Cataracts form when the naturally clear lens within the eye becomes cloudy. Vision can be minimally to severely affected by the opacity depending upon the size, density and location of the opacities within the crystalline lens.
The concern is given to the newborn with what is commonly termed ‘congenital cataract’. This lens opacification which can affect one or both eyes is not necessarily hereditary although at times there is a family history of this disorder. Occasionally, congenital cataracts may be a manifestation of more significant eye disease or systemic metabolic disorders. The pediatric ophthalmologist will be able to determine whether or not further testing is required after examining a child with cataracts.
During the very early weeks of life there is an enormous amount of maturation of the nervous system and visual pathways. If the eyes are not appropriately stimulated the visual processing systems in the brain will not develop. Once the critical period has passed, development of "normal" vision may not be possible. Children with significant congenital cataracts are usually recommended to undergo surgery before the age of six weeks.
The surgical process of cataract removal involves microscopic extraction of the cloudy lens while the eye is in its normal position. The eye is not removed during cataract surgery. Once the opacity has been removed an artificial lens may be inserted in the lens capsule from where the opacity was removed. If the intraocular lens is not inserted, then soon after surgery the child will be fit for a special contact lens which the parents will be trained how to care for, or glasses will be dispensed. Following surgery, amblyopia treatment is commonly needed to correct any laziness of vision induced by the cataract. Cataract extraction of the pediatric age group is a complicated surgical procedure involving specialized planning pre-operatively, complex intra-operative skill and post-operative care.
Below is a segment of a National Geographic Explorer series examining the developing infant with a specific look at pediatric cataracts. Pediatric Ophthalmic Consultants’, Dr. Marc Lustig is the featured pediatric cataract surgeon in this documentary.