Undoubtedly, you were distressed when you learned that your child has a cataract. The good news is that cataracts in kids are definitely treatable, and it's entirely possible to lead an active, normal life with good vision afterwards. And since the treatment process for cataracts extends into well after the surgery, parents are able to play a large role in their child's care.
While our specialists develop customized treatment plans for each child, they most often begin with a surgeon completely removing the lens that has the cataract. In some cases, we may recommend postponing the placement of an artificial lens inside the eye until the child is older, and using contact lenses in the meantime.
Why postpone the placement of an artificial lens?
After surgery, the lens that developed a cataract has been removed, leaving the eye very much out of focus. This focusing power needs to be replaced. This can be done with contact lenses, eyeglasses, or with an intraocular lens – a clear, plastic, permanent lens that the surgeon fits into the space where the old lens used to be. Since it's considered to be a permanent solution, many people prefer this kind of lens.
But it can be hard to guess how strong this new permanent lens should be - a little like looking at a baby's feet and predicting her shoe size as an adult. The older your child is, the easier it is to predict the lens power she'll need, and the less likely it is that she'll need to have surgery later in life to get a new lens.
When a child is born with a dense cataract, or develops one before her brain has learned to see, it's extremely important that the cataract is removed as soon as advisable.
When should my child have surgery?
Each child and cataract is different, but a general rule is that the older the child, the less urgent it is that the surgery be done “soon.” This means that some cataracts can be managed without surgery for months or years.
My child's doctor recommended surgery, but why can't she just wear glasses or contact lenses instead?
Glasses or contact lenses don't clear the cloudy area. A cataract is a different kind of eye problem than being farsighted or nearsighted. Of course, some children might have a cataract and also be farsighted or nearsighted glasses, and it's not uncommon for children to need to wear glasses at least some of the time after cataract surgery.
Can cataracts be treated medically?
No, there is no medicine to treat cataracts. The lens has to be removed and replaced.
Surgery to remove the cataract
Will my child need to be hospitalized overnight before or after the surgery?
In most cases, no. But if your child is younger than 1 month, we usually have her stay overnight just so we can make sure there are no complications after general anesthesia.
Will my child be asleep during the surgery?
Yes, we use general anesthesia for the surgery. If you think it's helpful for your child, you're welcomed to come into the operating room and stay with her until she falls asleep. After the surgery, you will be brought into the recovery room just as your child is waking up.
What happens during cataract surgery?
After your child goes to sleep with anesthesia, her eyelids are gently opened, and a small incision is made in the eye. The cloudy lens is removed with a special instrument. If the surgeon is going to replace the cloudy lens with a plastic intraocular lens, the lens is injected through the same tiny incision and unfolded to its full size, sort of like assembling a ship in a bottle. Then the surgeon will place some dissolvable sutures to close the incision, and finally place a patch and a shield over your child's eye.
Most children who haven't had a lens implanted at this time are fitted with specialty contact lenses a few days later through our Contact Lens Service.
How long does the surgery take?
We usually plan to be in the operating room for one to two hours for cataract surgery – but please don't be concerned if we seem to be taking a long time; this may happen for a variety of routine reasons, such as getting started later than expected.
What happens after surgery?
After surgery, we put a patch and shield over your child's eye. Most children will sleep for several hours after the surgery, and most of the time, you and your child can go home within a few hours of the surgery.
We'll send you home with a prescription for eye drops for your child, and make sure you know everything you need to know about how and when to give them. Your child will wear a shield to protect her eye from accidental injury for days or weeks following the surgery. If your child wears glasses, they can be worn instead of the shield during the day.
Young children tend to recover quickly from surgery, usually behaving normally by the next day or so. Older children may be uncomfortable for a few days, which is often due to a scratching or itchy feeling in the eye. Some find that Tylenol or ibuprofen is helpful.
Lenses – intraocular or contact
It's important to remember that removing the cloudy lens is just the beginning of treatment.Without a lens to focus light, vision is blurrier than ever; so your child will most likely need either an intraocular lens (a permanent lens implant) or contact lenses.
1. Intraocular lenses
When adults have cataract surgery, the cloudy lens is often replaced on the spot with a clear, plastic permanent lens. The benefit to an intraocular lens is that once it's in, the patient can usually just forget about it. But for children, this type of lens isn't always an option for a couple of reasons:
- Since an eye that's still growing and developing is more sensitive to foreign invaders, lens implants in young children are much more likely to cause complications (e.g., inflammation).
- It can be hard to determine the best lens power to use in a young child's eye that will be useful to her both now and as an adult.
Children's pediatric ophthalmology expertise comes in handy here. We use smaller incisions to ensure less trauma and disruption to the eye during surgery – we've successfully implanted intraocular lenses in babies as young as one month old. And we also use customized computer software to model the growth of the eye, and predict lens specifications that will work for your child now and into adulthood.
Still, because of the potential complications mentioned above, not every child is a candidate for a lens implant. You and your child's doctor will work together to determine the best course for her care.
Why is my child's doctor recommending both an intraocular lens and glasses?
Most children need glasses after intraocular lens implants. There are a few reasons for this, including:
- Reading glasses may be prescribed because we often have to leave the eye a little farsighted to allow for the eye to grow.
- The formulas, while quite exact, can never predict the final power of the eye perfectly.
- Natural lenses can shift focus from far to near, but intraocular lenses can only focus on one place. Once children are able to sit up, we often put them in bifocals to help them focus up close and far away.
If your child has been prescribed reading glasses or bifocals, she might not need to wear them all the time – only when she needs her best vision.
Are intraocular lenses noticeable?
Most often, the implant is invisible. Some parents say that the eye with the implant seems to have a “sparkle” or “glint” if light catches it just right, but that certainly doesn't cause any problems for your child.
2. Contact lenses
Most babies and young children wear contact lenses post-surgery, and if you're like most parents, you may be daunted by the idea of putting in your child's contact lens. It's true that it's not always so easy in the beginning, but don't worry– as the process becomes part of everyday life, you'll get better at it, and most parents find that their kids become quite accustomed to it. These lenses usually last about six months.
Infants in particular wear soft contact lenses. They're easier to put in and take out than you might expect, because they're pretty thick – not very floppy, like the ones most adults use. Our staff has helped lots of parents become comfortable with this process, and we'll help you, too. Watch a video about putting in and taking out contacts for your infant or toddler.
In some cases, this is a temporary solution used until it's time for intraocular implants; other times, the lenses work great, everyone is happy and there's no need for more surgery.
If your child has a cataract in one eye, the other eye will usually do most of the work. This means that vision in that eye gets stronger, and the eyes don't develop at the same rate. Patching the “good” eye forces the other eye to develop better vision, to compensate.
When are patches used?
1. Sometimes, if the cataract is only a tiny dot on the lens, the lens may not need to be removed. When that happens, we may recommend simply placing a patch over the unaffected eye, and maybe having your child wear glasses or contact lenses, too. We'll routinely monitor your child to make sure her vision isn't slipping.
2. Patches are also commonly used after cataract surgery, to help the eye that had the cataract “catch up” to the other one.
What does the patch look like?
It's an adhesive covering that completely blocks the eye, and they're available in fun, kid-friendly designs.
Will my child have to wear the patch all the time?
Most likely not. Your child's doctor will provide guidance, but typically the patch might be worn anywhere from one hour per day to fifty percent of waking hours.
How long will my child have to wear the patch?
This also varies:
- If only one eye had a cataract, your child might wear the patch for several years on a part-time basis. This is to help develop vision in the eye that had the cataract, because there's a lot of competition from the normal eye.
- If both eyes had cataracts, they're about the same, so there's isn't one stronger eye. If one eye is developing more quickly, we'll patch it to give the other one a chance to keep up.
If only one of my child's eyes had a cataract, will it catch up to the other eye?
A perfectly normal eye will always develop more normal vision than an eye that's had a cataract.
Is there anything I can do to help my child at home?
Help her with her contact lenses when needed, and encourage her to wear her patch (if prescribed). Other than that, your child just needs to be a child. Reading (especially books that encourage close looking, like Where's Waldo), coloring and playing with toys that draw on hand-eye coordination are all good ways to promote her vision development. We can suggest other activities too, and may be able to put you in touch with a family in a similar situation.
Are there activities my child should avoid after surgery?
Yes, for a little while. No heavy lifting, rough play, or high speed sports such as biking for several weeks, and we ask that your child stay out of swimming pools for two weeks. Showering, taking baths and washing hair are OK, but avoid getting water in the eye.
How often will my child need follow-up appointments?
Post-surgery, your child's team will most likely want to see her after one day, one week, and typically after one month. After that, we usually see children under 4 about every three months, and older children every six months. Then once her vision is recovered, we usually schedule annual visits.
One of our ophthalmologists is available to answer your questions and provide assistance 24 hours a day. If your child has any problems after you get home, please do call our office.
Coping and support
We understand that you may have a lot of questions if your child has a cataract. Will it affect my child long-term? What do we do next? We've tried to provide some answers to those questions here, but there are also a number of other resources to help you and your family through this difficult time.
Patient education: From the first visit through follow-up care, our staff will be on hand to walk you through your child's treatment and help answer any questions you may have — How long will my child be in the hospital? How often will my child require follow-up? They will also reach out to you by phone, continuing the care and support you received while at Children's.
Parent to parent: Want to talk with someone whose child has been treated for a cataract? We can put you in touch with other families who have been through the same experience that you and your child are facing, and share with you their experience at Children's.
Faith-based support: If you need of spiritual support, we will help connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
Social work and mental health professionals:We can offer counseling and assistance with issues such as coping with your child's diagnosis and dealing with financial difficulties.
On our For Patients and Families site , you can learn all you need to know about:
- getting to Children's
- navigating the hospital experience
- resources that are available for your family
Other online sources of support include: