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Preoperative Counseling

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Pediatric Cataract Surgery and IOL Implantation

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Abstract

Preoperative discussions with family members are an essential component of the early phases of patient care related to childhood cataracts. These conversations are detailed and complex, thus requiring the physician to set aside appropriate time and participate as both an active educator and listener. The physician will also need to coordinate the interdisciplinary needs of each unique patient. Appropriate parental expectations should be set, terminology should be introduced, and empathy should be used, particularly in addressing the concerns and needs of each family. The postoperative course after childhood cataract surgery often lasts for decades, so the family must be prepared for long-term care and follow-up. The family should understand that the physician-family-patient relationship will endure both triumphs and challenges requiring short- and long-term support from the medical team. Successful outcomes often depend on years of individualized vision rehabilitation and lifelong monitoring for complications.

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Author information

Authors and Affiliations

  1. Children’s National Medical Center, Washington, DC, USA

    Jana Bregman

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Janet Alexander & Moran Levin

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  2. Janet Alexander
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  3. Moran Levin
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Corresponding author

Correspondence to Moran Levin .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Johns Hopkins Hospital Wilmer Eye Institute, Baltimore, MD, USA

    Courtney L. Kraus

Appendix 1: Pediatric Cataract Surgery Consent Form

Appendix 1: Pediatric Cataract Surgery Consent Form

What Is a Cataract?

The lens is the clear part of your eye that helps focus images. A cataract happens when the lens of the eye becomes cloudy. Cataracts can cause blurry vision or blindness in children. If a cataract is not removed early in life, a child may develop permanent vision loss. This is a serious condition, since vision is important for the brain to develop.

What Causes Cataracts?

Some children are born with cataracts. Other children develop cataracts from medications, infections, eye injuries, or medical diseases. Some cataracts are genetic (can run in families).

How Are Cataracts Treated?

Surgery is the only way to remove a cataract. During cataract surgery, an eye surgeon will remove the cloudy lens. The surgeon may replace the cloudy lens with an “IOL” (intraocular lens, a clear artificial lens). The surgeon may choose to leave your child without a lens (aphakia). In this case, the child may need glasses and/or contact lenses following surgery. In some cases, an IOL can be placed in the eye years after the cataract is removed.

What Are the Major Risks of Cataract Surgery?

Cataract surgery is usually safe and successful. There are risks (problems that can happen) with cataract surgery. While the eye surgeon cannot tell you about every risk, here are some of the common or serious risks:

  • Risks from cataract surgery include vision loss, blindness, or negative results. Bleeding, damage to parts of the eye, infection, and inflammation can happen. The retina at the back of the eye can pull away from where it is attached (detached retina).

  • Your child may need another surgery to take out pieces of the cataract that were not removed.

  • Glaucoma (high eye pressure) can happen after cataract surgery. Children with glaucoma may need eye drops or glaucoma surgery. Glaucoma can happen whether or not your child has an IOL.

  • It is common for part of the lens to grow back. This can form a lens membrane or “after cataract.” Your child may need a laser procedure or another surgery to remove a lens membrane.

  • Most children will need glasses and/or a contact lens after cataract surgery.

  • Lazy eye (amblyopia) is common, and children may need eye patches or drops after cataract surgery.

  • Misaligned eyes (strabismus) and poor depth perception (stereopsis) can happen, and children may need eye muscle surgery.

  • Your child may need frequent eye surgery or exams that require anesthesia.

  • Anesthesia can cause heart and breathing problems. Very rarely, it can cause death.

  • Other risks. Cataract surgery only corrects vision problems caused by cataracts. This surgery cannot correct vision problems caused by problems in other parts of the eye. There is no guarantee that cataract surgery will improve your child’s vision. It is possible that vision loss, blindness, or even the loss of an eye can occur. These problems can appear weeks, months, or even years after surgery.

Risks from an IOL

Adults with cataracts almost always have an IOL put in their eye. In children, this part of surgery is slightly more risky, so for children with cataracts, an IOL is optional. The good part of an IOL is that it decreases the need for strong glasses or contact lenses. The bad part of an IOL is the slightly increased risk of needing additional future surgery. Most children will be good candidates for putting a lens implant in at a later surgery, when it might be safer or more accurate. As your child’s eye grows, the power of the eye changes. The IOL may be too weak or too strong. The eye surgeon may need to replace your child’s IOL or make changes to glasses months or years after surgery. An IOL can cause inflammation, glaucoma, scarring, a lens membrane, or other surgery complications.

Acceptance of Risks

I understand that it is impossible for the doctor to inform me of every possible complication that may occur. By signing below, I agree that I have read this form or someone has read it to me, that my doctor has answered all of my questions, and that I understand and accept the risks, benefits, and alternatives of cataract surgery.

I consent for my child to have cataract surgery with an intraocular lens (IOL) in the __________ (state right eye, left eye, or both eyes).

________________________________________       ____________

Person authorized to sign for the patient           Date

________________________________________       ____________

Surgeon                        Date

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Bregman, J., Alexander, J., Levin, M. (2020). Preoperative Counseling. In: Kraus, C. (eds) Pediatric Cataract Surgery and IOL Implantation. Springer, Cham. https://doi.org/10.1007/978-3-030-38938-3_7

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  • DOI: https://doi.org/10.1007/978-3-030-38938-3_7

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