Infection, antibiotics in pregnacy can cause cataracts in children!

Most people associate cataract with old age. Ironically, experts, in this report by Sade Oguntola, say a number of children also develop cataract when their mothers in pregnancy develop some infections or take some medications.

MANY people think cataracts only happen to older people, but children can get cataracts too. But Fuad Ogunsanya, 24-year-old best 2018 graduating student of Lagos State University (LASU), recounted having cataract also as a child.

Of the seven children from his polygamous father (now deceased),  Fuad, a Business Administration graduate, is the only one who suffered eye cataract like his dad.

“I had thought I would overcome the cataract naturally after some years, but that was not to be until I had the second surgery at the University College Hospital (UCH), Ibadan,” he told newsmen at the sideline of the event at the University.

That congenital health condition didn’t affect his health alone, it denied him full concentration in his studies, especially during his secondary school days, such that he had F9 grade in all the subjects he first sat for in the West African Senior Secondary School Certificate Examinations (WASSCE), conducted by both WAEC and NECO.

Fuad is one of the thousands of babies and children that get a cataract. Cataracts can be present at birth (congenital) or can develop later in life. It has been estimated that one in every 250 children will develop a cataract either prior to birth or during childhood.

A cataract is a cloudy area in the natural lens of the child’s eye. If it is large or dense, it can cause blurry or even blocked vision. A child may have a cataract in just one eye, or in both eyes.

Normally, the lens is clear and allows light entering the eye to clearly focus an image on the retina. When cataracts develop, the light rays become scattered as they pass through the cloudy lens and the retinal image becomes blurred and distorted.

According to Dr Bolutife Olusanya, a consultant ophthalmologist, University College Hospital (UCH), Ibadan, Oyo State, congenital cataracts occur in children for many reasons, including inherited tendencies, infection, metabolic problems, diabetes, injury to the eye, and inflammation or drug reactions.

He declared “the fairly common cataract in children in our environment is caused by rubella infection that affects mothers during pregnancy. We also see a lot of children with somebody in the family, like the parent or siblings, having cataracts.

Dr Olusanya declared that aside from rubella, exposure to radiation in pregnancy or some other illnesses may also predispose a child to congenital cataract.

As an example, tetracycline antibiotics used to treat infections in pregnant women have been shown to cause cataracts in newborn babies.

But, “proving that drug reactions in pregnancy causes cataract in Nigeria may be difficult because doctors hardly ever get any history from the mother,” he added.

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Rubella, or German measles, is an infection caused by the rubella virus. Symptoms are often mild, but if infection occurs during pregnancy, it can cause birth defects in the unborn child.

These birth defects include deafness, cataract, mental retardation, small head and problems with the heart and brain. Unfortunately, some of these complications like hearing problems are not obvious at birth, but are detected as the child gets older.

According to him, “The mother will not remember that she had rubella when pregnant because it is a mild illness in pregnancy. They may think that it is morning sickness. Rubella can be prevented by vaccination. So, vaccination of adolescent girls is very important.”

Often, it is given in combination with the measles vaccine and mumps vaccine, known as the MMR vaccine.  MMR is a safe and effective combined vaccine that protects against three separate illnesses – measles, mumps and rubella (German measles) – in a single injection. The full course of MMR vaccination requires two doses.

There is also a catch-up programme for children, teenagers and young adults who have missed out on the MMR vaccine. Anyone of any age who is not sure whether they have had two doses of measles, mumps and rubella vaccines can take MMR vaccine.

Unlike poor vision that vitamin A supplementation might be helpful in preventing, Dr Olusanya said diet or exposure to air pollutants have not been linked to the development of cataracts in children.

Nonetheless, he added that children with galactosaemia stand a risk of developing cataract. Galactosaemia is a condition where the sugar galactose, which mainly comes from lactose, the sugar in milk, cannot be broken down by the body.

Given that eye problem can have a profound impact on learning ability, personality, and even appearance, ultimately affecting a child’s entire life; he urged parents not to delay in taking any child not seeing well promptly to the hospital.

According to him, “a two-month-old baby should be able to follow activity around him or her with her eyes. Bumps into things and having difficulty picking up things may be signs of a poor vision in a child that is growing up.

“Also, if they see a white spot in the black part of the eye, it may be a cataract.  The child needs to be brought to the hospital for evaluation. The important thing is that it should be done quickly because the earlier it is attended to, the better the outcome.”

Dr Olusanya warned that without early intervention, cataracts can cause “lazy eye” or amblyopia. This condition then can lead to other eye problems such as nystagmus, strabismus (misalignment of the eye) and inability to fix a gaze upon objects.

Children’s eyes are still developing until they are eight or 10 years old, untreated cataracts can have serious long-term effects on their vision. Blurred or distorted vision will cause the brain to set up abnormal visual connections, what is called amblyopia.

Treatment for cataracts in children can vary depending on the type and severity. But the vast majority of children need surgery to remove cataracts.

Unlike adults with full-sized eyes, children require specialised surgical instrumentation and techniques. When performed by an experienced surgeon, cataract removal is generally safe. The most common risks include glaucoma, retinal detachment, infection and the need for more surgeries.

For most children, surgery is just the first step to rehabilitate the eyes. Ongoing treatment must repair eye-brain connections. This involves teaching the eyes how to focus properly.

After surgery, children often need some combination of contact lenses, intraocular lenses implanted in the eye or glasses. If amblyopia has developed, the child may need patching. This treatment involves covering the stronger eye to stimulate vision in the weaker eye.

Children that undergo cataract surgery by and large have very little pain or discomfort. Those who receive intraocular lenses cannot feel the lens inside the eye. Children can feel the presence of contact lenses but usually adjust to them quickly.

Children may develop an “after cataract” following the primary cataract surgery. An after-cataract is a clouding of the lens capsule, which can often be corrected with laser surgery, but may need an additional surgical intervention.