ATARACT PEDIATRIC CATARACT
Why Can’t this Child See? Addressing Issues of Poor Vision in Children
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part from trauma, among the broad reasons for poor vision in children include developmental causes and genetic or hereditary diseases. These are some of the topics that pediatric vitreoretinal surgeon Dr. Manoharan Shunmugam shared and discussed with ophthalmologists, opticians and optometrists in a recent webinar organized by OasisEye Specialists Centre in Kuala Lumpur, Malaysia.
by Joanna Lee
of which are warning signs and must be taken seriously. “If a child has any exotropia, check that their reflection on the cornea is normal,” he said.
“If a child has any exotropia, check that their reflection on the cornea is normal.”
Raise the red flags early For preverbal children, several tests can be done to determine the cause of poor vision. “If the tests are not accessible, you should check for leukocoria — abnormal white reflection from the retina — to make sure the pupils are normal. If you find any reduced red reflex, then you have to refer them up,” shared Dr. Shunmugam, cautioning to check for asymmetrical pupils or relative afferent pupillary defects, all
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There are also intraocular malignancies such as retinoblastoma, a rare cancer most commonly found in children, that physicians should look for. “Should you see any lens subluxation, there’s a high likelihood they’ve had trauma or a significant syndrome that needs to be investigated further,” added Dr. Shunmugam. “If there is a lot of excoriation of
| Sept/Oct 2020
the eyelids or erythema around the periocular area, then you can suspect the child has been rubbing his eye a lot. Not only can it cause keratoconus but it can also lead to lens subluxation,” he warned.
Watch out for pediatric cataract Pediatric cataract causes 10% of vision loss in children worldwide. It is important to treat it urgently — and if left untreated, visual deprivation can cause permanent amblyopia. About one in 250 children has this autosomal dominant (AD) condition. “Thus, it’s important to check family members to find out more information, especially if you refract the child and can’t get it down to 6/6 or 6/9,” he said. “You might know this already, but unilateral cataracts tend to be more amblyogenic, and the posteriorly located cataracts are worse and it’s best
