This prospective study found that surgical intervention can improve vision and quality of life in children older than 8 years of age with early-onset bilateral cataracts. Vision improved from “near blindness” in more than 90 percent of the patients, with some approaching normal vision.
These results are encouraging from a social healthcare perspective and argue for the provision of cataract treatment to all children, irrespective of their age.
The authors performed cataract surgery on 53 children older than age 8 with dense cataracts and sensory nystagmus with a visual acuity of counting fingers or less.
At six months’ follow-up, the majority of patients showed significant visual improvement in both distance and near vision, with no significant difference in the extent of improvement between older and younger children. Following cataract extraction, 61% of patients were able to read N12 with glasses alone and 24% improved further with low-vision devices.
Surgery also had a qualitative impact on the educational opportunities available to several of the children. In total, 9 of the 23 participants (39%) who attended schools for the blind were shifted to normal schools with special education facilities, and 4 of the remaining 14 who remained in schools for the blind started learning print along with studying Braille.
The authors conclude that these results demonstrate that not only can significant vision be acquired until late in childhood but that neural processes underlying even basic aspects of vision, such as resolution acuity, remain malleable until at least adolescence.
Furthermore, given the notable improvements with low-vision aids, the ideal intervention for children with long-term congenital cataracts should include surgery, as well as appropriate visual rehabilitation. This will help ensure that treatable blind children are given the best chance to be integrated into the world of sight.
Discussion question:
Does it surprise you that children with such dense cataracts can recover significant amounts of vision despite relative advancing age? Does this change your counseling of patients who are getting older and have had cataracts since early life?