Doctors' Views

Cataracts in Infants

Clouding of the eye lens by a cataract is an important and preventable cause of impaired vision and blindness in children. A new study reported in the British Medical Journal (BMJ) indicates that many cataracts in children are being missed.

Failing to detect a cataract in a baby is a potentially serious matter because surgical treatment of dense cataracts is thought to be needed within the first 3 months of life.

Routine eye examinations are recommended for all infants at birth and at 6-8 weeks of age. These examinations are being done in many countries, including the United Kingdom.

In the BMJ study, all children 15 or younger who were born in the U.K., in whom congenital or infantile cataract was newly diagnosed between October 1995 and September 1996, were studied. Data was complete for 235 of the 248 children (95%), which is an impressive measure of study completeness.

83 or (35%) of the 235 children had their cataract discovered at their newborn examination and an additional 30 (12%) at their 6-8 week examination. Therefore, only a minority (47%) of the children in the study had their cataracts detected through the eye examinations which are recommended for all newborns and 6-8 week old infants.

Although surgery for dense cataracts is (as mentioned) needed within the first 3 months of life, only 137 (57%) of the children with cataracts were seen by an eye specialist (ophthalmologist) by the age of 3 months.

To put it the other way around (and somewhat more bluntly), 98 (43%) of the children did not have their cataracts discovered in time.

A third of the children with cataracts (78 or 33%) were, in fact, not examined by an ophthalmologist until after their first birthday.

"A substantial proportion of children with congenital and infantile cataract are not diagnosed by 3 months of age, although routine ocular examination of all newborn and young infants is recommended nationally," concluded the authors, Drs. Jugnoo S Rahi and Carol Dezateux of the Institute of Child Health in London. They suggest that "new strategies are clearly needed to achieve earlier diagnosis and increase the proportion of cataracts detected through screening in the first 3 months of life."

In this study, we find it fascinating that the parents and other caregivers often suspected that the child had an eye defect before the cataract was diagnosed!

Parents, look your baby in the eye! And please call your doctor if you are at all concerned.

Source: JS Rahi, C Dezateux. National cross sectional study of detection of congenital and infantile cataract in the United Kingdom: role of childhood screening and surveillance. BMJ 1999;318:362- 365.