More than 2,500 children in the U.S. are born with cataracts, or a clouding of the eye lens. To rectify this clouding, doctors may perform cataract surgery—involving an intraocular lens transplant—early on in a child’s life. 

A 2020 study, published in JAMA Ophthalmology, has found that, after undergoing this surgery, patients have a 22% chance of developing glaucoma later in life.* Moreover, the study proves that intraocular lens transplants may be unnecessary during cataract surgery and “underscore the need for long-term glaucoma surveillance among infant cataract surgery patients,” said Direction of the National Eye Institute (NEI) Michael F. Chiang, M.D.

What they did

There were 114 study participants, all of whom had been born with a cataract in one eye. They ranged in age from one month old to six months old. While in the operating room, each infant was randomly assigned to receive an artificial lens implant or to go without a lens, a condition known as aphakia. 

The researchers followed up with the participants at the age of 10 to evaluate and understand their long-term eye status post-operation.

What they found

After 110 children were reexamined at the age of 10, researchers discovered the following:

• 25 eyes (24% of participants) had developed glaucoma.
• 21 eyes (20% of participants) had experienced elevated intraocular pressure (IOP), a risk factor for the development of glaucoma. 
• Visual acuity (i.e., vision sharpness) was similar among those eyes that developed glaucoma compared to those eyes that had not.
• They did not find any evidence of glaucoma-related eye damage after assessing eyes through optic nerve imaging (this might be attributed to close patient monitoring)

When interpreting the findings, investigators found that cataract removal may leave children with an increased risk of glaucoma, which is a condition damaging the optic nerve. According to the NEI press release, “Scientists speculate that surgery to remove the cataract interferes with the maturation of how fluid flows out of the infant’s eye leading to increased eye pressure and optic nerve damage in some of these eyes.” 

At the follow-up, 40% of the participants developed a glaucoma diagnosis or glaucoma suspect, like elevated IOP. 

What it means

Because of this risk, researchers implore lifelong monitoring to be considered a necessity for preventing disease progression and glaucoma-related vision loss in those who have undergone cataract surgery. “Any child who has had a cataract removed needs to be seen by an eye care provider once a year at a minimum,” explained Sharon F. Freedman, M.D., a pediatric glaucoma specialist at Duke University in Durham, North Carolina.

 “Any child diagnosed with glaucoma or above-normal intraocular pressure without signs of ocular damage—what we called glaucoma suspect—should be monitored every four to six months depending upon the stability of the condition and the health of the eye,” she recommended.

In addition, “the results challenge the notion that replacing the child’s lens with an implanted one protects the child from developing glaucoma, a belief among some pediatric ophthalmology surgeons,” said the trial’s principal investigator, Scott R. Lambert, M.D., professor of ophthalmology at Stanford University in Palo Alto, California.

The intraocular lens transplant plays a role in enhancing the patients’ eyes’ ability to focus light properly after removing the cataract. In some cases, children may be left without a lens and a contact lens or glasses may be used to correct vision.

Looking forward

Benefits and risks must be weighed before recommending that a patient with a cataract undergo surgery. A young patient who experiences this surgery may be at risk of glaucoma, but if they delay or forgo this treatment, they could develop amblyopia, a leading cause of visual impairment in children that results in an underactive, or “lazy,” eye.

Future studies on glaucoma risk following cataract surgery in children are needed to further this area of study.

*National Institutes of Health. (2020, Dec. 17). Cataract surgery in infancy increases glaucoma risk [Press release]. https://www.nih.gov/news-events/news-releases/cataract-surgery-infancy-increases-glaucoma-risk

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