But in the back of Stacey Freeman’s mind was a haunting fear that Brohdon might never be able to actually see the throngs of cheering fans, the zigzagging puck and the players looping around the glossy white rink. Only a week after the game, Brohdon was scheduled for surgery at Penn State Milton S. Hershey Medical Center to remove a congenital cataract in his left eye.
While cataracts are usually viewed as a disease of the elderly, the condition can strike the very young, too, with a far more complicated treatment and rehabilitation process.
A cataract is “a cloudiness of the normally clear lens of the eye,” said Dr. Carl Frankel, a pediatric ophthalmologist in Susquehanna Twp. Cataracts cause sufferers to view the world through a frosted or foggy window.
A malformed lens in a developing fetus is the cause of cataracts that are present at birth, Frankel said. It is relatively rare. In his 26 years of practice, he has seen about 200 cases.
Dr. Joel Weinstein, associate professor of ophthalmology and pediatrics at Hershey Medical Center, said he sees about 10 cases a year.
Fortunately, an alert pediatrician detected a black spot in Brohdon’s light-brown left eye, only two days after he was discharged from the hospital. He was referred immediately to Weinstein.
Brohdon’s cataract was surgically removed and he was fitted for a contact lens.
“I was ridiculously upset about it,” said Freeman, of Cleona, about her reaction at the time. “It was devastating.”
Today, at age 2, Brohdon’s cataract is gone, but its effects linger. He must wear an eye patch over his “good” right eye, use a special contact lens in his left eye, and receive eye drops often.
He is encouraged to watch TV frequently to stimulate his eyes, and sometimes must wear arm immobilizers to keep him from tearing off his eye patch. When Brohdon says “fix my patch,” Freeman laughingly admits, that means he took the patch off.
Although she has never worn contact lenses, Freeman is the only member of the family who can place Brohdon’s tiny contact lens in his left eye. “He fights me tooth and nail,” she said.
Freeman said they have lost plenty of contacts, finding them in Brohdon’s car seat, bedding and even his diaper. She is convinced that he has eaten more than a few.
Brohdon now goes to Hershey every three months for check-ups. While he is too young to read a traditional eye chart, he “reads” eye pictures.
“He doesn’t see well, but he can see,” Freeman said.
With congenital cataracts, doctors do not expect the baby to have perfect 20/20 vision, Weinstein said. They “will be happy with 20/40.”
Weinstein said 50 percent of children with cataracts might eventually need eye muscle surgery for crossed eyes. Thirty-five percent will develop glaucoma, and half of those will need surgery.
Importance of early diagnosis
“It is very, very important to get to these [congenital cataracts] early,” Weinstein said. “The length of the rehabilitation process depends on the length of time the eye is deprived of a good image.”
In adults, the cure for cataracts is simple surgery, and the patient is often better the day after surgery.
However, in children, the brain circuits for vision aren’t totally formed until about age 7. After surgeons remove the cataract, the brain must build the circuits that travel to and from the eye. Therefore, they might have to cover the child’s unaffected eye with a patch to strengthen the connections with the affected eye.
“We see with our brains, not the eye,” Weinstein said. As the eye-to-brain circuits are built, the brain demands “constant high-quality input from an eye.”
If an older child has bilateral cataracts, surgeons will remove the natural lenses and can either implant an intraocular lens or give the patient glasses.
In patients under 2, an intraocular lens is “controversial” because the eye will continue to grow and change, and the power of the lens might soon be too strong or weak.
If the cataract is unilateral, like Brohdon’s, the major problem is amblyopia, which is the lack of brain circuits to one eye.
Finding the problem
When cataracts are significant and in both of a newborn’s eyes, parents might notice that the baby will not make eye contact and will “not seem to be visually attentive,” Frankel said.
Rarely, cataracts are caused by an abnormality in some enzymes, Frankel said, so dietary changes might prevent the development or worsening of this type of cataracts.
Cataracts can also occur after trauma to the eye, so Frankel and Weinstein urge parents, coaches and athletes to use protective eyegear.
“Sports injuries are under-rated” as a cause of cataracts, Weinstein said. The most prevalent cataracts in kids are caused by trauma, he said.
“The lens is very, very delicate and subject to disruption,” Weinstein said. “You don’t even have to puncture the eye.” A simple hit to the eye can do it.
Weinstein reminds parents that cataracts in small children can entail “a long, several-year process of rehabilitation,” in which the removal of the cataract is only the first step.
In five to six years, Brohdon may be fitted for an artificial lens, which Weinstein described as a “thin wafer of silicone.”
Freeman urges new moms to request a neonatal eye exam, as they are not required by law. Had their doctor not caught the cataract, Brohdon might have lost his vision in that eye forever.
Freeman struggles to find the words to express her gratitude for Brohdon’s surgeon, and her son’s sight.
“Finding out my son might not be able to see and then finding a doctor who said ‘We can fix this’ and ‘We can get through this if we work together,’ and then to see him at 2 playing. ... I know he will be able to drive and read and run... I know he’s OK. He’ll be fine. He can do everything every other child is supposed to do.”
Brohdon loves the vibrant red of Sesame Street’s Elmo and the sharp black and white contrast of Mickey Mouse. He can rattle off all the Disney characters in one long verbal avalanche. In fact, he got to see them for himself when he visited Disney World about six months ago.
For the Freemans, it was truly something to see.
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