Understanding and Managing Paediatric Cataracts: Early Identification and Treatment

While cataracts are typically associated with advanced age, it is not uncommon for children to be affected by this condition as well. In India, the incidence of paediatric cataracts is 6 per 10,000 live births and accounts for 10% of childhood blindness.

In adults, cataracts are typically a physiological degenerative change that occurs as a consequence of aging and affects the transparency of the natural lens. However, the reasons for paediatric cataracts are varied. Congenital cataracts, which are present at birth, can be unilateral or bilateral and are often associated with a history of maternal infections or other systemic anomalies such as Down syndrome. In cases of partial cataracts (less than 3mm) that do not impede vision, surgery can be avoided or deferred for a later stage. If surgery is necessary, it is usually performed within the first 6 weeks to prevent amblyopia. It is important for parents to consult a paediatric ophthalmologist who is experienced in paediatric surgery as the procedure is different from that for adults. Other causes of paediatric cataracts include steroid abuse, trauma, congenital glaucoma, and retinal surgery.

The role of primary caregivers, such as parents, guardians, and schoolteachers, cannot be overstated in identifying and addressing paediatric cataracts. These individuals should be vigilant for early signs of the condition in children, such as diminished vision, failure to recognize objects, white spots in the center of the eye, social aversion, and deviation of the eye. Early treatment is crucial as this is the time for development of vision and any delay may result in permanent loss of vision.

Treatment modalities for paediatric cataracts are promising and may include surgery, prescription of glasses or contact lenses, and occlusion therapy. The child should have a robust support system in place to encourage and motivate them throughout the rehabilitation process, as visual rehabilitation takes time and requires active participation and coordination between the doctors and the family.