Nov. 2, 2009 -- At seven months, Carter Moll liked to be held close to his parents' cheeks. He liked to feel their warm breath and their features as he ran both of his hands down their faces.
"It reminded us of something a blind person would do," said Carter's mother, Susannah Moll, of Madison, Wisc.
A routine well-baby exam when Carter was born showed normal development of his vision. But then Moll noticed that her baby's left eye began turning inward. She took Carter to his pediatrician, who in turn referred him to an ophthalmologist.
Cataracts -- a clouding in the lenses of the eyes -- are a condition more often associated with older Americans or aging pets than with babies.
"They were very subtle so [the doctor] didn't see it was that big of a problem," said Moll. "He said surgery needed to be done, but I didn't know how soon."
That was last month. But within just a few weeks of his diagnosis, Moll noticed that Carter's left pupil was spotted by white clouds. And after a few days his right eye also developed milky white spots. And less than one month from his diagnosis, Carter underwent two surgeries to remove the cataracts from his eyes.
"The thing that's special about Carter is how rapidly his vision deteriorated," said Dr. Michael Struck, Carter's ophthalmologist at the University of Wisconsin. "The only thing he could tell was whether it was day or night; he couldn't see anything else."
Cataracts in Babies: Uncommon but Not Rare
Cataracts are usually considered a condition of age, but they affect three out of 10,000 infants under one year of age. The number of cases increases when children are between one and ten years old, according to the American Association of Pediatric Ophthalmology and Strabismus. A cataract impairs vision by blocking light to the back of the eye.
"I didn't even know that babies could have cataracts," said Moll.
Pediatric cataracts often occur because of abnormal lens development before birth and can either be seen immediately when a baby is born or develop during childhood, according to the AAPOS.
Genetic abnormalities are often the cause of infant cataracts, but metabolic disorders are also sometimes to blame. Cataracts in children can develop more quickly than adult cataracts, and children recover their vision slower than adults, said Struck, who specializes in pediatric cataracts.
Struck said all babies are born with poor vision, and they learn to see when images are sent to the retina, located on the back of the eye. When the retina is not receiving images, the optic nerve is unable to send signals to the brain and the nerve starts to degenerate, he said.
"If you never had hearing, you can't learn to speak," he said. "Well, it's the same for eyes, without the image being presented to the eyes, your vision does not develop."
Spotting Cataracts in Kids
Dr. Melanie Kazlas, medical director of Children's Hospital Ophthalmology Foundation at Massachusetts Eye and Ear Infirmary in Boston, said that because sight is a new sense to babies, surgery is crucial to develop normal eyesight.
"The critical age of visual development is birth, so we need to take away any impediment in vision so infants know what perfect vision is," she said. "Otherwise, the brain won't learn."
It is often difficult to spot cataracts or other vision-related problems in babies because they cannot speak yet, and, if they are born with poor vision, they are unable to tell the difference between their vision and what normal should be.
Struck said that in children, the earliest symptom of cataracts is if a child's eyes are not aligned, or a child is unable to use both eyes to see straight. These signs often appear before the telltale white spots on a child's pupil.
"One of the ways that most people come in is when they notice their baby's eyes are not straight in photographs," Struck said. "Even if they don't see it when they look at the baby, they see it in photographs."
Well-baby exams in the first few months of life often reveal if a child is born with an eye condition such as cataracts. But for Carter, since the cataracts developed after he was born, his eyes appeared normal at his first screening, said Moll.
Cataracts in Babies May Go Undetected
"When Carter first came in at seven months, he had signs of cataracts that only a doctor could see," Struck said. "By the time you are able to see the white clouds, it's an emergency."
Experts recommend children undergo a professional eye examination at age six months, 3 years and 5 years, according to the nonprofit organization Prevent Blindness America.
But many experts say that more frequent screenings may allow for earlier detection of severe eye conditions, and more effective treatment to prevent blindness.
"Delay in diagnosis is our biggest problem in fixing [eye problems in children]," Struck said. "Despite the surgery being possible, the vision recovery is impaired by the length of time and delay in diagnosis."
Seeing the New World
For infants with cataracts, surgery is often the only option to restore vision. Cataract surgery can be performed on infants as young as four weeks of age. But while surgery for adult cataracts immediately restores vision, children oftentimes need contact lenses to save their sight, Kazlas said. Sometimes doctors patch the dominant eye, or the eye without the cataract, to give the impaired eye time to improve, she sad.
"To be able to turn things around for him one month from having no visual problems, and then going blind, and then one month later having a procedure restoring his sight, is remarkable," Struck said.
Also, although Carter's cataracts have been removed and he is now able to see, it does not necessarily mean that he is clear of other possible vision problems, according to Dr. Kazlas. In fact, she said, glaucoma after cataract surgery is seen in up to 40 percent of children.
"Whether it's weeks down the line or even if it's years down the line, the possibility is there, so it needs to be monitored," Kazlas said.
Surgery Makes Difference in Infant Cataracts
Carter is still undergoing testing to determine the cause of his cataracts. Although he is now able to focus on nearby objects with his new lens implants, Moll said her son is considered legally blind for his distance vision and wears glasses to help him see objects that are far away.
But while treatment is ongoing for Carter, and he still needs to have frequent follow-up eye-care appointments, Moll says she is amazed that Carter's vision improved as quickly as it deteriorated.
"Even though he's done really well with it all, no parent wants their child to go through [surgery]," Moll said. "[Before surgery] Carter, you could tell, was really frustrated because he couldn't see, but now it's made a world of difference."