A cataract is defined as a clouding of the lens of the eye that is usually associated with aging. However, approximately 1 in 250 newborns in the US have a cataract on at least one eye at birth, or develop a cataract soon after they are born. While many cases of congenital cataracts are detected and treated quickly, it is estimated that up to 1/3rd of older children diagnosed with a cataract had it at undetected at birth. Early treatment is crucial for the brain to develop normally, and to prevent lazy eye (amblyopia) and other vision problems.
The reasons for congenital cataracts in newborns may include infection (especially measles during pregnancy), genetics, metabolic problems, inflammation, diabetes, trauma or reactions to drugs. Common tetracycline antibiotics taken during pregnancy can cause cataracts in the developing baby. Older children can get pediatric cataracts for reasons comparable to the ones above; eye injuries such as a blow to the eye are more typically the cause, associated with 40% of pediatric cataracts cases.
Most of the time, a significant congenital cataract is surgically removed and replaced with an artificial lens, a permanent or extended-wear contact lens or glasses. Sometimes the cataract is too small or on the periphery of vision and does not need treatment. Time is of the essence for a newborn as the “vision” part of their brain develops quickly. The brain uses input from both eyes to best determine what is being looked at, depth and distance. The brain can block or discount vision from the cloudy eye even after the eye is corrected. This can often be corrected through vision therapy.
A cataract that is not treated early can lead to amblyopia (lazy eye) and other problems such as an inability to stay focused on objects, nystagmus and strabismus. Since it is risky to put tiny infants under general anesthetic, the ideal timing for congenital cataracts surgery is between 6 weeks and 3 months of age. If the cataract was in one eye, some doctors will place a patch over the good eye and recommend vision therapy. This gives the brain and eye a chance to “catch up” and become as strong as the good eye.
A large percentage of the brain is dedicated to processing visual input. A child’s ability to see, read and function in the world depends greatly on having two healthy eyes that work together. Infants and children should receive regular eye exams to detect and treat vision problems such as congenital or pediatric cataracts.