Affiliations: Saint-Georges Hospital, Lebanon
Journal reference: https://doi.org/10.1016/j.jfo.2014.10.012
Summary: Cataract is an eye disease that alters the vision. Although it mainly happens with age, it can also be congenital. Here we describe congenital cataract and its treatment in babies.
Cataract is characterized by the loss of transparency in the lens of the eye, causing scattering of the light entering the eye and, at later stages, obscuring the light from reaching the center of vision on the retina.
Symptoms of cataract include blurry or dim vision, clouded vision, difficulty with vision at night, glare, halos, fading of colors, or double vision in one eye. Cataract may be acquired with age or due to other causes such as trauma; or it may be congenital, as in occurring before birth or during the first year of life.
The majority of cases of congenital cataract have no identifiable cause. We do know however that babies who are born premature, have had an infection before or soon after birth, or who have a family history of congenital cataract have a higher chance of being affected. The most common infections that cause this condition are the following: chickenpox, cytomegalovirus, herpes, HIV, rubella, syphilis, and toxoplasmosis.
It is important to educate parents on signs of congenital cataract that they can notice at home such as a gray or white pupil (supposed to be black), absence of “red glow” from photos, and unusual rapid eye movements.
The condition is often discovered by the doctor performing the newborn exam after the baby is born, or during a checkup by a specialist after the parents notice one of the signs mentioned above, mainly the gray spot in the middle of the pupil. Inspection of a dilated pupil by an ophthalmologist can quickly reveal the opaque lens and confirm the diagnosis.
Congenital cataracts can lead to other ophthalmologic problems including:
- Permanent low vision (lazy eye), a condition caused by prolonged obstruction of light and the lack of light stimulus to the retina which hinders the normal development of vision in young children. This condition is not correctable after the age of 8.
- Strabismus (or misalignment of the eyes).
- Glaucoma (or increased pressure inside the eye).
Treatment of cataract is surgical: the opacified lens is removed and the eye is fitted with a precise prosthetic lens capable of focusing the incoming light accurately on the retina. Special care and early treatment are key in cases of congenital cataract and can be done as early as 6-8 weeks of life with the goal of avoiding the consequences mentioned earlier of low vision, misalignment of the eyes, and increased eye pressure. After surgery the child may need to wear contact lenses or glasses to assist in reading and focusing properly.
Take home message
Parents should be vigilant when noticing any visual disturbance the child might have and immediately seek professional advice from an ophthalmologist who specializes in treating children.
Regular check ups and follow-ups must be respected and doctor’s orders of daily routines and medications must be strictly followed. In cases of congenital cataract with a genetic cause, genetic counseling for the family should be considered.
Please consult your ophthalmologist for any questions you might have about your child’s vision and to make sure the treatment schedule you are following is optimal.