Diagnosis of Cataracts in Children
Diagnosis of cataracts in children is a multi-step process involving clinical evaluation, imaging, and sometimes laboratory testing. Early and accurate diagnosis of cataracts in children is essential for initiating treatment before visual development is compromised, particularly in the critical early months of life.
1. Screening at Birth
All newborns should undergo a red reflex test within the first 48 hours of life and again during routine follow-ups. This simple test involves shining a light into the eyes to check for a reddish reflection from the retina. An absent or white reflex suggests a potential problem and requires urgent ophthalmological referral.
2. Comprehensive Eye Exam | Diagnosis of Cataracts in Children
A paediatric ophthalmologist will perform a detailed examination, including:
- Visual behaviour testing (fixation, tracking, and visual attention)
- Slit-lamp microscopy to visualise the lens and locate the cataract
- Dilated fundus examination to assess the retina and rule out other anomalies
- Tonometry to check intraocular pressure, especially if glaucoma is a concern
In preverbal children, the use of preferential looking tests or fixation preference assessments help determine visual acuity in each eye.
3. Imaging and Diagnostics
Ultrasound of the eye may be required if the view to the back of the eye is blocked. Ocular coherence tomography (OCT) and B-scan ultrasonography help assess the retina and optic nerve when cataracts obscure direct examination.
If systemic or genetic conditions are suspected, further testing may include:
- Genetic screening panels
- Metabolic blood workups
- Infectious disease screening, especially in cases of bilateral cataracts or maternal infection history
4. Functional Vision Assessment | Diagnosis of Cataracts in Children
Beyond the structural exam, determining how much the child is using their vision is key to deciding on urgency and treatment plans. The younger the child, the shorter the window for intervention due to the sensitivity of the visual development process.
A prompt and thorough diagnosis of cataracts in children ensures not only timely surgery but also appropriate follow-up with low-vision specialists, orthoptists, and therapists to support the child’s visual development and learning.
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