I diagnosed a seven-week-old infant with a congenital cataract today. The mom had noticed a white spot on his pupil, but the second I saw it I knew it was deeper than that, and sure enough, there it was on retroillumination: a nice compact dense cataract right in the stupid dead center of his visual axis.
The mom looked devastated when we told her. And I knew it was hard to hear that her kid was going to have to have surgery and then very thick glasses for the rest of his life (or at least until he was old enough to wear contacts), but we kept telling her over and over again how amazing it was that she saw it (which is the truth—this thing was not easy to see), and even better that she brought him in, because this kid should have had two eye checks already by his pediatrician and it still hadn’t been caught.
Still. I keep thinking about the mom’s face when we started talking about the cataract itself, and then the way she shut down when we started explaining that yes, this warranted an immediate referral to a surgeon, yes please wait while I make that appointment right now, yes this will require follow-ups and medicines and eye drops and a lot of your future hours spent in waiting rooms, and if we’re lucky and the system works and everything goes right this kid will come out of it with normal binocular vision despite an astronomical prescription in that eye, probably.
He has a couple things going for him, which is good. He has a relatively small cataract, he’s within the eight-week-old window, and he has parents who cared enough to bring him into the office to get this thing checked out instead of blowing it off.
Still. 0.06% of newborns. Poor little guy.