While most infants with congenital cataracts require no treatment and will develop proper vision, some rare cases require surgical treatment of the afflicted eye.

In these cases, doctors will surgically remove the lens where the cataract is present. In many cases, children will simply have to wear glasses or contact lenses after the procedure, but in some cases, doctors may insert intraocular lenses.

The two most common types of lenses doctors use are monofocal lenses, which can only focus on objects at a certain distance, and multifocal lenses, which can focus on objects at different distances.

What Are Congenital Cataracts?

A cataract is a misty or cloudy layer on the lens of your eye, just behind your pupil. In many people, this can cause clouded, blurry vision or difficulty seeing color, leading to problems with tasks like reading.

Congenital cataracts are cataracts found in infants. While most children’s vision is not heavily impacted by this condition, 3 to 4 infants in 10,000 are born with cataracts that will impair their vision without appropriate treatment.

In cases where treatment is necessary, doctors may operate on the afflicted eye by removing the damaged or cloudy lens. 

Types of Lenses Available for Congenital Cataracts

If a child is born with a cataract that must be treated, the most common procedure involves the removal of the clouded lens. In many cases, once the clouded lens is removed, the patient must use glasses or contact lenses to make up for the missing lens.

In other cases, a doctor may choose to implant a specially made plastic lens in place of the removed lens. These types of lenses are called intraocular lenses.

While the procedure remains the same, there are two types of lenses that can be inserted into the eye during the procedure. 

Monofocal Lens

This type of lens is only able to focus vision at a certain distance. While the lens can be set up to focus on near or medium range objects, it is most common for them to be set up to focus on distant objects.

This is generally the preferred lens type for babies with congenital cataracts.

Multifocal Lens

This type of lens has rings or different focal zones that are meant to allow the child to focus on objects both near and far, as opposed to only at a single distance. The proposed benefit of multifocal lenses is that they may be able to reduce the necessity for contact lenses or glasses.

A 2013 study found that multifocal lenses are effective, especially in cases where cataracts were bilateral, meaning that a cataract was present in each eye, not just one.

However, a more recent study conducted to compare the two types of lenses found that multifocal lenses do not provide a substantial advantage compared to monofocal lenses when it comes to childhood visual development.

Are Lenses Safe for Babies?

A 2019 study found that congenital cataract surgery is indeed safe for the patient. However, the insertion of intraocular lens may present the possibility of more complications or necessitate additional surgery if problems occur.

According to NHS, these are some of the problems that may be caused due to cataract surgery, such as these:

Posterior Capsule Opacification

This is the most common complication in cases where an intraocular lens is inserted. In these cases, cells grow over the inserted lens and may cause the child’s vision to cloud.

This requires further surgery, but the procedure is quick and should result in improved vision almost immediately after surgery

Complications With Unilateral Congenital Cataract Surgery

In many cases of unilateral congenital cataracts (only one eye is affected), the child’s vision will be weaker in the eye that has been operated on compared to the healthy eye. In these cases, doctors may recommend occlusion therapy.

Occlusion therapy involves covering the healthy eye with a patch, which is meant to force the brain to recognize signals from the weaker eye. After a period of time, vision should even out between the two eyes. Without occlusion therapy, the operated eye may not function properly, even if the affected lens has been removed.

In some cases, children who received congenital cataract surgery in only one eye can develop amblyopia, or lazy eye. In these cases, occlusion therapy may work, or further treatment may be required.

Other Potential Complications

These additional issues are possible with lens replacement surgery for congenital cataracts:

  • Glaucoma: Pressure inside of the eye can affect vision and even cause irreparable damage or blindness when left untreated. 
  • Strabismus: The eyes may look in separate directions.
  • Retinal detachment: The retina may become detached from the eye’s inner wall, causing vision problems.
  • Cystoid macular oedema: Fluid may build between layers of the retina, which can impact a patient’s vision.
  • Infections: If the eye becomes infected, prompt treatment will be necessary.

Despite the nature of these complications, they are rare. Congenital cataract surgery is generally very successful.

Alternatives to Lens Replacement

In most cases of congenital cataracts, no procedures are necessary. In these cases, doctors will organize routine checkups to make sure the child’s vision is on track and remains unaffected by the cataract.

In cases where a cataract does not necessitate surgery but may affect vision, one option is pharmacologic pupillary dilation. In these cases, doctors attempt to widen the child’s pupil to allow them to see through a part of the lens that is not clouded by the cataract.

However, in cases where congenital cataracts are predicted to impact a child’s vision, surgery is recommended. If a serious congenital cataract is left alone, a child will not develop proper vision.

References

Cataracts. (April 2022). National Eye Institute.

Cataracts in Children, Congenital and Acquired. (December 2021). American Academy of Ophthalmology.

IOL Implants: Lens Replacement After Cataracts. (April 2021). American Academy of Ophthalmology.

Comparative Analysis of Visual Outcomes of Multifocal and Monofocal Intraocular Lenses in Congenital Cataract Surgery. (January 2022). Journal of Cataract & Refractive Surgery.

Visual Outcomes and Complications of Congenital Cataract Surgery. (April 2019). Journal Français d'Ophtalmologie.

Childhood Cataracts. (April 2022). United Kingdom National Health Service.

Could New-Generation Lenses Be Considered for Children With Congenital Cataracts? (April 2022). Ocular Surgery News.

Contacts Better Than Permanent Lenses for Babies After Cataract Surgery. (March 2014). National Institutes of Health.

Congenital Cataract: a Guide to Genetic and Clinical Management. (July 2020). Therapeutic Advances in Rare Disease.

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