Ophthalmology

Boston Children's Hospital is extending the boundaries of cataract surgery in babies and children. Cataract surgery on babies is extremely difficult, but untreated cataracts prevent the developing brain from learning to see.

To treat "after-cataracts," which develop after cataract surgery and must be removed to allow normal vision, a laser can be used. Adults must undergo laser surgery in a sitting position, but for children and babies, it would be impossible to hold still. A special laser used at Children's, called a supine YAG laser, allows children to be cradled in a horizontal position after being anesthetized.

In addition, lenses, called intraocular lenses are being implanted in children of younger ages. These lens implants are standard treatment for adult cataracts, but are generally avoided in babies because inflammation and implant rejection are common. Ophthalmologists at Children's have successfully treated babies as young as a few days old with cataract extraction and as young as 6 months with lens implantation. The hospital is also part of a national study comparing intraocular lenses with contact lenses for babies with cataract.

Every year, thousands of babies who are born very premature develop a condition known as retinopathy of prematurity (ROP) that results in abnormal formation of the retina and ultimately results in blindness. At Children's our experts perform laser surgery to prevent blindness in these babies. Unfortunately, this surgery isn't always successful in restoring vision, but hope is on the horizon. Pediatric ophthalmologist Lois Smith, MD, PhD, has shown in animal models that doses of a growth factor that premature babies are deprived of can prevent this condition. Dr. Smith is planning a clinical trial of this agent at Children's Neonatal Intensive Care Unit. Click here to read more about this promising research.

Very few places in the New England region and in the country offer Botox injections as an option for treatment in children with strabismus. At Children's, eye doctors can sometimes use Botox (Botulinum Toxin A) in lieu of eye muscle surgery to correct strabismus. For adults and older children, this treatment can be given in the office. For young children, the procedure is performed in the operating room with a brief anesthesia.

Every year dozens of children who have had multiple failed attempts to correct misaligned eyes (strabismus) come to Children's for eye muscle surgery using specialized techniques. One technique that sometimes used in children with complex strabismus and almost always used our adult patients involves adjustable sutures.

Adjustable sutures allow our ophthalmologists to readjust the position of the eye after surgery. When a patient is asleep during surgery, it is difficult to tell whether the eye has been repositioned precisely as it should. Before adjustable sutures, surgery would have to be rescheduled to reposition the eye if it didn't come out as expected. But now, with adjustable sutures, the position of the eye can be readjusted in the recovery room to avoid the need to reschedule additional surgery.