Cataract : Symptoms, Surgery, Treatment | Pediatric Oncall
Last Updated : 1/4/2011
Jayesh N Doctor
What is a cataract?
When natural crystalline lens of the eye becomes cloudy, it is known as cataract.

Symptoms of cataract:
- Feeling of a film covering the eye
- Glare from bright sunlight or poor vision when viewing oncoming automobile headlights at night.
- Difficulty in performing routine tasks such as reading the newspaper.

Is operation the only remedy?
Yes, it is. Unfortunately, once the lens of the eye has become cloudy, there is no medical treatment or nutritional method available till date for clearing the cataract.

It is now not necessary to wait till the cataract ripens to thick white opacity; it can be removed when it starts to interfere with normal daily activities such as reading the newspaper.

Can intraocular lenses be put in children?
Gone are the days of wearing those heavy and unsightly specs which have so many drawbacks - difficulty in crossing the road, climbing the stairs etc. Changing times and advanced technology have brought a variety of intra ocular lens implants. These are natural lens. They are UV coated; hence protect the retina from harmful effects of UV radiation.

How is cataract surgery performed?
Traditional surgery involves making a large incision of 9 to 10 mm and closing it with several stitches. This pulls the eye out of shape resulting in distorted astigmatic vision.

Phacoemulsification makes use of small, highly sophisticated ultrasonic machine. This is steered into the eyes. Localised high frequency sound waves break up the cataract into small fragments, which are then, sucked out through the instrument's hollow tubing. A thin capsule or shell is left in place. This maintains the natural anatomy of the eye. The size of the incision is only 3 mm. Intraocular lens is implanted through this opening. It is placed inside the eye in place of the natural lens. With a foldable IOL, the incision remains 3mm. The healing is fast.

There are cases where the child is born with the cataract in both or either of the eyes which will require an urgent ophthalmic check up. If the cataracts are total, surgery has to be performed fairly soon otherwise the light reflex may not develop causing almost irreversible loss of vision. Whether to put an IOL implant or not is to judged by the surgeon thorough examination of the case and keeping in mind the overall assessment and physiological development of the child. At present cataract surgery in children has been made fairly safe and also IOL implants do give good sight. But these type of cases need through follow up examinations at regular intervals. If necessary IOLs have to exchanged at a later date.

How is the refractive error after cataract surgery taken care of?
There are 3 ways of taking care of refractive errors after cataract surgery:

a) By use of glasses:
The advantage is that they provide a very sharp vision, are very convenient and simple to use. The disadvantage is that it may be difficult to play sports in them. Also when only one eye is operated for cataract surgery, then it may lead to double vision as the operated eye is a lazy eye.

b) By use of contact lenses:
The advantage is that contact lenses usually provide both vision and appearance that is very natural. They can be used even if cataract surgery was done in one eye. The disadvantage is that it is difficult to place and remove them in young children and they can get lost if the child rubs the eyes. If proper care and cleaning precautions are not taken care of, it can lead to infection in the eye.

c) By implanting a lens in place of the lens removed:
This is called as intraocular lens (IOL) implantation. IOLs provide vision and appearance that is normal and is permanent. The main disadvantage is that when the child grows, the eye also grows and focusing power of eyes can also change. Thus, the child may still need to wear glasses or contact lenses after certain ages, though not with that high number.

Can a child who had a cataract surgery in the past still have an IOL implanted now?
Yes, a child who has cataract surgery a few years ago without an IOL can still have one placed by a second operation later.

Contributor Information and Disclosures

Jayesh N Doctor
Ophthalmic Surgeon, Doctor Eye Institute, Mumbai, India

First Created : 1/11/2001
Last Updated : 1/4/2011


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