Diabetic Cataract

Diabetic Cataract
Prevention of Cataract Progression

Retinopathy -- Glaucoma -- Cataract --

Precise cause of diabetic cataract is yet under study. The data available till date however shows prominent role of high oxidative stress experienced by the diabetics. Then, can parents slow down the progression of cataract formation and prevent visual impairment in their diabetic children?

Cataract

Cataract is commonly associated with old age, but even newborns are known to have cataract.

Opacification of the eye lens, seen as a white spot in the center of the eye, could therefore be linked to variety of underlying factors; aging process, infection, eye trauma, tobacco smoke, use of steroid containing eye medications and diabetes. Consequently, cataract is the single largest cause of visual impairment.

In both, type 2 and type 1 diabetes the risk of developing cataract is 60% higher as compared to general population. Diabetes accelerates the development of cataract.

Development of diabetic cataract

Through the polyol pathway, enzyme aldose reductase increases the rate of glucose reduction to sorbitol. The affinity of aldose reductase for glucose is considerably weaker.To form Sorbitol, it therefore targets only the glucose that is left over after the saturation of hexokinase in normal glucose metabolism.

The lens of poorly controlled diabetics thereby accumulate sorbitol more rapidly than its conversion to fructose. Moreover, sorbitol’s chemical property (polar character) prevents its permeability through the membranes. Consequently, abnormally high level of sorbitol remains trapped within the lens fibers and induces intracellular osmotic changes.

This hyper osmotic effect causes sodium ion influx, which lowers potassium to sodium ion ratio that is crucial for normal lens function. As a result lens fibers swell up, degenerate and form sugar cataracts: The diabetic cataract.

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What can parents do?

Diabetic cataract is one of the common diabetic eye diseases. Besides the genetic predisposition and duration of diabetic disease, a lot can be controlled by parents and teenagers’ vigilance in management of diabetes.

Paucity of essential nutrition, high blood glucose levels, insulin dependent disease, raised levels of selected serum lipids, presence of high blood pressure and stress aggravate the risk of diabetic eye diseases.

I. Closely TRACK childhood diabetes, both Type 1 and Type 2

T – Take medications as prescribed.

R – Reach the optimal BMI for age and sex and maintain it diligently.

A – Activity emphasis in daily routine.

C – Control closely the ABC of diabetes

A1C, glycated hemoglobin
Blood Pressure
Cholesterol level

K – Knock off stress, smoking and alcohol indulgence.

II. Protect child’s vision

Basal eye health evaluation
Soon after the diagnosis of diabetes is made an exhaustive evaluation by an ophthalmologist is crucial for children suffering from type 2 diabetes. However, in children with type 1 diabetes basal evaluation of eye health is recommended at 10 years of age or 2 years after the onset of the treatment for diabetes, whichever is first reached.
Follow up with regular comprehensive eye health evaluation
Diabetic eye diseases have no warning signs. Therefore, minimum once a year thorough eye check up that includes intra ocular tension evaluation and dilated eye examination.
Dilated eye examination can never be over emphasized in care of diabetic children. A dilated eye exam require administration of drops in the eye that dilate the pupil of the eye. Thereby the ophthalmologist can even visualize the diabetic eye disease changes on the peripheries of retina, which do not cause any symptoms. This can help the ophthalmologist to initiate treatment before child’s vision actually gets affected.

Periodic Dilated Eye Examination Is Crucial for Prevention of Visual Impairment in Diabetics

Management of diabetic cataract

At initial stages, diabetic cataract generally does not influence child’s vision. The diagnosis of diabetic cataract on one of the regular checkups at eye clinic may therefore come as a genuine surprise. Tween and teens sometimes do experience hazy vision both at dusk and in bright sunlight.

Ophthalmologist’s advice depends on the stage of cataract. Surgical removal of the damaged lens and replace it with an artificial one is usually recommended only in advanced cases to prevent visual impairment.

Other causes of cataract in children

Metabolic Disorders: Galactosemia, Hypocalcemia
Chromosomal disorders:
Trisomy 21, Trisomy 18, Trisomy 13, Turner syndrome, Lowe syndrome Alport syndrome and Fabry's disease
.
Infections: Congenital Infections –TORCH, Varicella-Zoster

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Retinopathy -- Glaucoma -- Cataract --

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