Infant Cataracts: Screening in Primary Care

From CHOP Expert Commentary Monte D. Mills, MD Posted: 09/26/2011 Director of the Division of Ophthalmology at Children's Hospital of Philadelphia. Infant cataracts are rare. About 1 in 2000 to 1 in 5000 children will have unilateral or bilateral cataracts during infancy. Early detection and treatment are crucial to getting the best visual outcomes for our infants with cataracts. The primary care provider is in the perfect situation to detect and refer these infants for treatment early on during early infant examinations in the hospital and office. The critical and best instrument to detect cataract is the direct ophthalmoscope that you have in your office and in the hospital. You would use it by setting it to the large white spot setting and shining it in a darkened room into the infant's eyes. As you look through the peephole, look at the quality of the red reflex in both eyes simultaneously, examining for symmetry, redness, and brightness of the red reflex. Cataracts would be seen as a dull red reflex or as an asymmetrical red reflex, bright in one side and dull in the other side. It can also be visible as a white pupillary reflex. Children with asymmetry, a dull red reflex, or a white reflex should be referred for evaluation to an ophthalmologist. Infant cataracts should be treated during the first 6 weeks of life to get the best visual outcome. With prompt detection and an early referral and treatment, we can get the best possible outcomes for our patients with infant cataracts. Later in life, infant cataracts might be seen with symptoms including nystagmus, poor visual fixation and following, poor social smile, or strabismus. These children, of course, should also be referred for a full evaluation to an ophthalmologist and potentially for treatment. With early detection using the red reflex test with the direct ophthalmoscope, you'll be able to detect early cataracts. Refer them promptly to achieve the best possible visual outcomes.