Infant Cataract: A Long & Winding Road to Achieve Vision 2020

Coimbatore, 11th July 2019

According to a report by the World Health Organization, every minute a child goes blind somewhere in the world. One of the major reasons of childhood blindness in India can be attributed to ‘Paediatric Cataract’. It affects nearly 15 of every 10,000 births in India, resulting in approximately 2,80,000 to 3, 20,000 visually impaired children being born each year. Around 10 million people have no eyesight, as a result of childhood cataract which accounts for nearly 14% of the approximate 70 million blind people affected by childhood blindness.

The good news is that paediatric cataract is treatable and can help save some of these ‘blind years’ lost by the children. It is imperative, that we keep a logical and tactical approach towards the management of childhood cataract for better diagnosis and treatment. However, better treatment is possible only after an accurate and timely diagnosis. What makes things difficult for the parents is their inability to identify that their child may be suffering from a vision defect as generally, there are not many visible symptoms at the onset of the problem. Usually, they get the child’s eyes tested only when the child complains or they notice that their child’s vision is deteriorating.

Types & Symptoms
Paediatric cataract is of two types – congenital and development. The first affects the foetus or closer to the time of birthing and is called congenital paediatric cataract. The defect can be due to reasons as varied as a nutritional deficiency in mothers, infections or drug reactions. Additionally, if a mother suffers from gestational diabetes or metabolic disorders, this can also cause the child to develop paediatric cataract as the disease from the mother can affect the child’s ocular development.

The symptoms of childhood cataract varies from child to child. It depends on many factors such as, how cloudy the lens is; where exactly is the cloudiness; if it’s one or both the eyes that are affected. Initial symptoms include blurred vision, seeing ‘halos’ around light, fading or yellowing of colours, sensitivity to light, white or grey pupil. Many such cases also turn out to be a symptom of retinoblastoma, squint eyes that look in different directions, and wobbling, rapid or uncontrolled eye movements.
Treatment & Prevention
Apart from irreversible damage to the eyesight, childhood cataracts can also cause lazy eyes and severe blindness if not treated promptly. If the cataract in child’s eye has stopped vision development, it is advisable to go for a surgical removal of the affected lens and replacing it with artificial lens and contact lenses, or even glasses in some cases. While cataract surgery improves the vision, it is impossible to measure the effectiveness of it. Possibility of having a clear vision may or may not be completely attained, and there are possibilities of reduced vision in the affected eye(s). The concern of reduced vision will always require regular follow-ups and eye check-ups.
It is unlikely that cataracts can be prevented, particularly for those who have a family history of this. This is important also because the detection of under-development or ill-condition of the ocular system is not possible in the womb. Dietary modifications may be needed as per the ongoing medications (if any). Gestational diabetes is a condition that can affect the sight of a child if the condition is mismanaged. Hence, it is important to keep it in check. As detection of under-development or ill-condition of ocular system is not possible in the womb, it is best to take up these preventive measures for a healthy development of foetus. The evaluation of health and body functions is done only after a child’s birth and hence pregnant mothers must be taken care of.
Given issues plaguing our society at large, such as poverty, ignorance and poor diets especially when it comes to women, paediatric cataract is likely to remain a cause for concern. This is where communication related to behaviour change addressing pregnant mothers and older women can make a significant difference to neo-natal health in rural India.
The surgery for paediatric cataract is very challenging, however reintegration either by glasses, contact lenses or the primary IOL implantation can prove to be helpful.
Parent Counselling
The treatment of the childhood cataract starts after surgery. Surgery is the first step towards management and betterment of the disease, post diagnosis. Parents need to understand this and make sure that follow-ups and treatment is done on a timely basis. Despite the IOL implantation, they need to assure that the child wears contact lenses or glasses. The successful management of childhood cataract is completed only if regularity in treatment and care is maintained.

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