Pediatric cataracts: Expect trauma

MIAMI — Pediatric cataract removal treatment differs from adult cataract removal, said M. Edward Wilson, MD, here at the Bascom Palmer Eye Institute Inter-American meeting.

Not only is removing cataracts different in infants and children, but ophthalmologists need to be comfortable interacting with the patient’s parents. Dr. Wilson often bases his decision to insert an IOL on how compliant he suspects the patient’s parents will be and whether the patient has inherited refractive errors from them, he said. In addition, he may inquire about the parents’ vision since the child may have inherited refractive errors as well, he said.

The subject of using IOLs in infants is largely debatable mainly because the patient’s eye growth is variable and chances of a second surgery are almost always necessary. The long-term effects of an IOL on an infant’s vision are still unknown, Dr. Wilson said.

If a patient’s parents appear noncompliant, Dr. Wilson will insert an IOL for the patient’s benefit. If the parents are compliant, he may wait until the patient is older to insert an IOL or correct a refractive disorder. In addition, Dr. Wilson bases his evaluation on what the child’s pediatrician has observed.

According to a worldwide survey by the World Health Organization, 32.6% of surgeons who perform cataract surgery on adults also remove cataract on children, 72% of pediatric ophthalmologists remove cataracts from children, and 64% of pediatric ophthalmologists had fewer than 10 cases per year, Dr. Wilson said.