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Childhood Cataracts: Definition, Causes, Symptoms, Diagnosis, and Treatment
Childhood cataracts are cataracts that form in a child and are either present at birth or acquired through other causes. A cataract is the opacity of the crystalline lens that is most commonly caused by the natural ageing process. There are two main types of childhood cataracts, congenital cataracts which are present at birth and acquired cataracts which are developed after birth. The causes of a cataract include genetic factors, an eye injury and pregnancy-related infections. Cataracts in children may result in symptoms or signs such as nystagmus, sensitivity to light and blurry vision which causes the child to bring things closer to see. Keep reading to learn more about childhood cataracts and how they can be diagnosed and treated.
What is a Childhood Cataract?
A childhood cataract describes a young person who has developed a cataract in their eye or it is present at birth. Cataracts are an eye condition that commonly affects older people due to natural changes in the lens caused by ageing. A cataract is a clouding on the lens that may affect a person’s vision leading to blurry eyesight and sensitivity to light. There are two different categorisations of cataracts in children, the first is congenital cataracts which are present at birth and caused by genetics, meaning it was passed down from the parents, or from genetic disorders such as chromosomal abnormalities. The second is acquired cataracts, meaning it was developed after birth, which include traumatic cataracts and radiation cataracts.
What are the Other Terms for Childhood Cataracts?
There are many different terms for childhood cataracts with the former being a broad term for all types of cataracts. The scientific term for childhood cataracts is pediatric cataracts and it is commonly referred to as congenital cataracts although this is a type of cataracts that is present at birth. Other terms include those that describe cataracts that are developed after birth which are juvenile cataracts, developmental cataracts, infantile cataracts and acquired cataracts. Another colloquial term for childhood cataracts is baby cataracts.
How Often Do Cataracts Occur in Children?
Cataracts most often occur in older aged people as it is typically caused by the natural ageing process, therefore, it is less common for cataracts to occur in children. According to Vision Eye Institute Australia, approximately 1 in 5000 children in Australia are impacted by cataracts. On a global scale, the prevalence of childhood cataracts is a median of 1.04 in 10000 children according to a study in the National Library of Medicine. A baby born with cataracts is classified as having congenital cataracts, which is how young you can get cataracts.
What is the Age Range for Childhood Cataracts?
Childhood cataracts cover the age range of newborn to teenager. Childhood cataracts that are present at birth are known as congenital cataracts. A person can develop a cataract at a young age that is not present at birth, which is known as an acquired cataract. Types of acquired cataracts include traumatic cataracts and radiation cataracts.
What are the Different Types of Childhood Cataracts?
Childhood cataracts can be categorised into two main types, congenital cataracts which are present at birth and acquired cataracts which develop after birth. The different types of childhood cataracts and their definitions are listed below.
- Congenital cataracts: Congenital cataracts describe cataracts that are present at birth. Congenital cataracts may be hereditary or caused by genetic disorders.
- Acquired Cataracts: Acquired cataracts is any cataract that is developed after birth. Types of acquired cataracts include traumatic cataracts and radiation cataracts.
1. Congenital Cataracts
Congenital cataracts are a type of childhood cataracts that is present in a child at birth, meaning they are born with a degree of opacity in their lens. According to the Vision Eye Institute, approximately 25% of congenital cataracts are caused by genetics, meaning they are passed down by the parents, making it a hereditary condition. The other cause of congenital cataracts are genetic disorders such as metabolic or chromosomal abnormalities. Congenital cataracts may impact a baby’s ability to see as the light coming into the eye is affected by the cloudy part of the lens.
2. Acquired Cataracts
Acquired cataracts are any type of cataracts that are not present at birth. Types of acquired cataracts include traumatic cataracts and radiation cataracts. Traumatic cataracts are caused by an injury to the eye which is any trauma sustained to the eye which can be a hit in the eye, an object penetrating the eye or a chemical injury. Traumatic cataracts may develop soon after the injury or it can occur years later. According to the National Library of Medicine, surgery may be used to manage or treat this type of cataract. Radiation cataracts occur in children after they have been exposed to certain types of radiation such as radiation therapy for cancer.
What are the Causes of Cataracts in Children?
The different causes of cataracts are genetic factors, rheumatoid arthritis, eye injuries and pregnancy-related infections. These causes and their definitions are listed below.
- Genetic factors: Childhood cataracts can be caused by genetic factors which are known as congenital cataracts as the cataract is present at birth.
- Rheumatoid arthritis: Rheumatoid arthritis in children, known as juvenile idiopathic arthritis, may cause eye inflammation, leading to a cataract forming in the child’s eye.
- Eye injury: Cataracts can be caused by an eye injury, which is known as traumatic cataracts. Eye injuries can include blunt or penetrating trauma, radiation and chemical burns.
- Pregnancy-related infections: Pregnancy-related infections include chickenpox, rubella, cytomegalovirus (CMV) and toxoplasmosis. A pregnancy-related cataract is categorised as congenital cataracts.
1. Genetic Factors
Childhood cataracts can be caused by genetic factors which are known as congenital cataracts as the cataract is present at birth. There are two ways genetics can cause cataracts. The first is hereditary cataracts that were passed down from the parents. This type of cataract means there is a fault in the eye lens, causing the child to develop this condition. The second is genetic disorders, which according to the NHS may be caused by chromosomal abnormalities such as Down’s syndrome.
2. Rheumatoid Arthritis
Rheumatoid arthritis may cause cataracts in children, which is more recently known as juvenile idiopathic arthritis. Juvenile idiopathic arthritis affects children under the age of 16 and, according to the Mayo Clinic, can cause joint pain, stiffness and swelling. Certain complications of juvenile idiopathic arthritis include eye inflammation which if left untreated, may lead to cataracts among other eye conditions such as glaucoma. As eye inflammation can occur without symptoms, children who have juvenile idiopathic arthritis should be seen regularly by an eye care professional.
3. Eye Injury
Cataracts can be caused by an eye injury, which is known as traumatic cataracts. Eye injuries can include blunt or penetrating trauma, radiation and chemical burns. A childhood cataract caused by an eye injury is known as an acquired cataract as it was developed later rather than present at birth. It is important to take proper safety precautions to potentially prevent eye injuries and also cataracts caused by trauma to the eye. This can be done by wearing eye protection when playing sports and also being aware of your child’s surroundings. A cataract caused by an eye injury may present soon after the incident or it can develop years later.
4. Pregnancy-Related Infections
Pregnancy-related infections include chickenpox, rubella, cytomegalovirus (CMV) and toxoplasmosis which can be passed from the mother to the child during pregnancy. A pregnancy-related caused cataract is categorised as a congenital cataract as the infection causes this eye condition to be present at birth. According to an article published in the Therapeutic Advances in Rare Disease journal, rubella is the most common congenital infection that causes cataracts across the world.
What are the Symptoms of Childhood Cataracts?
It can be difficult to identify the symptoms of childhood cataracts as if the child is very young, they may not be able to recognise or communicate that they are experiencing issues with their vision. There are however visual symptoms that a parent or caregiver can look out for. The symptoms of cataracts in children include nystagmus or uncontrollable eye movements, bringing things closer to see, sensitivity to light and the eye lens becoming cloudy or white. The symptoms of childhood cataracts are listed below.
- Nystagmus or uncontrollable rhythmic eye movements: Nystagmus is a symptom that may develop in a child who has cataracts. Nystagmus is uncontrollable rhythmic eye movements.
- Bringing things closer to see: Childhood cataracts can cause blurry vision, requiring the child to bring things closer to see clearly.
- Sensitivity to light: Sensitivity to light is a symptom of childhood cataracts which can cause eye discomfort when looking at bright lights such as lamps and headlights.
- Eye lens becomes cloudy or white: Some cataracts can be visible through the pupil causing the eye lens to become cloudy or white.
1. Nystagmus or Uncontrollable Rhythmic Eye Movements
Nystagmus is a symptom that may develop in a child who has cataracts and it is more common in advanced cataracts. Nystagmus is uncontrollable rhythmic eye movements that can affect a person’s vision, leading to balance issues, dizziness and unstable or hazy eyesight. According to the American Academy of Ophthalmology, nystagmus, along with amblyopia and strabismus, may persist as symptoms after the cataract has been removed in surgery.
2. Bringing Things Closer to See
Childhood cataracts can cause blurry vision, requiring the child to bring things closer to see clearly such as a book. Cataracts may cause blurry vision as this eye condition interferes with the lens’ power to receive and focus light. A child who has a cataract may experience blurred or cloudy vision due to the disruptions to their lens.
3. Sensitivity to Light
Sensitivity to light is a symptom of childhood cataracts which can cause eye discomfort when looking at bright lights such as lamps and headlights. Light sensitivity is caused by cataracts as the lens of the eye is not clear, meaning when light enters the eye, it scatters.
Photophobia, which is the scientific name for light sensitivity, can cause children to squint when looking at bright lights.
4. Eye Lens Becomes Cloudy or White
When a child or person develops a cataract on the lens in their eye, it may cause the lens to appear cloudy or white. This change to the lens is caused by the cataract being visible, although it is typically only visible in more advanced cataracts. A white pupil, also known as a leukocoria, can be considered an ocular emergency in children as it could refer to other serious eye conditions. If you suspect any of these symptoms in your child, seek medical attention.
How are Childhood Cataracts Diagnosed?
Childhood cataracts can be diagnosed in the same way other eye conditions are diagnosed, through an eye test by an eye care professional. According to the Kids Health Organisation, childhood cataracts may also be diagnosed during the newborn exam which occurs after a child is born. The newborn exam assesses many different aspects of a baby such as their general appearance, growth status and neurological factors including their eyes for signs of congenital cataracts.
What are the Tests or Eye Exams Done to Diagnose Childhood Cataracts?
The tests or eye exams performed to diagnose childhood cataracts may include a visual acuity test, slit lamp exam, intraocular pressure test and fundoscopic exam. These tests and exams for diagnosing childhood cataracts and their definitions are listed below.
- Visual acuity test: A visual acuity test assesses the sharpness and clarity of a child’s vision. For young children who are unable to read, a different chart will be used with recognisable icons rather than letters.
- Slit lamp exam: A slit lamp exam examines the eyes microscopically for problems or abnormalities. It involves a microscope with a bright light looking at different structures of the eye including the lens, cornea and retina.
- Intraocular pressure test: An intraocular pressure test measures the intraocular pressure of the eye, which is the pressure inside the eye. This test is also known as tonometry and is often performed as a part of pretesting.
- Fundoscopic exam: A fundoscopic exam evaluates the back of the eye including the retina. This exam may require the child’s pupils to be dilated for better visualisation for the optometrist to examine using an ophthalmoscope.
Who Diagnoses Childhood Cataracts, Optometrist, or Ophthalmologist?
An optometrist or ophthalmologist can both diagnose childhood cataracts through specific tests such as a visual acuity test and slit lamp exam. It is also common that an optometrist or general practitioner will examine a child’s eyes and refer them to an ophthalmologist if they suspect they may have cataracts.
Are Early Childhood Cataracts Reversible?
No, early childhood cataracts cannot be reversed but they can be treated with surgery. According to the NHS, cataracts that are not treated early may lead to irreversible damage to a child’s sight, potentially causing lazy eyes and in severe cases even blindness.
How are Childhood Cataracts Treated?
Childhood cataracts are treated in a similar way to adult cataracts, which includes corrective devices such as glasses and contact lenses, and surgery. Cataract surgery is a common and safe surgery that is performed by an ophthalmologist to remove the lens affected by a cataract. This type of cataract surgery is called a lensectomy according to Cataract Kids Organisation. A lensectomy is performed in a hospital and after the surgery the child will have follow-up appointments to ensure the healing process is progressing normally. Patching may also be used to treat the symptoms of childhood cataracts when it is not severe enough to require removal through surgery. According to the Children’s Hospital Organisation, this treatment involves a patch that is worn over a child’s eye to block the sight of the eye without the cataract, forcing the other eye to develop better vision.
When do Childhood Cataracts Need Eye Surgery?
Childhood cataracts typically need eye surgery as soon as possible. In an article published in the National Library of Medicine titled, Childhood Cataract: Home to Hospital, one of the 10 key messages on childhood cataracts is that treatment is a matter of urgency in children as the earlier the surgery is performed, the better the outcome for the child’s vision. Treatment for cataracts in children should not be delayed as it could lead to irreversible vision impairment. Cataract surgery is categorised as minor surgery as, according to the North Florida Cataract Specialists, minor surgery does not require the surgeon to open the body cavity.
What is the Risk of Cataract Surgery in Children?
Cataract surgery is a very common and safe procedure although as with all surgeries, there are certain risks involved. According to the American Academy of Ophthalmology, the risks involved in cataract surgery include infection, loss of vision, retinal detachment and development of glaucoma. According to an article published in the National Library of Medicine titled, Childhood Cataract: Home to Hospital, one of the 10 key messages on childhood cataracts is that long-term follow-up on childhood cataract surgery patients is essential as it allows the doctor to monitor the child's vision and manage any complications.
What are the Age Restrictions for Childhood Cataract surgery?
While there are no specific age restrictions for childhood cataract surgery, it is important to operate as soon as possible due to the risks associated with delayed treatment. However, the type of cataract surgery that inserts an intra-ocular lens increases a child’s risk of developing glaucoma at a later age. According to the Cataract Kids Organisation, inserting an intra-ocular lens after the age of 1 or 2 typically does not increase the risk of glaucoma. According to the American Academy of Ophthalmology, operating on a child for cataract surgery before 4 weeks of age will increase the risk of complications of general anesthesia although waiting until after 6 weeks increases a child's risk of developing amblyopia. Therefore, for unilateral cataracts, it is best to operate between 4-6 weeks.
How can Childhood Cataracts be Prevented?
Cataracts are not typically preventable, although according to the Children’s Hospital Organisation, there are certain ways to prevent certain causes of cataracts such as wearing eye protection when playing sports to reduce the risk of developing traumatic cataracts due to an eye injury. According to the National Health Service (NHS), cataracts that are genetic, meaning they have been inherited from the child’s family, cannot be prevented.