() Comments
Fixing the cure: Racine youth has new eyes after his were made dim by asthma steroids
BY DAVID STEINKRAUS
Journal Times
VIDEO: Watch a guided tour of Jerry Price's cataract surgery here in Racine
*EXTENDED VIDEO*: A conversation with Dr. I. Paul Singh about the procedure
Jerry Price had a physical just before school began in the fall, and then he found that he couldn’t see. “And, like, I was in school, after a couple weeks I couldn’t see the board. I thought it was my allergies in my eyes. But even when I was closer I couldn’t see it.”
His mother took him to a physician who found cataracts, a clouding of the lens in the eye and a disorder associated with old age. Why this appeared in a 16-year-old makes sense when you know more about this Racine youth.
“Cataract is a natural process in all of us,” said Dr. I. Paul Singh, a Racine ophthalmologist who recently removed Jerry’s cataracts and put new artificial lenses in his eyes. “For the average person the lens is clear. As time goes on, just like our hair changes color, our skin changes, the natural changes that occur in a life, the lens properties change.”
One change is a stiffening of the proteins inside the lens. That makes it more difficult for your eye to bend the lens and focus light from different distances, which means you need glasses, or perhaps bifocals or reading glasses. Another change is cataract. Although cataracts can appear when people are in their 40s or 50s, they typically don’t interfere with vision until people are older than 60. The National Eye Institute says that by the age of 80 more than half of Americans have cataracts.
Jerry has been on two types of steroids for years. He has asthma, and when he has an attack, about once a month (“Like, if I’m outside around a lot of pollen, it’ll flare up.”), he takes steroids for three to five days in order to bring the asthma under control. He also has eczema, a swelling of the skin, which he’s had since he was about 8 and which often accompanies asthma. He had no relief using regular ointments, so his doctors at Children’s Hospital prescribed a topical steroid cream, said Tanisha Nesby, Jerry’s mom.
Jerry developed a posterior subcapsular cataract, meaning it was behind and below the capsule which holds the lens of the eye. When it develops that type of cataract affects vision much faster than other cataract types, Singh said.
Steroids, he said, have been notorious for causing glaucoma — an increase in the internal pressure of the eye — because they close the drains inside the eye which help maintain proper pressure, and also for triggering posterior subscapsular cataracts. Why this happens is still unknown, Singh said, but researchers suspect the steroids affect the sorbitol pathway, part of a cell’s method of processing sugar, and that this changes the chemical makeup of the lens.
Medical studies have found an increased risk of cataracts in older people who take steroids, an increase of about two to three times normal depending on the dose and the duration of use. Singh said he’s seen enough patients to know that cataracts are also a problem for young people even though they haven’t been studied. And asthma is more prevalent in children than in adults (8.5 percent of children, according to the U.S. Centers for Disease Control and Prevention), and more prevalent in blacks than in whites.
So many of the substances people take, such as Flonase, contain steroids, too, Singh said.
“I think the benefits of steroids outweigh the risks. And that risk of cataract we can always take care of so it’s still OK to use, but I definitely think it’s prudent for the patients — obviously primary care doctors as well — to make sure the eyes are checked at least once a year, especially if they’re on a steroid.”
Even some of his own patients are developing cataracts because they’re on topical steroids to reduce inflammation in their eyes. Yet, he said, he can’t stop the steroids because the inflammation would return.
But cataract, as he said, can be fixed. That’s just what he did a couple of weeks ago in an operating room at Wheaton Franciscan-All Saints hospital, 3801 Spring St.
Quick and easy
Gone are the days when cataract patients had to wait for their cataracts to “ripen,” meaning become hard so the lenses were more easily removed through a large incision. Now, Singh said, the sooner cataracts come out the less the risk of complications. The whole procedure required about 20 minutes.
Wearing a pair of dark brown preparation gloves, Singh cleaned Jerry’s eyelid, injected an anesthetic to numb the skin, then stripped off the brown gloves to reveal the standard cream-colored gloves he would use during the surgery. Meanwhile, an anesthesiologist started Jerry on a mild sedative. Singh talked to him through the operation, reassuring him, urging him not to move.
Looking through a microscope, Singh made an incision of a couple of millimeters in the side of Jerry’s left eye. He slid in a small probe which combined a low-energy ultrasound emitter and a suction tube. The ultrasound broke up the cloudy lens into pieces looking very much like Jell-O. Singh removed them while the suction pump played an accompanying tune as like a musician’s fingers wandering up and down the scale on a synthesizer keyboard.
The lens went in folded up, then expanded inside the eye. On each side were tiny hooks, and Singh prodded the lens to attach the hooks to the muscles above and below the lens.
Jerry received a new type of lens. Older models were hard plastic and typically gave sharp focus only at a distance. The new lens Jerry has is flexible like his natural lens and will enable his eye to focus light from both near and far.
“To make him have to wear bifocals to read all the time I felt was not fair for him,” Singh said. Jerry’s health insurance wouldn’t pay for the more costly flexible lens, Singh said, so manufacturer Bausch & Lomb donated it, and Singh donated his services.
Results
Between surgeries — there was a break of a couple of weeks between doing the right eye and then the left — Jerry said how much his vision had improved just the day after the first cataract had been removed. Before the first surgery, he wasn’t able to read the Sony name on the family television set without getting very close to it. Now he can see it from the kitchen. Even with only one eye fixed he didn’t have to hold a book right in front of his face to read it. He’s not looking at the world through a fog.
And when the bandage came off after his first eye was corrected, he looked at his jacket and saw what he hadn’t seen before — a stain.
Special Offer: Get 5 Weeks of the Journal Times for $7!
 |
||
| The great lobster debate: Claws vs. tails |
