Are cataracts hereditary? Find out…

Cataracts develop as we get over age 50.  In fact, according to the National Eye Institute, more than half of all Americans aged 80 or older have cataracts or have already had cataract surgery. Eye doctors get questions daily about what cataracts are and how people get them.  A common misconception is that all cataracts are hereditary.   Patients often comment, “I knew I was going to get cataracts since my mother had them.” 

What is a cataract?

Cataracts hereditary

Before we delve into the causes of cataracts, we should review what a cataract is. There is natural lens inside the eye that helps focus light to the back of the eye (known as the retina).  To see clearly, the lens must remain clear and transparent. However, there are multiple factors that can cause loss of transparency of the natural lens.  Any loss of transparency (or clouding) of the lens can directly impact the quality of vision.

The lens is made up primarily of protein and water.  The proteins are arranged in a very specific pattern to maintain their transparency. When the proteins become disorganized, the lens loses its transparency and cloudy areas within the lens occur. This loss of transparency of the lens is called a cataract.

What are the risk factors for cataracts?

As mentioned, age is the major risk factor for the development of cataracts. However, there are many other contributing factors.  These factors include health issues, past trauma to the eye, past inflammation of the eye, medications, smoking, poor diet, and ultraviolet light “such as prolonged exposure to sunlight”.  

We can reduce many of these risk factors such as stopping smoking, wearing sunglasses “with UV protection”, and having a healthy diet.  However, genetics may play a role in cataract formation.

What are congenital cataracts?

Congenital cataracts are present from birth.  Genetics are strongly associated with congenital cataracts. It is estimated that there is a family history of congenital cataracts in approximately 1 in 5 cases. There may be an improper functioning gene passed down from parent to child. Many of these cases are autosomal dominant.   Autosomal dominant means that a single copy of the mutated gene (from one parent) is enough to cause a congenital cataract.  However, there are other possible causes of congenital cataracts. These other causes include infections or medications during pregnancy, trauma to the eye during birth and certain metabolic disorders.  Measles, influenza, rubella, chicken pox, herpes simplex or herpes zoster are just some of the many infections during pregnancy that can lead to congenital cataracts.  Sometimes the cause of congenital cataracts is never determined.

What problems can congenital cataracts cause?

A congenital cataract can be present in one or both eyes.  The cataract may obscure vision. If cloudiness is limited to a peripheral part of the lens, central vision may be preserved, and the child may have excellent vision. However, if the cloudiness involves the central portion of the lens, vision is impacted. The cloudier the central lens becomes, the more likely it is for vision to be reduced.

During infancy, the brain, which is responsible for processing vision, is still developing.  If the vision is reduced due to a cataract, the visual system portion of  the brain is unable to develop. Vision may become permanently reduced.  When vision is permanently reduced, this is called amblyopia.  Monocular amblyopia results from a significant congenital cataract in one eye and binocular amblyopia results from significant congenital cataracts in both eyes.  

Left untreated, this can unfortunately result in a lifetime of poor vision in one or both eyes.  Other complications may occur.  The brain may no longer rely heavily on the poorer seeing eye.  The more blurred eye may no longer fixate on whatever the child is looking at.  The eye swings away from its normal position.  This is called strabismus. 

Poorly seeing eyes also may involuntarily “shake” known as nystagmus. If the cataract is only in one eye or even both eyes, a child may not be able to communicate his or her reduced vision to his or her parents. 

They become accustomed to their vision and have no way of comparing their decreased vision to normal vision.  They believe their blurred vision is normal for them.  So, a child may not complain of their reduced vision.

The important thing for a parent to do is to seek eye care as soon as a problem is suspected. 

Examples that there may be a problem with an infant’s vision include: the infant seems to be relying on one eye over another, one eye seems to be turned to an abnormal direction, an infant is not seeing objects that others can see, the pupil (the black portion of the infant’s eye) appears unusual or their pediatrician recommends seeing an eye doctor.

What treatment options are available for congenital cataracts?

Luckily, there are treatments available. Surgery is the treatment for cataracts. The optimal time for cataract surgery is often not set in stone.  A pediatric ophthalmologist is an eye doctor that is specially trained to perform such a procedure.  The pediatric ophthalmologist will let the parents know the ideal time to perform the surgery and expectations.   The natural lens is taken out of the eye and replaced with a surgically implanted intraocular lens. This intraocular lens is an artificial lens.   There may be some situations when an intraocular lens cannot be implanted in the eye.  In these cases, there are special pediatric contact lenses or eyeglasses that can be fitted for an infant’s eyes.

Congenital cataracts sometimes are small and outside the visual axis, and do not affect vision.  However, significant congenital cataracts can impede the natural development of vision and result in permanently reduced vision. It is imperative that parents seek out professional eye care if there is any suggestion of vision loss or a problem with a child’s eyes. There are treatment options available that can reduce the risk of permanent vision loss.

The staff at Suravision have highly trained doctors who can determine if you have cataracts.  They will explain if treatment is necessary and provide you with all the information you need to make an informed decision.  Please call Suravision at 713-730-2020 or schedule your eye exam online. We welcome the opportunity to address any questions you may have and look forward to helping you with your eye care needs.