Cataracts in children: Early signs and effective treatment

It is a myth that Cataracts occur only in older adults; they can also develop in children due to various factors.

Imagine trying to see through a car windshield that has fog on it. You can still see but the vision is blurry. This is how vision appears to someone with a cataract. A Cataract is a condition where the protein in the eye's lens breaks down making it cloudy, leading to blurred or hazy vision.


Causes: Cataracts in children can happen as a consequence of congenital factors, where some children are born with cataracts; developmental issues, or infections during pregnancy. Other reasons include eye trauma, inflammation and steroid-induced cataracts that occur due to steroid intake or eye drops.


EARLY SIGNS
Cataracts can affect younger and older children differently making it vital to identify the signs for effective intervention.
Younger Children:
In young children, the telling signs are:
● White or greyish discoloration in the pupil, particularly noticeable in bright light or photographs.
● Eyes may squint / not be aligned
● Infants may show signs of impaired vision by struggling to recognize faces.
● Children might experience delayed visual development, not meeting milestones like tracking objects with their eyes.
● Sensitivity to bright light can significant discomfort emphasizing the importance of early detection and care.
Addressing these symptoms promptly can lead to better visual outcomes and quality of life.




Older children:
In older, the signs that shouldn't be ignored are:
● Blurry or distorted vision – Not seeing clear images.
● Double vision - Seeing two images of an object at once.
● Misalignment of the eyes (strabismus) – Eyes don’t look in the same direction simultaneously.
● Uncontrolled eye movements (nystagmus) – Involuntary eye movements which may cause the eyes to move rapidly and may blur vision.
● Holding books or toys close to their faces.
Recognizing these early signs allows parents and guardians to seek timely medical advice, ensuring children receive the treatment they need for potential cataracts.


Treatment
Cataract treatment in children often requires surgical intervention, although non-surgical treatments are also available depending on the case.
The primary method involves removing the cloudy lens and implanting an intraocular lens (IOL).
For small or visually insignificant cataracts, a watchful waiting approach may be suitable, with regular monitoring for any vision changes. If immediate surgery isn't necessary, glasses or contact lenses can help until surgery is indicated.
Careful management with pharmacologic dilation may also be considered, keeping in mind the potential risks of complications like amblyopia.
There are a few key factors that can influence treatment decisions, such as the child’s age, cataract type, and size, and any accompanying health conditions. The timing of surgery is particularly crucial for infants under two years, who may face higher risks related to IOL implantation.
Whether a cataract is congenital or acquired also impacts treatment urgency.

Long-term management after surgery is important for monitoring visual development and preventing complications like amblyopia. Regular follow-ups with ophthalmologists are also essential for achieving the best visual outcomes as the child grows. This comprehensive approach maximizes the potential for improved vision and enhances the child’s quality of life.

(Dr. Sneha Shah, Ophthalmologist and Aesthetic Surgeon)