Pediatric cataracts: When is surgery needed?
Adults aren't the only ones who get cataracts. They can develop in children, too. 
Three out of 10,000 children have a cataract, according to the American Association for Pediatric Ophthalmology and Strabismus.
"Age of presentation is variable. Some babies are born with cataracts. Other children develop cataracts at various points throughout childhood. The age of presentation depends on the cause of the cataract," says Samantha Feldman, M.D., a pediatric ophthalmologist at the Krieger Eye Institute, a LifeBridge Health center.
A cataract, whether in an adult or a child, is a clouding of the lens that can occur in one or both eyes. Pediatric cataracts can be idiopathic (meaning they can occur spontaneously without a known cause) or result from genetic disorders, infections, trauma or other systemic diseases.
Cataracts can be large or small. The size often determines whether the cataract is visually significant. If the cataract is large, Feldman says, parents may notice a white spot in the pupil or a dim or white reflex on photos taken with flash. "It is also possible for eye misalignment to develop due to the poor vision. However, poor vision may not be apparent in young kids, especially if only one eye is affected," she adds.
Although cataracts can cause blurry or cloudy vision, not all children will complain of a vision problem. This, in addition to parents sometimes missing abnormalities, is why it's important for children to get routine examinations by their pediatrician.
"Pediatricians may note an abnormal red reflex in the newborn nursery or during a routine well-child check and refer the patient to be examined by a specialist," Feldman says. "The pediatrician's office also performs vision screenings that can pick up on eye misalignment and poor vision."
Small cataracts that aren't affecting the child's vision should still be frequently monitored by a pediatric ophthalmologist. In some cases, glasses or patching may aid visual development in children with a cataract that's tiny or off center and surgery can be delayed or even avoided, according to the American Association for Pediatric Ophthalmology and Strabismus. But once it's apparent that a cataract is causing vision problems, it should be removed as soon as possible. Because children's eyes and brains are still developing, a delay in removal could lead to lifelong visual impairment. It is especially urgent to remove a visually significant cataract that is present at birth.
"Surgery may be required as early as four weeks of age," Feldman says.
Although cataract surgery performed by an experienced surgeon is generally considered safe, no surgical procedure is completely without risk. Some risks associated with pediatric cataract surgery include:
- infection
- bleeding
- inflammation
- retinal detachment
- glaucoma
- loss of vision
- lack of improvement in vision or poor visual outcome due to amblyopia
- the need for additional surgery
- displacement of the intraocular lens (an artificial lens for the eye)
- development of cloudiness in the visual axis
- anesthesia complications
Your child's pediatric ophthalmologist can explain the benefits and risks of pediatric cataract surgery in greater detail if the procedure is necessary.
"If there is a known systemic or genetic disease, such as diabetes or Down syndrome, or if there is a family history of childhood or early-onset cataracts, then a yearly eye exam is a good idea," Feldman says. "However, for most normal kids, the pediatrician will examine the child's eyes at each well visit and can refer the patient to a pediatric ophthalmologist if there are abnormalities such as an abnormal red reflex, strabismus, nystagmus or a failed vision screening."
Pediatric cataracts is one of many conditions treated by the Krieger Eye Institute team. Call 410-601-2020 to learn more about KEI services or make an appointment. You can visit lifebridgehealth.org or call 410-601-WELL for more on other services offered by LifeBridge Health, including specialty care and community events.