UAB Medicine News
Confronting Congenital Cataracts
Congenital cataracts, an opacification of the eye lens, are typically diagnosed at birth or infancy. As an embryo’s eye begins to form, a blood vessel develops that runs through the gel of the eye and functions much like an umbilical artery. The vessel inserts in the developing lens and surrounds it with nourishing blood vessels. This is similar to an umbilical cord, but instead, this cord nourishes the lens, says Martin S. Cogen, MD, professor and Division Chief of Pediatric Ophthalmology and Strabismus in the Department of Ophthalmology. Typically, after the lens is fully developed this artery isn’t needed anymore and just disappears near the second trimester.
Once in a while this process goes awry and part of the artery doesn’t disappear properly—leaving a defect in the lens. This defect progresses and eventually forms a cataract in the eye, continuing to cloud the lens until the child can’t see anymore. This is one of the more common forms and causes of congenital cataracts in children.
This was the case for then 8 month-old Anderson Glover, of Knoxville, Tennessee. In 2010, Anderson was diagnosed with a congenital cataract in his left eye. His family was told by a pediatric ophthalmologist in Knoxville they had detected the cataract too late, and that it wasn’t going to be fixable.
Anderson’s parents, Melissa and Brandon Glover, conducted their own research and decided they should get a second opinion with Dr. Cogen at Callahan Eye Hospital. They traveled to Birmingham over the long Martin Luther King Jr. holiday weekend in January 2011, and were right away comforted and impressed by Cogen’s frankness and passion for pediatric ophthalmology.
“He was a straight shooter from the start,” Melissa says. “He explained our options from worst to best-case scenario. He told us what this meant for our child. Dr. Cogen gave us hope and a chance to correct Anderson’s vision, and that is all we needed. At this visit we decided to go ahead with cataract surgery using an artificial lens implant, and returned to Birmingham in February 2011 to have the surgery.”
“Over time, the pediatric ophthalmology community has learned that, in many cases, artificial lens implants are a desirable way to treat congenital cataracts,” Cogen says. The cataract has to be removed surgically, and then an intraocular lens can be implanted to replace the defective human lens. After the surgery, the real work begins by patching the child’s dominant eye—a tedious process of covering a child’s better-seeing eye for multiple hours a day to allow the brain to communicate with the weaker eye.”
After the surgery, the Glover family began patching Anderson’s dominant eye. For any parent with a young child, this can be a difficult task. Having to cover their child’s better-seeing eye for several hours a day, along with driving back to Birmingham to check on Anderson’s progress, was a lot to juggle for two working parents with small children. The experience was a challenge, but as Dr. Cogen informed them, it would be worth the struggle.
Dr. Cogen described the process as a marathon, not a sprint, informing the Glovers that if they continued patching Anderson’s good eye, then he would have restored vision for the rest of his life. Patching time for Anderson has decreased to just two hours a day, three days a week. During their last appointment over the 2016 Thanksgiving week, the Glovers learned that, for post-surgical unilateral congenital cataracts, vision is often 20/200. Then they learned that Anderson’s vision was 20/25. Needless to say, the family was thrilled.
“In the beginning, I cried because it was so challenging, so much worry, and lots of anxiety,” Melissa says. “Now I cry because my child can see and I am so thankful. It comes down to dedicated physicians like Dr. Cogen, because I know he is one of the best at what he does and this is why we drive multiple times a year, from out-of-state, to see an ophthalmologist at Callahan Eye Hospital. He takes his time and is patient with us.”
Properly patching a child’s eye is important because congenital cataracts can lead to amblyopia. Amblyopia is decreased or loss of vision in one or both eyes because of abnormal visual input during the first few years of life. If cataracts are caught too late, the chances of amblyopia are high because the brain has already had significant time to communicate with the good eye, neglecting the unhealthy eye. This makes amblyopia difficult to treat because, as long as the brain adapts for vision from one eye, a child will report no symptoms. By the time the child is old enough to realize that one eye is dominant, it may often be too late to reverse the condition.
“Amblyopia is when the brain starts putting all of its eggs in one basket, with the working, healthy eye,” Cogen says. “As a surgeon, I can surgically correct the eye, but if I don’t address the amblyopia it won’t matter because the brain won’t communicate with both eyes, only the working eye. It’s kind of like if you have a great camera with a beautiful lens that takes great images, but if it isn’t connected to a computer those pictures don’t mean anything.”
Anderson recently turned 7, and he loves science and football. It was his dream to be a football player, but Cogen has discouraged this because of possible injury to the artificial lens implant. So instead, Anderson has decided he is going to be a kicker. He says his ultimate dream is to be a marine biologist on the weekdays and a kicker on the weekends. He is in the highest reading group for his school grade, and his family couldn’t be more thankful. Melissa says all of these activities Anderson gets to participate in are miracles, because he was supposed to be blind in his left eye.
The Glover family has learned a lot from this experience, but one of the most important lessons is the value of early vision screenings for children“As parents we do so many things to protect and nurture our children,” Melissa says. “We read to them and try to give them the right food with nutrients and vitamins. Really, at the end of the day, if they can’t see, then none of those other things matter. This is why it is so important for parents to take that hour out of their day to see a vision specialist. Parents take their children to the dentist when they start to get teeth so they should absolutely take their child to the eye doctor. If we hadn’t seen Dr. Cogen when we did, it would have been too late. Anderson would have permanently lost vision in his left eye.”
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