Pediatric Cataracts

Diagnosis and Evaluation The diagnosis of a congenital cataract 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. Irreversible damage will occur if a congenital cataract is not treated in the first few months of life.

Because of the association of cataracts with other ocular and systemic disorders, 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 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 short diameter of the infant eye, a high power optical correction is necessary, which eliminates the use of glasses in an infant. Glasses may also be contraindicated in a child following unilateral cataract extraction because of their magnification effect and impediment to binocular vision. 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. Although contact lenses have long been the gold standard in the rehabilitation of children with cataracts, many ophthalmologists now consider implanting an intraocular lens in the appropriate pediatric patient. 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.

Prognosis Children with bilateral cataracts tend to do better than those with unilateral cataracts. Amblyopia is a major obstacle to the development of good vision in these children. Amblyopia therapy is the single most important issue in the management of childhood cataracts. A good visual outcome is highly dependent on the compliance with amblyopia treatment. Other complications that can develop at any time following cataract surgery include retinal detachment and glaucoma.