Yes, young people can get cataracts, a condition more commonly associated with aging. A cataract is the clouding of the eye’s natural lens, which is typically transparent and focuses light onto the retina. When the lens becomes opaque, it obstructs light, leading to blurred or diminished vision. While most cataracts occur later in life due to aging, they can affect infants, children, and teens, requiring specialized treatment because of the developing visual system.
Understanding the Causes of Pediatric Cataracts
The causes of cataracts in young people differ significantly from age-related changes, often relating to genetic, infectious, or traumatic factors. A significant portion are classified as congenital cataracts, meaning they are present at birth or develop shortly thereafter. Genetic mutations are responsible for many congenital cases, particularly those affecting both eyes, where changes disrupt the lens’s clarity.
Maternal infections during pregnancy also contribute to congenital cataracts, notably the TORCH group (rubella, toxoplasmosis, and cytomegalovirus). These infections interfere with fetal eye development. Inherited metabolic disorders, such as galactosemia, can also lead to cataract formation in early childhood.
Cataracts that develop after birth are called acquired or secondary cataracts, often resulting from external factors. Traumatic cataracts are common, occurring after a direct injury to the eye, such as from sports or accidents. The trauma damages the lens capsule, causing the lens material to opacify.
Secondary cataracts can also arise from underlying systemic diseases or the prolonged use of certain medications. Uncontrolled diabetes mellitus accelerates lens clouding due to high blood sugar levels. Prolonged oral or inhaled steroid use is known to increase risk, as can other eye conditions like uveitis (inflammation inside the eye).
Recognizing Visual Symptoms in Young People
Detecting cataracts in infants and children is difficult because they cannot articulate vision problems, requiring parents and pediatricians to look for physical signs. The most apparent sign, especially in infants, is leukocoria, an abnormal white or grayish reflection in the pupil, often first noticed in flash photographs where the affected eye lacks the typical red-eye effect.
Older children and teens may report symptoms similar to adults, such as cloudy or blurry vision affecting their ability to read or see at a distance. They may also exhibit increased sensitivity to light (photophobia) and a noticeable glare or halo effect around bright lights. In infants, a cataract can also lead to nystagmus (involuntary eye movement) or strabismus (misaligned eyes).
The diagnostic process begins with a comprehensive eye examination, often involving a red reflex test during routine well-baby checks to screen for opacity. If a cataract is suspected, an ophthalmologist performs a dilated eye exam to assess the size, location, and density of the clouding. Specialized visual acuity tests are used for very young children to determine the impact on functional vision.
Treatment Options and Visual Development
For cataracts that significantly impair vision, surgical removal of the cloudy lens is necessary, requiring an approach uniquely tailored for younger patients. The timing of surgery is important, especially for congenital cataracts, because the developing brain needs clear visual input. To prevent permanent vision loss (amblyopia), a visually significant congenital cataract is often recommended for removal by six weeks of age.
The surgical technique, often a lensectomy, removes the cloudy lens. The decision to place an artificial intraocular lens (IOL) during the initial surgery depends on the child’s age. IOL implantation is typically considered for children over one or two years old. Younger infants may be left without an IOL (aphakic) and rely on contact lenses or glasses until a secondary IOL can be implanted later.
Post-operative management is a long-term undertaking focused on visual rehabilitation and amblyopia prevention. After the lens is removed, the child requires continuous correction of their refractive error, usually through specialized contact lenses or glasses. The most crucial part of recovery is aggressive amblyopia therapy, which involves patching the stronger eye to force the brain to use the operated eye, ensuring the visual pathway fully develops.