A cataract is any clouding or opacity of the eye’s lens, a structure that sits behind the pupil—the hole in the iris or colored part of the eye. The lens of the eye focuses what the eye sees to make a clear image, much like a built-in eyeglass lens. Cataracts may be mild and have no effect on vision, or they can be severe and cause significant vision loss. About three out of 10,000 children have a cataract. To prevent possible vision loss, early diagnosis and treatment of cataracts by an ophthalmologist is critical.
In a healthy eye, the lens is clear. When light enters the eye, it goes through the lens to the retina, which is like the film in a camera. The retina forms a picture that is sent to the brain. To develop good vision, a child needs focused light to hit the retina so the brain receives a clear image. When an eye has a cataract, the light and image are distorted or they may not reach the retina, which keeps the eye from making a clear image for the brain.
Congenital cataracts occur at birth. The most critical period for sight development occurs from birth to 2 months old, so it is important for infants with cataracts to be diagnosed and treated as soon as possible. Early diagnosis and treatment improves the chance of preventing severe vision loss or blindness.
Most congenital cataracts develop for unknown reasons, but they can be due to certain birth conditions like Down syndrome or trisomy 21. Some pediatric cataracts are the result of abnormal lens development during pregnancy, trauma to the eye and genetic or metabolic problems.
Symptoms of congenital cataracts may include:
- Unawareness of visual world or visually disinterested
- Gray or white cloudy pupil (the hole in the iris or “colored” part of the eye)
- Missing “red eye” glow in pupil or different glow in each eye in photos
- Shaking eye movements (nystagmus)
Cataracts can also develop during childhood and may be linked with these symptoms:
- Lack of reaction to light
- Strabismus (misalignment of eyes)
- Failure to notice toys and faces
- Other developmental delays
Parents who notice these symptoms should contact their pediatrician or healthcare provider as soon as possible. An ophthalmologist can provide a thorough eye examination, confirm the presence of a cataract and determine whether treatment is needed.
Diagnosis of Cataracts
An examination by an ophthalmologist is needed to diagnose cataracts. At an initial appointment, a Riley at IU Health physician or ophthalmology technician reviews your child’s history of symptoms and any previous medical care. Afterwards, an ophthalmologist examines your child’s eyes and tests his or her vision. If a cataract is suspected, the following may be necessary:
- Slit lamp examination of both eyes (microscope examination)
- Check of the eye’s pressure
- Ultrasound to see inside the eye
- Review of family history
- Complete pediatric and development examination
Additional lab and diagnostic tests may be done as deemed necessary by your child’s ophthalmologist and/or pediatrician.
In some cases, removal of the cataract is not necessary. A physician can monitor small cataracts that do not seem likely to interfere with vision. Surgery can be delayed or even avoided if a cataract is very small or off-center. Glasses and/or patching can be used to help with visual development.
If a cataract interferes with vision, it should be surgically removed as soon as it is safe to do so, especially if a child has been born with the cataract. Moderate to severe cataracts can increase the possibility of amblyopia (lazy eye) if they are not removed. After surgery, the stronger eye may be patched to strengthen the weaker eye.
Infants and children who have a cataract require long-term vision treatment to prevent amblyopia and to treat refractive issues like nearsightedness, farsightedness and astigmatism. Our ophthalmology team can provide the on-going care and support your child needs.
Cataract surgery generally takes about one hour. If surgery is needed on both eyes, it is done one eye at a time, with a few weeks between surgeries.
The lens of the eye is like a grape. It has a skin (lens capsule) and contains softer material inside that is usually clear and flexible. To remove a cataract, a small incision is made in the eye and an opening is made in the front of the lens capsule.
The soft, cloudy inner part of the child's lens is suctioned out of the capsule. Younger children may need to have another opening in the posterior lens capsule and some vitreous gel removal (called a vitrectomy). An intraocular lens (artificial lens implant) may be inserted at the time of surgery or at a later date. Alternatively, contact lens or glasses may be used to correct vision. Your physician will recommend what is best for your child based upon age and other medical factors.
Removing a congenital cataract is considered a safe procedure, but as with any surgery, complications can occur. After cataract removal surgery, there is a slight risk of bleeding, infection or inflammation. Other risks include retinal detachment, glaucoma, displacement of the intraocular lens and capsular or vitreous cloudiness.
If the cataract is caused by a congenital condition, additional evaluation or treatment of any associated genetic conditions may be needed. Infants who have a congenital cataract may develop another cataract (after-cataract) or scar tissue that requires additional surgery or laser treatment.
Keys Points to Remember
Keys Points to Remember
- A cataract is a clouding of the lens of the eye.
- Children can be born with a cataract or develop a cataract during childhood. Some cataracts have an undetermined cause.
- It is important to diagnose a cataract as soon as possible to limit possible vision loss. In infants, treatment during the first few months of life is most effective.
- If a cataract interferes with vision, it should be surgically removed as soon as it is safe to do so, especially if a child has been born with the cataract.
- Not all cataracts need to be removed. If a cataract is small, off-center and does not limit vision, it can be monitored.
- Surgery to remove a cataract is generally safe and effective.
- Infants and children who have a cataract require long-term vision care to prevent amblyopia and to treat other vision issues.
Support Services & Resources
Support Services & Resources
Visit the trusted websites below to learn more about cataracts in children and teenagers.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The American Academy of Ophthalmology is the largest national membership association of eye MDs. Their website, EyeWiki™, has information on the diagnosis and treatment of congenital and pediatric cataracts.
This website has information for parents and health care professionals about the daily challenges of dealing with pediatric glaucoma and cataracts.
Our physicians are committed to excellence in pediatric ophthalmology care, demonstrated through participation in research at the Indiana University School of Medicine. Recent research explores the use of intraocular lens and secondary Artisan lens implants in children as a treatment for cataracts, new drugs to treat glaucoma, new therapies for macular degeneration and treatment of strabismus. We have also completed research in molecular biology of the chemical cycle of vision, neurophysiology of eye movements and physiology of blood flow in the eye.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.