What will my child be able to see in the future?
This has to be the most difficult question to answer, but
the one that parents really want answered, so we'll try.
The simple answer is that it could be anything from
completely normal vision to really very little in the affected
eye(s). The reality for most children with a unilateral
cataract is normal vision in the eye without the cataract and
poor vision in the eye that was affected. Most children who
have treatment for cataracts in both eyes achieve partial
sight. Many adults who have had single cataracts removed as
children will be able to drive in the UK although there are
some hoops to jump through for the DVLA to get there. Few
adults who have had two cataracts removed as children will be
able to drive in the UK, but very few will be totally blind
either (no light perception).
In general, children who have had two cataracts removed have
better vision in each of their eyes than the vision that
children with one cataract are able to gain in their affected
eye, but children with one cataract will usually have much
better overall vision because of their unaffected eye. Not all
cataracts are best managed by their removal with a surgical
operation. The lens of the eye cannot be ‘cleared’
with any treatment with medicines, diet or even lasers. As
‘cataract’ just means that part of the lens is
opaque (cloudy) this may only be a small portion of the lens
(e.g. anterior polar) or just scattered speckles in the lens
(pulverulent) or wispy rings of haze (lamellar). Many
individuals with partial cataract will develop good eye sight
without surgery though some will require glasses. In the case
of many children with lamellar cataract, as the lens of the eye
adds new clear proteins the hazy portion is condensed in the
central core (nucleus) and vision may slowly decline and
surgery may be necessary to retain good sight. This often
happens around 5 years of age.
The other thing that makes answering this question so
difficult is the idea of ‘outcome’; medical studies
might follow children for a few years, until they're over 8, or
until they are 18 years old. Very few studies follow patients
for up to thirty years. People who've had cataracts removed as
children can and often do have changes in their vision at any
point during their lives. All of us want to know what's going
to happen to our child's vision and it's just about impossible
to know that. Many of us think that this is one of the hardest
things about bringing up a child with cataracts: if we knew
what would happen it would be easier to prepare them well for
adult life.
One (unilateral) cataract
If the cataract is found and treated early (before 3 months)
or only develops later in childhood, you are able to do all the
patching and there are no other problems with your child's eye,
there is a better chance of better vision. Some eyes still will
still remain blind, or not develop very much vision even when
everything goes well. A few children gain stereo or 3D vision
and even perfectly normal 6/6 vision, but this is an
exceptionally good result.
If the cataracts were nuclear, caused by PFV (persistent
foetal vasculature, sometimes called PHPV), the eye is smaller
than usual (microphthalmic), your child has other eye problems
or learning difficulties, the cataract was found late, you
don't manage to do the right amount of patching or there are
complications from the surgery, then your child has less chance
of developing good vision in the affected eye. It's not
impossible that they can develop some useful vision and even
quite a lot of vision, despite the odds, especially if you do
the patching well.
Because one eye can make up for the work the other eye does
very well, with a little loss of field of view and of 3D
perception, there is very little that will be a problem in
daily life for a person who only has normal sight in one
eye.
Cataracts in both eyes (bilateral cataracts)
Virtually all children who have cataracts removed from both
eyes will have a ‘visual impairment’ or VI, meaning
that their vision cannot be corrected to normal, even with
glasses / contacts lenses. In many cases this is not too far
off normal vision though. A few adults who've had two cataracts
removed in childhood may be able to drive, although the answer
to the question every parent wants to know about whether their
child will be able to drive is: probably not – until cars
are better adapted for drivers with visual impairments.
Most children will go to normal mainstream school although
the majority will need some extra support. Input from
specialist teachers often starts before even nursery school
giving advice to families on vision stimulation and on planning
school placement. Support varies in different areas of the
country and you may have a battle to get your child the right
support in class and to make sure all their educational
material is provided in a way they can see it. Having your
child placed on the register of vision impairment may help you
obtain an educational statement of needs and hopefully the
support itself.
Most people who've had cataracts removed from both eyes as
children will have visual impairment, and some will be able to
register as sight impaired / partially sighted. Some will be
able to register as severely sight impaired / blind. As sight
may get worse as we age, the older the person is who has had
the childhood cataracts, the greater the chance that they have
a more severe visual impairment.
The things that reduce vision the most for people who've had
childhood cataract surgery are:
Amblyopia / Lazy eye (the brain not learning to see
perfectly) Glaucoma (about 3 out of every 10 children who have the
surgery at under 3 months of age develop glaucoma and this may
cause a lot of vision loss) Retinal detachment (this usually happens years later)
Your child is more likely to have poor eyesight in the long
term if the cataracts were of the ‘nuclear’ type,
caused by PFV (persistent fetal vasculature, sometimes called
PHPV), the eye is smaller than usual (microphthalmic), your
child has other eye problems or learning difficulties, the
cataracts were found late, or if they have a long lifespan.
Your child is more likely to have better eyesight if
he or she had no other eye problems, learning difficulties or
immediate complications from the surgery.
It may well be that newer treatments are better in the long
term and obviously many expert specialists feel that they are,
or they would not recommend them, but it will be impossible to
say for sure until our children have grown up and grown
older. Our guesses at what outcomes may be are based on
information from people who've had older types of treatment,
about which there are published studies so unfortunately they
really aren't a very reliable guide to what will happen to
children who receive newer treatments.
Checked for medical accuracy by Miss Isabelle
Russell-Eggitt, Consultant Paediatric Ophthalmologist, Great
Ormond Street Hospital, London
Last updated: 05/08/08
|
Childhood Cataract Network
