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Is Surgery A Necessity For Bilateral Cataract Detected In A 3-year-old Child?
Question: Hi Dr,
My son is 3.5 years old, He is diagnosed with a bilateral cataract on a routine eye exam one month ago and, he was referred to a pediatric ophthalmologist after. Our appointment with the pediatric ophthalmologist was this morning and she told me that the cataract appears significant and central, however, she added that his vision is not that bad but not perfect as well, one eye with 20/50 and the other eye is 20/60. She also mentioned that the cataract surgery does not guarantee a significant eyesight correction and he might wear eyeglasses forever after surgery and she gave me the choice whether to proceed with surgery right away or wait and keep following up and if any further deterioration we will proceed right away.
My concern now that my son is a naughty kid and will give us a very hard time after surgery if we decided to do it right now, he is kind of a kid who can fight and scream so bad if you try to apply some eyedrops to his eyes so I do not guarantee if he will not remove eye patch when we patch his eye after the surgery, he also jumps a lot and very hyperactive.
The doctor prescribed Cyclogyl OP 1% (Cyclopentolate HCL 1%)
so my I am writing to you to kindly what do you recommend? shall we proceed with the surgery right away or follow up for some time and if any further deterioration we do the surgery??
Thank you
My son is 3.5 years old, He is diagnosed with a bilateral cataract on a routine eye exam one month ago and, he was referred to a pediatric ophthalmologist after. Our appointment with the pediatric ophthalmologist was this morning and she told me that the cataract appears significant and central, however, she added that his vision is not that bad but not perfect as well, one eye with 20/50 and the other eye is 20/60. She also mentioned that the cataract surgery does not guarantee a significant eyesight correction and he might wear eyeglasses forever after surgery and she gave me the choice whether to proceed with surgery right away or wait and keep following up and if any further deterioration we will proceed right away.
My concern now that my son is a naughty kid and will give us a very hard time after surgery if we decided to do it right now, he is kind of a kid who can fight and scream so bad if you try to apply some eyedrops to his eyes so I do not guarantee if he will not remove eye patch when we patch his eye after the surgery, he also jumps a lot and very hyperactive.
The doctor prescribed Cyclogyl OP 1% (Cyclopentolate HCL 1%)
so my I am writing to you to kindly what do you recommend? shall we proceed with the surgery right away or follow up for some time and if any further deterioration we do the surgery??
Thank you
Brief Answer:
No surgery at the moment.
Detailed Answer:
My dear,
Thanks for sending your query to us.
I personally would agree with the suggestion of keeping a watch over the child and doing the surgery later.I in my practice have half a dozen children with the same issue and am following them up.
Reasons for postponing the surgery at present are
1) I have done away with general anaesthesia in children and have been able to operate under local anesthesia in children by 11&12 year old
2) in such young children if surgery is done ,it is either without lens implantation or later on lens exchange is to be done.As the eye grows and the power of lens put in today will not be effective later on ,say 5years later.
3) After cataract surgery,as no lens is put in contact lenses are given to the children, which are another day to day hassle.
These are some of the factors I have enumerated why I prefer continuing with cyclopentolate,which is just one drop daily.
what we observed is that during some stage of intra uterine life if some factors occurred which caused cataract,there was no further development of cataract,so at times it remained stationary so surgery is planned at 12 years +,when you have a more co operative patient and reasonably assured outcome of surgery.
Though if have explained things in detail,still if you have any further query in this regard please do get back to me immediately.
No surgery at the moment.
Detailed Answer:
My dear,
Thanks for sending your query to us.
I personally would agree with the suggestion of keeping a watch over the child and doing the surgery later.I in my practice have half a dozen children with the same issue and am following them up.
Reasons for postponing the surgery at present are
1) I have done away with general anaesthesia in children and have been able to operate under local anesthesia in children by 11&12 year old
2) in such young children if surgery is done ,it is either without lens implantation or later on lens exchange is to be done.As the eye grows and the power of lens put in today will not be effective later on ,say 5years later.
3) After cataract surgery,as no lens is put in contact lenses are given to the children, which are another day to day hassle.
These are some of the factors I have enumerated why I prefer continuing with cyclopentolate,which is just one drop daily.
what we observed is that during some stage of intra uterine life if some factors occurred which caused cataract,there was no further development of cataract,so at times it remained stationary so surgery is planned at 12 years +,when you have a more co operative patient and reasonably assured outcome of surgery.
Though if have explained things in detail,still if you have any further query in this regard please do get back to me immediately.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Does 20/50 in one eye and 20/60 in the other eye is significantly bad?? I can see that he sees well, he just needs to concentrate and focus when he looks at near objects.
Brief Answer:
Vision is slightly less.
Detailed Answer:
My dear,
Thanks for getting back to me.
This is usually a adequate vision,left eye though being slightly less , children with such vision do not have any difficulty in carrying on with normal working.You have to keep in mind that the eyes are tested separately but they work in a combined manner.Such qualitative assessments are also necessary by day to day observations by family members to ascertain the time of surgery if it is to be done early.
You have to keep in mind that cyclopentolate drop will put some additional strain on near vision.
Be vigilant and have periodic check up and he will be fine.
Vision is slightly less.
Detailed Answer:
My dear,
Thanks for getting back to me.
This is usually a adequate vision,left eye though being slightly less , children with such vision do not have any difficulty in carrying on with normal working.You have to keep in mind that the eyes are tested separately but they work in a combined manner.Such qualitative assessments are also necessary by day to day observations by family members to ascertain the time of surgery if it is to be done early.
You have to keep in mind that cyclopentolate drop will put some additional strain on near vision.
Be vigilant and have periodic check up and he will be fine.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks,
What is that eye drops for ??bAnd if it is okay to give him the eye drops while he is sleeping because it is a hassle to apply it when he is awake??
What is that eye drops for ??bAnd if it is okay to give him the eye drops while he is sleeping because it is a hassle to apply it when he is awake??
Brief Answer:
Ok to give while sleeping.
Detailed Answer:
My dear,
Good of you to get back to me.
The cataract is central and this drop dialates the pupil moderately, thereby allowing the light to get in to the eye from the sides of cataract. This will help in improving the vision. The eye drop has an effective time period of 12 to 18 hours so can be safely put while he is asleep in the morning, rather than in the night when you loose effective early hours of action of eye drop.
Ok to give while sleeping.
Detailed Answer:
My dear,
Good of you to get back to me.
The cataract is central and this drop dialates the pupil moderately, thereby allowing the light to get in to the eye from the sides of cataract. This will help in improving the vision. The eye drop has an effective time period of 12 to 18 hours so can be safely put while he is asleep in the morning, rather than in the night when you loose effective early hours of action of eye drop.
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Above answer was peer-reviewed by :
Dr. Prasad
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