Guest: Dr. Edward Wilson Jr. - Pediatric Ophthalmology
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to MUSC health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin and today I am interviewing Dr. Edward Wilson who is a Department in Chair of Ophthalmology at the Medical University of South Carolina. Dr. Wilson you are a pediatric ophthalmologist and I know you have a special interest in pediatric cataracts, which, I am sure, many people don’t even think of cataracts is occurring in children.
Dr. Edward Wilson: That is true, cataracts can occur at any age. They are certainly more common in elderly adults, but we find that cataracts can be present at birth, they can occur during the toddler years, they can come on during any stage in development, and of course they can occur after trauma too, which unfortunately happens often in the childhood.
Dr. Linda Austin: How common are cataracts in children?
Dr. Edward Wilson: It is very difficult to know exactly how often it occurs as these studies are hard to do, but probably in the range of five to eight per thousand in population and that doesn’t sound like a lot, but it means that the average surgeon is going to come across a cataract in child infrequently. Some places like Strom Eye Institute, we develop some of the procedures and the instrumentation, which is very different then in adults, so that we could be the center that those surgeons partner with those surgeons who would say I would only do four or five a year and I we will do a hundred a year, why don’t I just follow all the patients to place and then partner with the before care and the aftercare.
Dr. Linda Austin: So, who many due you personally do in a year, which you guess?Dr. Edward Wilson:I do all the once it come into the Medical University of South Carolina and probably in the neighbourhood of a hundred per year.Dr. Linda Austin:So, for you it is a very common procedure.
Dr. Edward Wilson: So, we are doing this every week.
Dr. Linda Austin: What is the youngest you take cataracts out?
Dr. Edward Wilson: Well, we found from some of our research that if a cataract is found by the pediatrician at birth that there is no real benefit in outcome by operating in the first 30 days of life. We use to operate as soon as we could the child into the operating room, but now we found that while a lot of delay is bad for a cataract found at birth, we operate usually between four and six weeks of age, that is the earliest sort of prime time. So, we allow the child to have that first month to feed and grow and we haven’t lost anything, but we like to get them as soon as possible after the first 30 days.
Dr. Linda Austin: Because?
Dr. Edward Wilson: Well, vision development is occurring rapidly in the young child, and we especially, in cataracts that affect one eye, don’t want that eye to fall too far behind in its development compared to the normal eye. If the cataract affects both eyes and we wait too long then the visual system just doesn’t develop in either eye and you end up with nystagmus or jiggling of the eyes, which is an indication that the visual system has been deprived for too long. Nystagmus won’t occur until about three or four months even in total deprivation.
Dr. Linda Austin: So just to explain a little bit more, vision doesn’t only happen in the eye ball right?
Dr. Edward Wilson: That is true, it’s the visual part of the brain that is very immature at birth, and we know eye sight in babies while is present, is certainly not 20/20 level, and there continues to be a development both in the eye ball and in the visual part of the brain.
Dr. Linda Austin: Is here any age at which you could more or less reliably say that if a serious cataract is not removed by that age, the person will be permanently blind because of lack of the brain development that goes along with that eye ball.
Dr. Edward Wilson: I don’t think we can say that. If I find a cataracts that has been diagnosed in delayed fashion, it is so variable how dense that cataracts was, whether was some light getting around it, even though I might be disappointed in the outcome usually we get some and sometimes we get all of the vision back even with a delay in treatment. So, I don’t get that pessimistic about it certainly earlier is better, but the child can recover remarkably even with late diagnosis, if after the surgery if the parents can patch the good eye and force the brain to recognize this new image that we have given the eye, this new focused image. So, I say, in that situation, that it may be difficult to recover vision it the cataract has been there a long time, but if we have good parents and the parents willing to work hard, the brain will respond. So, I don’t ever really say it is lost and sometimes we do have delay in diagnosis. Another important part of that is many cataracts are partial. If the cataract starts out as a small defect, a small opacity, in the lens of the eye just little bit like having a small defect in the windshield of the car, if it is partially blocking vision, but not totally blocking vision that is not as damaging to the brain. If we then see the child two, three, four, or five years later and now a cataracts has grown to involve the entire pupil and may be the entire lens, which sits behind the pupil, we can’t say that all is lost because this cataract was probably this bad at birth; It may very well be, but it wasn’t that bad at birth, and it wasn’t that the pediatrician missed it that it just slowly developed to become that severe and finally someone noticed it. So, we don’t jump to conclusions about how long the cataract has been there.
Dr. Linda Austin: You can not tell it just by examining.
Dr. Edward Wilson: And we can tell. Some characteristic patterns of cataract will lead us to believe that it was not there at birth. Some layers of the lens that were not even present at birth if they get cloudy, I can be pretty comfortable this come on as toddler or it came on as a school age child, and if that child had good visual experience prior to the developed cataracts then we get good vision back.
Dr. Linda Austin: Dr. Wilson, I know that listening to this program will be some mother or father in some part of the country who may I have just from their pediatrician that their baby or toddler has a cataract and they are trying to find information and they find this site, because you are an expert in this field and people do fly in from all over the country, what would the next step for that person be if the wanted to have their child evaluated by you, what would they do after that diagnosis?
Dr. Edward Wilson: The most common way to reach us is by the family selecting a local pediatric ophthalmologist and as part of the evaluation of the cataract if they indicate to that local Doctor that they heard about me or they visited the website, often the pediatric ophthalmologist who do this surgery infrequently will want to partner with us. So, most of the time it comes with a partner Doctor, that is important, because we like for the family to have an advocate for the child, someone how will participate in the aftercare and encourage them to titrate patching and glasses and anything else that is needed. If there is a partner doctor that doctor’s office calls us at the medical university and we will help with hotel arrangements. We help anyway we can with travel and make sure that the family gets in. Usually, I see them the day before surgery. Surgery is done as an outpatient. They stay in a hotel after surgery usually released from the operating room within an hour after the child wakes up and then we do an examination the next morning, give them some instructions, and send them back to the local Doctor. It is okay for a family to contact us directly, but normally we are going to say to them - find a partner Doctor. There are a lot of pediatric ophthalmologists that we have worked with around the country who are glad to have someone else participate by doing the surgery, and they then will takeover the care afterward.
Dr. Linda Austin: Thank you so much Dr. Wilson.
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