A cataract is a clouding of the eye’s naturally clear lens, located just behind the iris and pupil. This lens focuses light onto the retina; when it becomes opaque, vision becomes hazy or blurred. While most commonly associated with aging, cataracts are not exclusively a disease of the elderly. Individuals can get cataracts at a young age, affecting people from infancy through young adulthood. This condition is often referred to as childhood, pediatric, or early-onset cataracts.
Types and Origins of Early-Life Cataracts
Cataracts in younger individuals typically arise from causes different than the age-related breakdown seen in older adults. The condition is broadly categorized based on appearance time.
Congenital cataracts are present at birth or develop shortly thereafter, often due to genetic factors. These can be isolated or part of a broader systemic issue, linked to genetic syndromes like Down’s syndrome or metabolic disorders. Maternal infections during pregnancy, such as rubella or cytomegalovirus, can also disrupt normal lens development, leading to congenital cataracts.
Developmental or juvenile cataracts form later in childhood or adolescence, often due to a genetic predisposition that manifests later. A third category is secondary cataracts, acquired due to an external factor or underlying health issue. Eye trauma is a frequent cause of secondary cataracts. Additionally, poorly controlled diabetes mellitus, prolonged use of steroid medications, or previous eye surgery can induce cataract formation in young patients.
Identifying Symptoms in Children and Young Adults
Identifying cataracts in infants and young children is challenging because they cannot verbally communicate vision problems. A significant sign often detected during routine screenings is leukocoria, an abnormal white or grayish-white reflection in the pupil visible in photographs. A white pupil reflex requires immediate medical evaluation, as it can indicate a cataract or other serious conditions.
Other visible signs include nystagmus (rapid, involuntary eye movement) and strabismus (misaligned or crossed eyes). These occur because the brain is not receiving clear visual input, hindering normal visual system development. Older children and young adults report typical symptoms, such as blurred vision, increased sensitivity to bright light, and glare or halos around light sources.
Specialized Treatment Considerations
Treatment for a cataract in a young person differs from that in an adult because the developing visual system risks permanent impairment. Timely intervention is necessary, especially for infants, because the brain needs clear images during a specific developmental window to learn how to see. If a dense cataract is not removed promptly, it can lead to amblyopia, or “lazy eye,” where the brain ignores images from the affected eye.
The surgical technique, known as lensectomy, involves removing the cloudy lens. For infants under two, an intraocular lens (IOL) is often not implanted, leaving the eye aphakic (without a lens). This accounts for the rapid growth of the infant eye, which would render a fixed-power IOL inaccurate.
A common complication is posterior capsule opacification (PCO), where scar tissue forms behind the lens, requiring a secondary procedure. In children over two, an IOL may be implanted, but power calculation is complex due to anticipated eye growth. The surgery is only the first step in visual rehabilitation, focusing immediately on maximizing visual development.
Post-Surgical Visual Development and Care
Following lens removal, the eye requires immediate, precise optical correction to focus images on the retina. If an IOL was not implanted, the child must wear a high-powered aphakic contact lens or specialized glasses to replace the missing lens’s focusing power. The prescription must be adjusted frequently as the eye grows.
A significant component of post-surgical care is managing amblyopia, often accomplished through occlusion therapy. This involves patching the stronger eye for prescribed periods to force the brain to use the eye that had the cataract. This visual training is sustained over months or years until the child’s visual system matures.
Long-term follow-up is required to monitor for potential complications, such as glaucoma, which is a heightened risk after cataract surgery in young children. Regular monitoring and adherence to the rehabilitation plan are necessary to achieve the best visual outcomes.