That day, I was in my clinic doing my routine clinical work, when 17-year old Manav entered my chamber with his parents. There were obvious worried expressions over his parent’s face. As per my normal process, I asked him to account for all his eye problems since the beginning. He complained of redness and itching in both his eyes since a very long time. He used to take treatment for it from various eye doctors. After the eye drops, he would feel better for some time and as soon as he stopped the treatment, he used to face similar itching and redness in his eyes. He and his parents got quite bugged with this recurring issue! After several visits to the eye doctors, his parents started buying eye drops directly from the pharmacy without consulting any eye doctor. For last few years he was self-medicating. So, basically every time he had redness and itching, he would go to the pharmacy and start self-medicating. He never realized that these medicines may be causing some side effects in his eyes. Until one day he noticed that he is unable to see very clearly with his own glasses. He was advised at the optical shop to consult an eye doctor.
We did a detailed eye check-up for him. Vision in both his eyes was poor. His right eye had a better vision of 6/9 but left had much poorer vision of 6/18. He was a classic case of vernal conjunctivitis (Type of allergic conjunctivitis) and had developed cataract in both his eyes. His parents were surprised to know that their young child had developed cataract. They were already primed by the optometrist, but they could not believe it as they thought that cataract happens only in the old age. Their overall understanding was correct, but they did not realize that cataract can develop as a side effects of other things as well. Their casual act of putting eye drops without ophthalmologist’s opinion landed their child with an early age cataract. Young child was putting steroid eye drops for last few years without any guidance. With the steroid eye drops, he used to feel better. This vicious cycle continued till he developed vision issues (cataract) in his eyes. Take home message is NEVER USE ANY EYE DROPs WITHOUT DOCTOR’S ADVICE.
Cataract is always equated with old age and usually it occurs after 50 years of age, but there are specific conditions in which cataract may develop in young age (< 40 years) as well.
Following are some of the causes of an early age cataract:
- Congenital/Developmental cataract
Congenital cataract occurs in new-born if mother had suffered from any of these infections like Measles, Mumps, Rubella, CMV, Varicella, Toxoplasmosis, influenza etc during pregnancy. Congenital Cataract is associated with some chromosomal abnormalities as well like Down syndrome, Edwards syndrome, etc. Depending on the severity these cataracts may need to be operated soon after birth. Pediatric cataract eye doctors are the best eye doctors to guide about the right time for surgery for these types of cataracts.
- Drug induced cataract
Long term exposure to steroids in the form of oral or topical medicine is a well-known cause of early cataract formation just like in case of Manav. Some other medicines like statins (Used for hypercholesterolemia), miotics, amiodarone, chlorpromazine, etc. can also cause early cataract.
- Traumatic cataract
Blunt or penetrating injury to the eye at any age can cause cataract. Injury is in fact one of the commonest causes of unilateral cataract in young age. Cataract can develop immediately after the injury or a few months/years after the actual trauma.
- Radiation exposure
Chronic exposure to UV rays in farmers, field workers etc can lead to cataract at a young age. Doctors and lab technician who are more exposed to radiation (X rays) can develop early cataract. Intense infra-red radiation exposure (as in glass blowers) may rarely cause true exfoliation of the lens capsule leading to cataract formation.
- History of previous ocular pathology/ surgery
Uveitis (Inflammation of uvea, iris etc.), glaucoma etc. can cause cataract at a young age. Inadvertent touch to natural lens while getting retinal surgery can also lead to early cataract formation.
- Lifestyle factors:
Smoking acts as an additional factor for early appearance of lens opacity.
So, really there are many reasons why people may develop cataract at an early age. In case of Manav, he was first treated for his allergic eye disease. Once the eye surface stabilized and allergy subsided, he was operated for cataract surgery in both eyes by an experienced pediatric eye surgeon at the eye hospital. Manav is now enjoying clear and perfect vision post cataract surgery. He continues to be on a safe long term anti-allergic medicine to prevent its recurrence. Manav’s story teaches us two important lessons- first never self-medicate and second cataract can occur at a young age and may need surgery which can be successfully performed today.
