal or chromosomal abnormality (e.g., Down syndrome). Another 25 percent of the time, cataracts are hereditary, which means that the child’s mom or dad also had a cataract in childhood.
Some possible causes of acquired cataracts are:
- idiopathic (unknown)
- trauma to the eye
- diabetes or another metabolic disease
- steroid use
- complications from other eye diseases, such as uveitis (inflammation in the eye)
- complications from treatment of other childhood diseases, like rheumatoid arthritis
- radiation therapy after cancer
Often cataracts are idiopathic – meaning they occur for no identifiable reason.
What are the symptoms of cataracts?
While each child may experience symptoms differently, some things that they may notice include:
- cloudy or blurry vision
- decreased vision
- double vision
- lights appear too bright and/or present a glare or a surrounding halo
- colors seem faded
If your child is too young to complain about vision problems, you might notice a white pupil if you shine a flashlight into her eye. You may also be able to see a white or grayish area on her eye, but many cataracts can’t be seen with the naked eye because they’re too far back in the lens.
If many cataracts aren’t visible, what should I be watching for?
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 appropriately, 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.
Strabismus, or misaligned eyes (eyes that are not looking in the same direction), usually aren’t a sign of cataracts – most often, they’re just the result of a newborn’s poor coordination. However, sometimes strabismus occurs if there is a cataract in just one eye. Your child’s pediatrician can easily check for a cataract, and if the misalignment hasn’t gone away by 4 or so months, talk to your child’s pediatrician, who will be able to refer you to a specialist if need be.
Q: What is a cataract?
A: A cataract is a cloudiness of the lens of the eye, which is supposed to be crystal clear. Imagine if the clear lens of your camera just turned white. That's basically a cataract. Even if the lens just developed a white dot in the middle, it would still be a cataract.
Q: How do I know if my child has a cataract? Can I see it?
A: Parents occasionally notice a white pupil (or white dot in the pupil) in their baby's eye, but usually the primary care doctor notices it first. And doctors always check for cataracts in newborn babies, too.
Q: Don't only old people get cataracts?
A: It's certainly much more common for people to get cataracts as they age, but adults and children tend to have different types of cataracts. In kids, the lens clouds over because it didn’t form properly. In adults, a normal lens just gets old, hard and yellow and finally clouds over.
Q: Why must my baby's cataract be treated right away?
A: 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, if this happens, your child may not be able to see with that eye, even if the cataract is eventually removed. That’s why babies with a cataract should be referred to our Pediatric Cataract Service as soon as a cataract is discovered.
Q: Do all cataracts have to be removed?
A: 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.
Q: Will my child need to wear glasses?
A: Likely so. We often leave the eye a little farsighted (difficulty seeing objects up close) to allow for it to grow, so most children will wear glasses for their absolute best vision (which they may not need all the time).
Also, remember that the eye’s natural lenses can shift focus from distance to near, but implanted plastic lenses can only focus at one place. To compensate for this, we often put children in bifocals once they’re able to sit up. This helps them focus both up close and far away.
Q: Will my child require ultrasonography to break up her lens before it can be removed?
A: 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.
Questions to ask your doctor
After your child is diagnosed with a cataract, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. If your child is old enough, you might suggest that she write down some questions to ask her doctor, too.
Here are some questions to get you started:
- How did you reach the diagnosis?
- What treatment do you recommend for my child now? Why?
- How will you follow-up with my child?
- What will I need to do when my child comes home?
- What changes/accommodations will my child need at home or at school?
- Will my child need surgery?
- If so, what restrictions will be necessary after surgery?
- What are our options after the surgery?
- Will my child need to wear a patch? If so, for how long?
- Is there anything in particular that I should watch out for, and what should I do if I see it?
- Are there any other resources you can point me to for more information?
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