Congenital Cataract

Definition:

Cataract is a visual impairment in which the eye lens is cloudy (while in normal conditions it is clear and transparent).

The lens is located behind the iris and concentrates the light on the retina.

The retina is an inner layer located at the back of the eye. The purpose of the retina is to receive light that the lens has focused.

In a normal eye, light penetrates through the pupil and the cornea and lens focus this light on the retina.

In a lens with cataract, the light cannot go through and as a result the retina does not capture lights or images clearly.

Congenital cataract is usually not progressive (gets worse). In some cases, the cataract appears initially only in a small portion of the lens (and will not affect eyesight), but after a while the cataract might spread, a bigger part of the lens becomes cloudy and the eyesight deteriorates.

A cataract may appear in one eye or in both eyes, but it does not pass from one eye to the other.

 

Symptoms:

  • Blurry vision
  • Blinding by strong lights, sunlight and light reflecting from a smooth surface. The child sees an aura around the object.
  • May cause strabismus – the eye rotates because it cannot focus correctly.
  • Sometimes, when shining a light on the eye or when taking a picture of the baby, there is a white reflection in the pupil, instead of the usual black or red

 

Types of cataract in young children:

  • Congenital cataract: the baby is born with a cataract or develops one at a young age
  • Traumatic cataract: cataract that might develop after an eye injury
  • Secondary cataract: a cloudiness that develops after cataract surgery. In fact, this is not a cataract, but turbidity of a membrane residue left after the surgery

 

Causes of congenital cataract:

Every abnormality in the lens structure might lead to cloudiness. It may be due to a genetic disorder or certain problems during pregnancy. Metabolic disorders and trauma to the mother or the fetus might cause formation of cataracts in the baby’s eyes.

 

Effects of congenital cataract:

In a baby born with cataract, there is a lack of stimulation to the still undeveloped visual system. Lack of these stimulations slow down the normal development of eyesight. If the cataract is not treated properly, strabismus, amblyopia (lazy eye) and nystagmus (in case the cataract affects both eyes) may develop in the future. Without sufficient stimulations during the critical time, which is the child’s first years of life, central vision might be damaged for good. Some degree of peripheral vision may remain functional, but eyesight in general is very poor.

When the cataract affects only one eye, the child’s brain will create good connective circuits with the good eye, and only rarely sight in the affected eye will be normal. When the cataract affects both eyes, it may be thicker or more condensed in one eye. If the picture is clearer in one eye compared to the other, than using this eye will become favorable with further inhibition of sight development in the other eye. In many cases where cataract affects both eyes, eyesight will eventually be quite good, with the right treatment and if further complications do not develop.

 

Treatment – cataract surgery:

Children born with cataract go through surgery as close to their birth as possible. The cloudy lens is removed, causing post-operative mild pain or no pain at all. To maximize the child’s ability to see after the surgery, he should wear glasses or contact lenses customized to his visual capacity. At an older age, a lens transplant may be performed. Without visual aids after surgery, eyesight might remain poor without the possibility to achieve spontaneous improvement.

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