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Congenital Cataracts
If you are told that your
newborn baby has a
congenital cataract, this
means
that the eye's natural lens
is cloudy instead of clear.
Vision could be hampered to
the extent that cataract
surgery may be required for
removal of your child's
natural lens (that is, the
cataract).
In about 0.4 percent of all
births, congenital cataracts
are found or soon develop.*
Not all congenital cataracts
require surgical removal,
but many do. Cataracts that
cloud only the peripheral
portion of the lens may not
need removal, because
central vision remains
unimpeded. Very small
cataracts, too, may be
considered too insignificant
to require surgery.
.
This congenital cataract
should be removed, since it
impedes central vision.
Opinions vary about when
cataract surgery should be
performed on an infant,
because of concerns about
complications such as
development of high internal
(intraocular) eye pressure
(IOP) known as secondary
glaucoma. High IOP can occur
if cataract surgery causes
associated defects in
moisture outflow structures
(trabecular meshwork) inside
the eye. Also, the use of
anesthesia for surgery
involving very young infants
can be cause for safety
concerns.
On the other hand, cataract
surgery may need to be
performed as soon as
possible to ensure that
vision is clear enough to
allow normal development of
your baby's vision system.
Some experts say the most
optimal time to intervene
and remove a visually
significant congenital
cataract is between six
weeks and three months
following the birth of your
baby. Make sure you discuss
any concerns about timing of
cataract surgery with your
eye surgeon.
Once the cataract is
removed, it is absolutely
vital that your child's eye
be corrected with a
surgically implanted lens
(intraocular lens), contact
lens or eyeglasses. Without
vision correction following
cataract surgery, the eye
will have poor vision, and
normal visual development
will be impeded.
Opinions also vary about
whether an artificial lens
should be surgically
inserted in a baby's eye
following cataract surgery
because of concerns that
normal eye growth and
development might be
hampered. IOLs also may need
to be changed out as your
child's eyes grow and
change, not because of any
difference in eye size but
because refractive or vision
errors often change.
In some cases, contact
lenses fitted on the eye's
surface (cornea) may be used
to help restore vision lost
after the natural lens is
removed during cataract
surgery. Also, eyeglasses
may be prescribed to aid
vision in lieu of an
inserted artificial lens or
contact lens.
Because it can be tough to
convince a very young child
to wear contact lenses or
eyeglasses, you might try
some of these strategies:
-
Apply contact lenses
while your child is
sleeping. If you use
extended wear lenses,
this process will be
needed only weekly or
monthly.
-
If your child wears
eyeglasses, make sure
you and other family
members frequently make
complimentary remarks
about appearance.
-
If you are a parent or
guardian and don't need
eyeglasses, consider
wearing clear lenses in
frames to inspire your
child to follow your
example.
-
Consider use of bendable
ear pieces that fit
snugly on the back of
the ear, along with
sturdy pediatric frames,
to make sure your
child's eyeglasses
aren't damaged, lost or
easily removed.
What Causes Congenital
Cataracts?
Cataracts clouding the eye's
natural lens usually are
associated with aging
processes. But congenital
cataracts occur in newborn
babies for many reasons that
can include inherited
tendencies, infection,
metabolic problems,
diabetes, trauma,
inflammation or drug
reactions.
As an example, tetracycline
antibiotics used to treat
infections in pregnant women
have been shown to cause
cataracts in newborn babies.
Congenital cataracts also
can occur when, during
pregnancy, the mother
develops infections such as
measles or rubella (the most
common cause), rubeola,
chicken pox,
cytomegalovirus, herpes
simplex, herpes zoster,
poliomyelitis, influenza,
Epstein-Barr virus,
syphilis, and toxoplasmosis.
Older babies and children
also can be diagnosed with
cataracts, known as
pediatric cataracts, for
similar reasons. However,
trauma associated with
events such as a blow to the
eye is the underlying cause
in 40 percent of cases of
cataracts in older children.
In 33 percent of cases of
pediatric cataracts,
children were born with
congenital cataracts that
may initially have been
overlooked.**
In inherited and other forms
of congenital cataracts,
abnormalities may occur in
formation of proteins
essential for maintaining
transparency of the eye's
natural lens.
Types of Congenital
Cataracts
Examples of more common
forms of congenital
cataracts include:
-
Anterior polar cataracts
are well defined,
located in the front
part of the eye's lens
and thought to be
commonly associated with
inherited traits. These
types of cataracts often
are considered too small
to require surgical
intervention.
-
Posterior polar
cataracts also are well
defined, but appear in
the back portion of the
eye's lens.
-
Nuclear cataracts appear
in the central part of
the lens and are a very
common form of
congenital cataracts.
-
Cerulean cataracts
usually are found in
both eyes of infants and
are distinguished by
small, bluish dots in
the lens. Typically,
these types of cataracts
do not cause vision
problems. Cerulean
cataracts appear to be
associated with
inherited tendencies.
Without early intervention,
congenital cataracts can
lead to development of "lazy
eye" or amblyopia. This
condition can then lead to
other eye problems such as
nystagmus, strabismus and
inability to fix a gaze upon
objects.
Such problems can profoundly
impact learning ability,
personality and even
appearance, ultimately
affecting a child's entire
life. For these and many
other reasons, make sure
your child's eyes are
examined regularly and as
soon as possible after your
baby is born
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