Congential Cataracts in Children
A congenital cataract is a clouding of the lens of the eye which is present at birth. Normally the lens is clear and focuses light onto the retina. When the lens is cloudy, vision is very blurry. Often the cloudiness can be seen without special equipment and looks like a cloudy spot in an otherwise dark pupil. In some cases it is detected when an infant does not show any response to the world around them, which may signify cataracts in both eyes. An eye doctor can readily diagnose congenital cataracts and will advise on treatment.
Causes of congenital cataracts
Although cataracts are a common problem in older people, cataracts in young people are unusual. Congenital cataracts are very rare, occurring in just 0.4 percent of all births and often the cause is unknown. Taking tetracycline antibiotics during pregnancy or developing common infections such as rubella, measles, influenza, syphilis and other ailments may cause congenital cataracts. Other causes include:
- Down syndrome (trisomy 21)
- Chondrodysplasia syndrome
- Congenital rubella
- Conradi syndrome
- Marinesco-Sjogren syndrome
- Pierre-Robin syndrome
- Trisomy 13
- Ectodermal dysplasia syndrome
- Familial congenital cataracts
- Hallerman-Streiff syndrome
- Lowe syndrome
In some cases the congenital cataracts are mild and do not affect vision, requiring no treatment. Some cataracts only affect the peripheral portion of the lens and may not need removal. More severe cataracts will require surgery to remove the clouded lens and an intraocular lens implant will replace it.
When should the cataract surgery be performed?
There are various opinions concerning when the best time may be for the cataract surgery. There is some risk of high intraocular pressure developing after surgery which can lead to secondary glaucoma, a serious disease which can cause blindness. The can happen if the surgery causes defects in the outflow of eye fluid through the trabecular meshwork of the eye. Other causes for concern are the risk associated with giving very young children anesthesia for the surgery.
If the congenital cataracts are deemed to affect the development of the child, then the most optimal time to remove a visually significant congenital cataract is between six weeks and three months of age.
Intraocular lenses for children
Once the cataract is removed, it is absolutely vital that your child's eye is corrected with a surgically implanted lens, or with a contact lens or eyeglasses. Without vision correction at this stage the child would have extremely poor vision leading to problems with normal development. During childhood, vital vision-related connections are formed within the brain.
Concerns about eye growth can mean that an artificial lens may not be recommended or may need to be replaced as the child’s eye grows and changes. As the eye develops there are many changes in refractive and vision errors which may require different lenses. Surgery may need to be repeated to change the intraocular lens.
Is treatment of severe contacts mandatory?
Without early diagnosis and treatment, congenital cataracts can lead to the development of 'lazy eye' (also called amblyopia). This condition can then lead to other eye problems such as the inability to fix a gaze upon objects. Vision problems can greatly affect the child's learning ability, appearance, and even personality, and may ultimately affect a child's development for their entire life. For this reason, make sure your child's eyes are examined as soon as possible after your baby is born and regularly thereafter.
Getting your child to wear their corrective eyewear
Some children don't want to wear eyeglasses or contact lenses, but there are some tactics you can use that help. For contacts, use extended-wear lenses if possible, so you will need to change the contacts less often. If the child does not wake easily, you can try putting in the lenses while he or she is asleep. If you child wears eyeglasses, compliment them often when they are wearing them. Positive reinforcement works wonders, especially when it comes to self-esteem, and is generally a better tactic than being apologetic or negative about the situation. You could also try wearing glasses yourself, to set an example of normalcy and further encourage the child. (If you don't need vision correction, a pair of clear lenses in frames will work nicely.)
When choosing eyeglasses for your child, look for frames with bendable or adjustable earpieces that will fit snugly, so the glasses cannot easily be removed, damaged or lost.
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