What are the methods of treatment for childhood cataract?
The treatment options are:
• No surgery with periodic follow up
• Cataract removal without intraocular lens implant
• Cataract removal with intraocular lens implant
What factors decide the treatment option and the timing of surgery?
The treatment option and the timing of surgery will be decided by the ophthalmologist, based on the following factors:
• Age of the child
• Density of cataract
• Whether cataract involves one eye or both eyes
If the cataract is not very dense and the child is able to see through it, then the surgery may not be required or it may be deferred till the child reaches a age where a cataract surgery with lens implant can be done safely.
Generally the lens implantation is not preferred in a child below 2 years of age because these eyes are still in growing stage, moreover there is a tendency for severe inflammation (uveitis) in these young children and the chances of aftercataract (opacification of the capsule of lens) is almost 100%.
Cataract involving only one eye has to be treated more urgently because the chance of amblyopia is greater in these cases.
What are the complications of surgery?
Cataract surgery is very safe, but as in any surgery, complications are possible. There is a very small risk of serious bleeding or infection after the surgery. If a lens has been implanted, there is a very high chance of aftercataract formation, which may require laser treatment or even a small surgery. Even years after surgery, related eye problems such as retinal detachment can develop and threaten sight. For this reason it is very important to have a regular follow up even after the surgery is done. To examine the eye properly in an uncooperative young child after cataract surgery, the ophthalmologist may occasionally give sedative medicine or even general anesthesia.
What to do after surgery?
The care of the eye after surgery is the most important part of treatment. As we remove the lens of the eye, the refractive power of the same has to be compensated in some form to enable the eye to see properly. Also, because the lens is not there, the eye can not change the power for near work (accommodation). For this reason, the child will require to wear an additional near addition (like in presbyopia) for doing near work. The various options available for this purpose are:
• Glasses
• Contact lens
• Intraocular lens implant
The advantages of glasses are that they are very convenient and simple to use and there is no chance of harming the eye. The disadvantages are that they are very thick and heavy, and the child (especially teenagers) may not like to wear them because of poor appearance and because it hampers in sports. Moreover, they are unsuitable for children who have cataract in only one eye, because the vision from the two eyes cannot be properly combined in the brain, when one eye focuses in the normal way and the other looks through a very strong spectacle lens.
Contact lenses provide both vision and appearance that is normal. But the main disadvantage is that they have to be properly cleaned and maintained, or else there is a small risk of infection. It may be difficult to place them in the eye and to remove them for cleaning especially in small children between 1 to 5 years of age. Also the chances of losing the contact lens is also very high in this age group.
Intraocular lenses are a very good option, as they do not require any maintenance. But these are not preferred in children below 2 years of age. They also have a higher chance of developing aftercataract.
The best form of visual rehabilitation for child is a very complex decision and the ophthalmologist will decide after discussing these issues with the parents.
Amblyopia therapy: In some cases of cataract in children below 5-6 years of age, especially in those where only one eye is involved, the child may have to be treated for amblyopia.
