Did you know that cataract — generally known as safed motiya — is common among children? Data shows that in India, six out of every 10,000 children are born with such a condition and overall, it accounts for 10 per cent of childhood blindness. Doctors pointed out that the incidence of paediatric cataract is, in fact, on the rise due to multiple reasons.
A cataract is a medical condition that is a physiological degenerative change which affects the transparency of the natural lens.
It occurs when the normally transparent, crystalline lens inside the eye gets opaque or cloudy. In children, however, the reasons for this occurrence are varied, according to eye specialists.
“A congenital cataract is seen in newborn babies. It can be unilateral or bilateral and is usually associated with a history of maternal infections or other systemic anomalies like Down Syndrome,” Dr Satya Prasad Balki, an ophthalmologist at MaxiVision Eye Hospital in Hyderabad, told News18.com.
“Compared to 10 years ago, the incidence in rural areas is promising as it has declined due to good prenatal care, reduction in maternal infections and clean delivery practices. In urban population, the incidence is inverse and steadily rising due to other factors like steroid abuse, genetic aberrations, metabolic disorders, and premature births.
About 5 years ago, in my practice in an urban area, I would have seen about 6-7 cases over a year. Now, I get about 10-15 cases in a year. Although the numbers are not alarming yet, paediatric cataract has to be addressed immediately as it may have an impact on the child’s future,” he added.
Cataract among children is a leading cause of childhood blindness in India, Dr Saurabh Choudhry, chief executive officer at ICARE Eye Hospital in Noida, said.
“About 15% of cases of childhood blindness are due to heredity. India has about 3-3.5 lakh blind children of which 15% are estimated to be caused by cataract.”
According to Dr Amrita Kapoor Chaturvedi, Senior Consultant at the Department of Ophthalmology, Amrita Hospital, Faridabad: “It is estimated that 2 lakh children worldwide are blind due to cataract and that 20,000-40,000 children are born each year with this condition.”
Most cases of paediatric cataract, ophthalmologists said, get picked up during routine eye screening of children or when parents notice a white glow in their eyes as children on their own cannot comprehend a decrease in their vision.
“In our practice, we see 1-2 cataracts among every 1,000 children that we examine,” Chaturvedi from Amrita Hospitals said, adding that referred patients from other speciality departments, who also have other systemic diseases, are more frequently found to have associated cataracts.
Several factors are driving the rise in the incidence of childhood cataracts in India, Chaudhary from ICARE said.
“Childhood mortality is going down and more premature babies are surviving compared to earlier times. There is also an increase in asthma cases in children. Steroids are often used as the main line of treatment in these cases, which can cause cataract.”
What are the reasons?
Paediatric cataracts are of two varieties: congenital and developmental.
If there is a family history of cataracts in younger age groups, the odds of developing a congenital cataract are increased. Most cataracts that children are born with occur in conjunction with other eye or health issues. This form of cataract could be caused by genetic factors.
When a mother contracts an infection during pregnancy, such as measles, congenital cataracts can develop. Inadequate nutrition, metabolic issues, gestational diabetes, or adverse drug reactions in the mother could also be the cause for it.
Also, the use of steroids by the mother during pregnancy or by the child after birth can lead to cataract. Other causes of paediatric cataracts are steroid abuse, trauma, congenital glaucoma, and retinal surgery.
Some cataracts also develop after eye surgery for other issues or as a result of eye injuries known as traumatic cataracts.
Chaturvedi said children may acquire cataracts after birth because of injuries to the eye, malnutrition, exposure to chemicals or side effects of certain medicines.
Paediatric cataracts are diagnosed when suspected cases are referred to the ophthalmologist for examination. In some cases, the parents directly bring the child on noticing a white reflex in the pupil, a squinting eye or poor vision.
How to diagnose?
The primary caregivers — which includes parents, guardians and school teachers — should look out for early signs in the child such as diminished vision, failure to recognise objects, white spots in the centre of the eye, social aversion, and deviation of the eye.
However, experts said the signs of childhood cataract differ from child to child. “Some of them have cloudy lenses in either one or both of their eyes. A white dot can be seen in the children’s eyes’ black areas,” said Dr Sandeep Buttan, technical lead at Eye Health & Health System Strengthening, Sightsavers India, a non-profit organisation.
Buttan said parents can easily spot this and bring their children to the hospital for treatment. Other children may exhibit hazy vision, the ability to see haloes around light, fading or yellowing of colours, sensitivity to light, as well as rapid and jerky eye movements.
These cataracts have the potential to render an eye permanently blind.
Doctors warned that when the cataract is not found early, it persists into adolescence. Hence, regular vision testing for children is extremely important which otherwise is not a routine among Indian parents. “Long-term vision improvement depends on detecting cataract as soon as possible,” Buttan said.
What is the possible treatment?
Doctors suggest that it is imperative to treat this condition at the earliest as this is the time for the development of vision and any delay would cause a permanent loss of vision.
“The child’s symptoms, age, and overall health will influence the treatment. It will also be determined by the seriousness of the problem. The child may require glasses or contact lenses in some instances,” said Dr Digvijay Singh, head of ophthalmology department at Narayana Superspeciality Hospital, Gurugram.
Incidence of paediatric cataract is increasing, both due to increased awareness among parents and increasing risk factors, Singh added. He also said one in every 1,000 children in his OPD is diagnosed with such a condition.
Treatment modalities, experts said, are promising in paediatric cataracts. After surgery, the prescription of glasses, contact lenses or occlusion therapy can help the child to have a robust support system.
“With advances in surgical techniques and intraocular lenses, the treatment of childhood cataracts yields good results. Post-operative visual rehabilitation with glasses and amblyopia treatment is required in most cases,” Chaturvedi said.
Choudhry from ICARE said there are two critical factors for good management of paediatric cataracts — early detection and identification, and effective management through surgery or glasses.
Combined efforts of parents, surgeons, optometrists, paediatricians, surgeons, and anaesthesiologists are a must for favourable outcomes in cases of childhood cataract. Timely detection and surgery can prevent blindness.
“The best time to operate on a new-born with cataract is 6 weeks to 6 months of age, especially if there is squint or white glow in the eye,” Choudhary said.
Challenges in the cure
However, there are several challenges too in cataract surgery for children. The doctors explained that the eyes of a child are small and yet to develop fully.
Singh from Narayana Superspeciality explained that cataract surgery in a child is technically more complex than in an adult and should only be undertaken by a surgeon with sufficient experience in paediatric cataract procedures.
“There is the risk of anaesthesia. It is generally a difficult surgery because the posterior capsule of the eye has to be removed by surgeons. The power of the intraocular lens needs careful calculation. Also, the surgery requires advanced technology like microscopic biometrics,” Choudhary advised.
Post-surgery challenges include the risk of inflammation in the eye and preventing injury due to the child rubbing the eye. There is also a risk of intraocular pressure leading to glaucoma in the child.
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