Congenital Cataracts – Can You Have Cataracts Early in Life?

Written by Dr. David Evans   Last modified on April 23, 2019

The vast majority (> 99 percent) of patients who have cataracts are 40 or older. (According to the National Eye Institute, more than 95 percent are 55 and older. However there are rare cases when younger adults, children or even infants can develop cataracts. Young adults and children may develop cataracts as a result of eye trauma, but infants are at risk of something else entirely… congenital cataracts.

Congenital cataracts is a rare condition in which a baby is born with cataracts (or they develop shortly after birth). If undetected, the baby is at risk for developing amblyopia, or lazy eye. This occurs when the cataract is only present in one eye, or when it is much worse in one eye than the other. Why? The brain begins to rely more on the eye with better vision, eventually shutting down the cataract-ridden eye.

The good news is that congenital cataracts is treatable. Extracting the cataractous lens in infants is a highly successful procedure with an excellent safety record (just like cataract surgery for adults). Deciding when an infant should have cataract surgery depends on the severity of the cataract(s) and whether or not both eyes are afflicted. If only one eye has a cataract, or if one eye is much worse than the other, surgery is suggested sooner. Earlier surgery can preclude the development or severity of amblyopia. If both eyes are affected similarly and the cataracts are mild, then the surgery may not be immediately necessary.

The other big decision regarding congenital cataracts is whether an intraocular lens (IOL) should be inserted, or if the infant should wear contact lenses or glasses. This decision is based on a number of factors. If an IOL is placed in the eye at a very early age then it is likely that a second IOL surgery will be needed to replace it with another lens as the eye matures. If no IOL is used initially, then the infant would require contact lenses or glasses. (An IOL would eventually be placed at a later time.) Although, IOL replacement surgery is highly successful, placing an IOL in the eye for the first time almost always has less risk than removing a lens and replacing it with a new one. So all things considered, if the parents can manage, a contact lens or glasses solution is the better option.

After surgery the infant may be required to wear a patch over the operated eye to treat amblyopia or its potential onset. By allowing the infant to see only through the operated eye, the brain learns to rely on it and the development of lazy eye is precluded or greatly diminished.

It is always best for a newborn to have eye examinations early on to detect the presence of congenital cataracts or other eye problems. If cataracts are detected, then parents and eye surgeon can work together to determine the best treatment strategy for surgery and the eventual IOL insertion.