Saturday, February 14, 2009

Another eye problem

Sarah has my general facial structure.

Grace has my quick temper.

And, now, it seems Hannah has my eyes.


At Christmas, my Dad noticed that Hannah's left eye was turning in toward the nose. I agreed that it might be an issue and filed it away for verification at Hannah's upcoming one-year-old well visit. That visit was Thursday afternoon and our pediatrician also agreed that something wasn't quite right. Lazy eye is not uncommon in some kids, but something else seemed to be amiss. When the pediatrician shone a light into her eye, he did not get the red light reflected off of the retina that is normal. Instead, he got a black reflection . . . which is to say he got no reflection at all.

He got us a quick appointment on Friday morning with a children's opthamologist. The concern? Cataracts, if you can believe it. (Like father  like daughter, huh?) After some testing at the children's hospital, the suspicion was confirmed. Hannah has several issues:

a) she does have a cataract developing in her left eye. This  seems to have been encouraged by 

b) a misshapen (bubbled) "sac" that holds the lens in place in the eye's interior. This bubbled sac was, it seems, improperly formed at birth and caused the lens to develop imperfectly. As the left eye became less useful, Hannah's brain began discounting it which led to 

c) the lazy eye that Dad first noticed. 

So . . . here is the plan of attack.

First, we will address the cataract that is making her left eye weaker. It will be done in a similar fashion to the cataract surgery that I just had with some significant differences. 

First, Hannah will have to be completely sedated for this procedure because she can't stay still enough for the surgeons to do their work properly. Additionally, during the sedated period, the opthamologist can do the complete eye measurements that adults have done at each eye check up. (Again, because infants can't follow directions, such complete measurements can't be done unless sedation is used. These measurements will give a complete picture of what Hannah's existing eyesight truly is and what corrections must be taken.)

The opthamologist also told us that Hannah seems to be strongly far-sighted--meaning she easily sees distant things in focus but must work the eye muscles abnormally hard to establish clear focus at the middle range and close up range. Therefore, the artificial lens to be implanted will match the farsighted vision of her normal, right eye. This is done to allow the eyes to work in tandem as she ages. It will also ensure that she will require corrective glasses as soon as the surgery is completed to maintain close to 20/20 vision.

After the cataract lens is eliminated and she has healed, we will begin addressing the lazy eye situation. With two "normally" sighted eyes, the right eye (the industrious one, lets say) will be patched to force Hannah's brain to use the lazy, left eye. This is a fairly standard practice, and will, in fact, involve placing a patch over Hannah's right eye. If we are lucky, the lazy eye will acquire a work ethic and reposition itself in a proper, center fashion and Hannah will have proper, if corrected, bifocal vision.

If this work out, we won't have to resort to a second surgery down the road that involves repositioning the muscles attached to the outside of the eyeball which pulls the eye into the centered position. Again, I know about this because I had the same surgery when I was eighteen. It was unsuccessful . . . something that my doctor warned me was quite possible given my age at the time of the surgery. Because Hannah is MUCH younger, the likelihood of muscle repositioning being accurate is much higher. Yet we would obviously prefer that the patch eliminate the need for this second surgery.


So, that is what Hannah sees in front of her, so to speak. We have already scheduled the cataract surgery for this coming Monday. It is to be out-patient, so we might even be able to get her back into daycare the next day . . . maybe? (Lynda and I are still very busy with work, but luckily Monday--President's Day--is a company holiday for us.) I'm sure the work will suffer a bit over the next few weeks, but it may not be too difficult.

We will have to put eye drops in her rehabilitating eye for  several weeks following Monday's surgery AND we'll have to keep her away from the post-surgical bandage. And, of course, when we begin the Lazy Eye patching, she will strongly resist because we will be forcing her to use her weak, unreliable eye to see. But it seems that she won't have to be patched all day, every day. (The details will be clear once the surgery is done and we've moved on to Phase II.)

But it'll give me lots to blog about, I guess . . .


As I've noted here before, I tend to take these sorts of things in stride. Accustomed as I have been to my own surgeries, I am not afraid of facing them in others. I am naturally worried about Hannah being completely sedated on Monday, as that always carries risks, but the idea of surgery is a common one for me. I also don't feel upset that Hannah won't have perfect vision, regardless of how all of these procedures turns out. My attitude is, which of us DO have perfect vision?

Rather I am glad that we have identified these problems at this young age, when Hannah is less aware of the procedures and recoveries that follow. She will be less self-conscious of how she looks as she goes through it all and when it is all said and done, her vision will be repaired and she will have reliable sight for when she needs it most as she grows and interacts with others and at school.

No comments: