Childhood Cataract Surgery
Can cataract present itself in children?
Yes, congenital and developmental cataract is a disease found in an infant or a child’s one or both eyes.
What is an Intraocular lens (IOL)?
An intraocular lens implant is a synthetic, artificial lens placed inside the eye that replaces the focusing power of a natural lens that is surgically removed, usually as part of cataract surgery.
Why is an IOL used after childhood cataract surgery?
When the natural lens is removed, much of the eye’s focusing ability is lost. To restore vision, lost focusing power is usually replaced by one of three methods. The first method is the use of glasses (spectacles). The required lens power is high and the corrective lens quite thick. This option is less desirable for cataract surgery on one eye since the magnification caused by the one thick lens may hinder binocularity. The second option is to wear a contact lens. This option can be utilized for cataract surgery on one or both eyes. However, handling and tolerating a contact lens can be difficult for some children. The third option is to place a permanent IOL inside the eye, making compliance less of an issue.
What are the considerations of cataract surgery for a child?
In addition to the infrequent risks of any intraocular surgery, (infection, bleeding, inflammation, retinal detachment, etc.) there are special considerations for a child. Children’s eyes can develop inflammation after cataract surgery, especially. Inflammation sometimes makes further surgery necessary. Glaucoma also occurs more frequently after cataract surgery in children. Lastly, cataract surgery for a child usually requires general anesthesia.
Are IOLs approved by the Food and Drug Administration (FDA) USA?
IOLs are approved by the FDA for implantation for those eighteen years and older. Use of an IOL under age eighteen years is off-label. Drugs and devices are often used off-label when a physician determines that use is in the best interest of a patient. The placement an IOL in a child’s eye is made after a thorough eye examination followed by a discussion with the parent/guardian about the risks and benefits of an IOL versus a contact lens or glasses (informed consent).
At what age can an IOL be inserted?
An IOL is frequently utilized when cataract surgery is performed after the first birthday. The use of an IOL in the first year of life, especially in the first few months of life, is investigational. If a contact lens or glasses are used initially, secondary IOL insertion can be considered when the child is older and eye growth more complete. Use of an intraocular lens is an individualized decision for each child made after discussion with the ophthalmologist. Our eye specialist Dr. Mazhry has presented international lectures on childhood cataract management.