Eye Surgery and The Blind Child

Eye Surgery and The Blind Child

Future Reflections July 1982, Vol. 1 No. 4
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EYE SURGERY AND THE BLIND CHILD

By J. Kemper Campbell, M.D.
Ophthalmolgical surgery has undergone tremendous changes in the past decade and many conditions
which were previously thought to cause irreversible blindness may now be ameliorated by early surgical
intervention. The possibility of at least partial conservation or retention of eyesight should always be fully
explored. Psychologically it is easier for both child and parents to accept and adjust to blindness if they
feel everything possible has initially been done to preserve vision. Therefore several special points should
be made to parents of children with potentially blinding conditions.
First, since many of the serious eye disorders of infants are rare, in most instances, consultation at a
large ophthalmological center for a "second opinion" should be obtained. Disorders such as
retinoblastomas (eye tumors), retrolental fibroplasia (RLF), congenital glaucoma, and congenital
cataracts are now treated and managed in a much different manner than ten years ago. The initial
evaluation and recommendations of ophthalmic subspecialists at these centers who may see larger
numbers of patients with similar problems are often useful in later management by the local
ophthalmologist.
Also, sophisticated equipment is available which allows assessment of the brain's electrical responses
to visual stimuli. This test, called a visually evoked reponse (VER); and a test of the electrical response of
the eye to light stimuli (electroretinogram or ERG) may often be helpful in predicting an infant's visual
prognosis. Both tests can be done in larger medical centers.
Finally, if the child is found to have an inherited blinding disease, genetic counselling will also be
available which can be of aid to parents in future family planning.
After the child's initial workup and diagnosis have been completed, then the child's parents and
primary ophthalmologist must decide upon the goals of future treatment. Parents should never be afraid
to ask any question of the physician however basic it might seem.
"Will my child be able to perceive light or color?" Will the eyes become ugly or painful?" Will they swell
up and burst?" "How many operations may be necessary and how much will they cost?" These are all
questions which the ophthalmologist will be prepared to answer.
Multiple examinations under anesthesia may be required for proper management and followup of
younger children. However, if the financial burden for the child's care becomes too great for the family,
"crippled childrens'" funds for this purpose are available in most states. The physician should be able to
help the family make an application for these services as well as helping them contact state organizations
for the visually impaired. Pediatric ophthalmic surgery and anesthesia are no longer the unpleasant and
traumatic experiences which many blind adults remember from their own childhoods. Ether, with its
unpleasant odor and after effects, is no longer used. In the hands of the modern anesthesiologist, pediatric
anesthesia is safe, painless, and usually no more uncomfortable than drifting off to sleep.
Surgery and anesthesia for crossed eyes and blocked tear ducts is very common and usually performed
before the child's first birthday. Many surgeons utilize an outpatient surgical setting so that the child does
not have to spend a night in unfamiliar hospital surroundings. Preparing a poorly sighted child for
surgery should be no different than preparation of a child with normal eyesight. Prior to age two or three,
the experience is only minimally disturbing to the child since hospitals encourage parents to remain with
the child in his room as much as possible. For older children a preoperative visit to the pediatric ward can
be arranged to help alleviate any unnecessary anxieties about the hospital. It is also important for the
ophthalmologist to directly discuss the childs' fears as well as those of his parents. Many children will be
satisfied by simply being told that "the doctor is going to fix his eyes." Some will have more specific
questions and worries such as whether the eyes will be patched, or whether the eye is removed from the
socket during surgery.
In summary, surgery for blind children is approached in the same way as surgery for a normally
sighted child. Patient, parents and ophthalmologist must communicate well and discuss the goals, visual
expectations and possible complications of the surgical procedure. It is important for the doctor to take
enough time to fully explain the present and future plans for the child in terms that the parents
understand so that the disappointment of falsely high expectations may be avoided. If this
communication is lacking, the ophthalmologist has failed to fulfill his most basic responsibility to the
patient.

Dr. Campbell is an opthomologist, well-known and respected by Federationists and
professionals in Lincoln, Nebraska where he practices. His willingness to be
frank with his patients is refreshing and appreciated.
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