Childhood cataracts are caused by malnutrition, low birth weight, neonatal complications such as hypoglycemia and hypophosphatemia, intrauterine infection such as rubella, and genetic variations. If one observes closely, all these institutions are common in the Indian scenario. average birth weight of a baby India About 2.8 kg compared to 3.5 kg in the developed world. Low birth weight babies are more likely to develop complications in the early neonatal period. This can result in cataract formation. “Similarly, in children, recurrent episodes of diarrhea or other systemic illness can cause developmental glaucoma. Although maternal infections during pregnancy are becoming less common, they remain an important cause of glaucoma in children.” Genetic causes of cataract are also common in India due to presence of blood relation and local breeding among many populations,” Dr. Shailja Tibrewal, Senior Consultant, Department of Pediatric Ophthalmology, Strabismus and Ocular Genetics, Dr. Shroff Charity Eye Hospital, New Delhi says. ,
causes of cataracts in children
Dr Tibrewal shares the causes of cataract in children:
- Genetic changes (mutations) in genes involved in lens formation, resulting in defective proteins and subsequent lens opacity.
- Infection in the mother during pregnancy, especially in the first trimester. Infections of the TORCH group are among these (toxoplasma, rubella, cytomegalovirus and herpes). During pregnancy, they manifest as rashes with or without fever.
- Injuries to the lens of the eye due to blunt or penetrating trauma are also very common in children and, in the vast majority of cases, result in traumatic cataracts.
- Down syndrome, Lowe syndrome, galactosemia, hypocalcemia, juvenile rheumatoid arthritis, and diabetes are all associated with childhood cataracts.
- Childhood cataract may be seen in association with other eye development abnormalities such as persistent fetal vasculature, aniridia and anterior segment dysplasia, where it is part of a larger developmental anomaly.
- Long-term indiscriminate use of certain eye drops (steroids) may lead to cataract.
- Low birth weight is also associated with an increased risk of cataracts in childhood.
What symptoms should parents look out for?
Childhood cataracts may be present at birth or may develop at any time during childhood. When a child is very young and unable to explain their vision problems, there is often a delay in detecting the problem. “Cataracts that are extremely dense can be seen as a whitish reflex in the center of the eye (pupil). When a dense cataract is present from birth, the eyes are unable to remain fixed and tend to move, resulting in There are abnormal eye movements. An observant mother will notice that the baby is unable to make eye contact or smile while looking at the mother’s face, which is normal after 2-3 months of age,” says Dr. Tibrewal.
Decreased vision in an older child may cause difficulty walking, getting closer to watch television, and bringing objects closer to the face to see. Children are often unable to express their visual issues. Some children may withdraw from social activities, avoid playing with friends, and feel fearful or uncomfortable in unfamiliar surroundings because of poor vision. Cataracts can be detected in school-age children during eye health screening activities. Older children may inform their parents about their low vision or difficulties with school work, which should not be ignored, and professional help should be sought immediately.
How is cataract detected in children?
Cataracts can be detected by an eye doctor or eye care professional using a variety of tests. The ArcLight or Direct Ophthalmoscope is a simple screening tool that can detect any obstruction to light entering the eye. “A decrease in the red glow produced by a normal retina indicates such an obstruction (at the back of the eye). To confirm the presence of a cataract, the doctor dilates the pupils with eye drops and examines the patient’s eye with a slit lamp biomicroscope.” examine carefully,” says Dr Tibrewal.
How is childhood glaucoma different from adult glaucoma?
Childhood glaucoma differs from adult glaucoma in terms of aetiology, impact on patients’ lives, consequences if left untreated, and management strategies. As stated earlier, events that occur during a child’s birth and development are closely related to the formation of a cataract. Better maternal and child nutrition and health may reduce the prevalence of childhood cataracts overall. Dr. Tibdewal feels that childhood glaucoma may be associated with other systemic problems that also require referral and treatment. Most cataracts in adults are caused by the aging process. When compared to adult glaucoma, childhood glaucoma adds several disability years. If the child is not treated, the disease will follow him for the rest of his life.
Blindness and untreated visual loss have a negative impact on a child’s overall motor and social development. It also has an impact on their education, occupation and productivity, resulting in a huge socioeconomic impact. “Long-term untreated pediatric glaucoma can result in amblyopia (lazy eye). When the developing retina and brain are deprived of high-quality images, the eye-brain connection fails to develop properly. This results in Amblyopia, or lazy eye, occurs. Once this happens, no cataract surgery will be able to restore vision completely,” says Dr. Tibrewal. Amblyopia in children under 10 years of age with the right treatment Cataracts can be reversed. However, as people get older, their response to treatment tends to decrease. As a result, it is important to treat pediatric glaucoma as soon as possible.
In terms of management, additional steps are needed to avoid pediatric cataract surgery recurrence (post-cataract or visual axis opacification). If these additional steps are not taken by trained surgeons, visual axis opacification will occur in 100% of cases. Unlike adults, children will always need glasses after surgery. This is because the size of the growing eye changes as the child ages. As a result, the child may need smaller glasses to achieve the clearest vision possible, despite the intraocular lens being inserted. As stated earlier, surgery may be required to treat amblyopia. Thus, maintaining good vision quality requires frequent check-ups and evaluations for years after surgery.
How is cataract treated in children?
Currently, the only treatment option for childhood cataracts is surgery. To remove the lens of the cataract, micro-incision surgery is used. To replace a cataract, an intraocular lens is implanted. Despite micro-incision cataract surgery, sutures may be required for protection. To avoid complications, the intraocular lens is sometimes not implanted in the eye when the eyeball is small. In such cases, the child will need high powered glasses after the surgery. When the eye reaches the proper size, the intraocular lens can be implanted. Regular follow-up is needed to ensure the best possible results.
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