As a parent, when you learn that your child has congenital cataracts, your mind often jumps to the worst case scenario. You may be feeling intimidated by a prospective surgery and overwhelmed by all the information available. To help ease any nerves you may have about prospective congenital cataract surgery, we've put together a simple explainer of what to expect before, during and after the procedure.

What are Congenital Cataracts?

Congenital cataracts are a cloudiness or opacity in the lens of the eye which develops while your child is still in the womb. They can occur in one or both of the eyes and vary in size and affect on the child's vision. If the cataract only occurs in one eye, the brain may stop relying on it to see a clear image. This prevents that eye from developing properly, leading to Amblyopia. 

To learn more about Congenital Cataracts and their impact on your child's vision, check out this blog.

How are Congenital Cataracts corrected?

Treatment for this condition is dependent on the size and location of the cataract. In minor cases, eye specialists may recommend a wait and see approach and schedule regular check-ups to monitor the condition. If the cataract does not resolve itself naturally, a lensectomy will be performed. This surgery is often done as soon as possible so that the child’s vision milestones are not affected.

A lensectomy is often done as an outpatient procedure and requires general anaesthesia, so you can take comfort in knowing your child will be asleep. Once asleep, the surgeon will use an eyelid speculum to hold the eye open and will make a small incision in either the sclera (the white part of the eye) or the cornea (the clear lens covering the pupil) so they can gently remove the affected lens. 

If you have been doing your own research on cataract surgery, you may have read that an Intra-Ocular Lens (IOL) will then be inserted. Most ophthalmologists do not recommend inserting an IOL in kids’ eyes as they are not yet fully developed. Children’s eyes are more spherical than adults, so, if an IOL is inserted it can distort their vision, often leading to myopia (nearsightedness). Consequently, it is more common to prescribe the use of contact lenses until the child is older and their eyes are ready to have the IOL inserted. Yes, unfortunately, this means they will likely need further eye surgery in the future but rest assure it is one of the safest procedures done by skilled surgeons in this field. 

How to prepare your child for surgery.

The best way to alleviate fears of surgery for kids and parents is through information. It is a good idea to give your child a general idea of what they will experience and why it is important, however, the delivery of this information is important. 

If they are old enough to understand, we recommend that you start by explaining to your child what congenital cataracts are and how the surgery will remove the cloudy part of their eye so they can see the world better. You can use calming words to explain that the doctor will put them to sleep with medicine so they will not feel or remember what happens during the surgery. Ask your surgeon what precautions to take before and after the anaesthesia, such as not eating or drinking and explain these to your child as well. If your child has fears about waking up during surgery, or not waking up at all, reassure them that these thoughts are completely normal, your surgeon is experienced and that complications from anaesthesia are very rare.

Depending on your child's age, it may not be appropriate to explain what happens during the procedure, as this can lead to anxiety. However, we encourage you to provide the opportunity to your child to ask questions and if this topic arises, stick to using reassuring language like "the doctor will use their special tools to remove the cloudy part of your eye so that you can see better".

It is also important to explain to kids what they may experience after the surgery, which is listed below!

What to expect after the surgery

It is easy to become alarmed or anxious when your child is in pain so we encourage you to remember that congenital cataract surgeries are common and these side effects are normal. You can expect your child to experience

• Grogginess or nausea from the anaesthesia
• Pain in the eye or eyes that were operated on
• Redness in the eyes
• Pink discharge from the eyes and nose
• Double vision
• Aftercare such as applying ointments or eye drops
• Prescription of contact lenses
• Occlusion therapy (patching)

You can relieve your child's pain through medicines like Panadol, just remember to always read the label and use only as directed. Other ways to calm and comfort your child include dimming the lights and popping on an audiobook, holding a cool washcloth on their closed eye to reduce swelling or simply lying down with them while they fall asleep. Take precautions to prevent infection by washing your child's hands regularly and encouraging them to avoid rough play, swimming or getting water in the eye for at least 1 week after surgery.

To counteract the aphakia (not having a lens inside the eye), your ophthalmologist will prescribe glasses or contact lenses for your child. Wearing these will allow light to enter their eye and focus on the retina correctly, preventing distorted or blurred vision. They will also give you eye drops to use on your child regularly following the procedure. This can sound intimidating but don’t worry, your eye care team will teach you how to use these and how to insert, remove, clean and care for your contact lens.

Your child will also need to do occlusion therapy (patching) after surgery to prevent Amblyopia (an imbalance in the strength of the eyes). By patching the stronger eye, the weaker eye is given the chance to catch up to its friend, ensuring the eyes and muscles develop at the same rate. You can learn more about why we patch the eyes in this blog. 

When should you be concerned?

If you notice any of the following symptoms, we recommend you take your child to their eye care professional or your local hospital for aftercare.

• Signs of infection, such as green or yellow eye drainage
• Vision loss
• Pain, swelling, nausea and vomiting that won’t go away
• Fever higher than 38º

We hope this explainer has helped give you a better insight into Congenital Cataract surgery, whilst hopefully easing any stress.  If you have further questions, shoot an email to hello@specklesforkids.com, DM us on social media or speak to your friendly eye care professionals.