A congenital cataract is a condition that a baby is born with, or that develops shortly after birth where the lens of the eye is cloudy instead of perfectly clear. The lens is located at the front of the eye and focuses light and images on the back of the eye on the retina. It is essential for vision, and if it is not transparent, vision will be blurry. If a cataract is present the baby's immature nervous system will not receive the visual stimulation that it needs to develop the vision pathways in the brain and permanent vision loss will occur. If the cataract is small it may not affect vision very much, but it can lead to amblyopia, where the brain blocks out the signals of the weaker eye. Over time the optic nerve between the brain and that eye becomes non-functional and there is permanent vision loss. Congenital cataracts can affect one or both eyes, but if both are affected, one eye's cataract might be more severe than the other.
Congenital cataract occurs in 3 of 10,000 live births, making it quite rare. In only 20% of cases is there a family history of cataracts, so most are not considered genetic in origin.
Common Associated Conditions
Most children with congenital cataracts do not have significant associated conditions.
Short-term Treatment and Outcomes
The cataract will be surgically removed and vision will be corrected using glasses or contact lenses. Contact lenses can be quite effective with babies and young children who refuse to keep their glasses on; however, families might find it difficult to learn to insert the contact lens in a wiggly, resisting child.
Children may need to have their stronger eye patched for several hours a day so that they are forced to use their weaker eye. This patching (if done in a child under age 5 years of age) will cause the weaker eye's vision to improve over time. The outlook for children with successfully treated cataracts can be near-normal vision, if no complications occur and they use their corrective lenses.
Long-term Treatment and Outcomes
Children who have had cataract surgery will require ongoing visits to an ophthalmologist so that any further problems can be quickly detects and treated. They will wear corrective lenses throughout life.
Glaucoma (increasing pressure in the eye that can damage the optic nerve) and retinal detachment (injury to the delicate tissue at the back of the eye) are the main complications of cataracts. Both glaucoma and retinal detachment are treatable conditions if detected early. Therefore children with cataracts must be followed at regular intervals by a pediatric ophthalmologist so that any secondary conditions will be prompted treated.
Implications for Children's Development
Children with congenital cataracts that are promptly and successfully treated can have few to no developmental effects of their condition. They will require glasses or contact lenses, as well as close follow-up. Some children who have more complex conditions or whose eyes are only partially correctable may have low vision, and thus will require special school services, such as enlarged print, extra lighting, preferential seating in the classroom, etc. It is very important that families and teachers foster children's independence and self-confidence by normalizing their environment and routines in every way possible. The child and family should be exposed to people who live full and active lives despite their vision problems. Many resources are available to families and caregivers about low vision, and adaptations are quite readily available.
Continuous follow-up by pediatric eye specialists with extensive experience with congenital cataracts will be very important so that the growing child can take part in any new developments that might further improve the condition's outcome.
For more information, including resources for parents and general information about congenital cataracts, visit the following websites:
- Congenital Cataract
- Cataracts Support Group