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Young Eyes, Devastated by Diabetes

Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly.  In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they are different from  other children.

Their lives as care-free children or teenagers will be forever entwined with having a chronic, life-threatening disorder. Simply being able to manage sugars takes a huge psychological toll on these children, who have much higher rates of depression than non-diabetic children. Thankfully, with aggressive integrated medical and social care, many of these children do very well at dealing with this disease.

Last year I performed surgery to remove cataracts from both eyes of a teenaged patient. This was a young man who played  multiple sports, excelled at school and wanted to be an executive chef, all while managing the juvenile form of diabetes. He was sent to me because he noticed his vision had become blurry and he thought he only needed a pair of glasses. Instead he was told he had cataracts, which is the formation of a cloudy lens in the eye that is typically an age-related change in the eye. But in this case, it was an effect of childhood diabetes.

The only solution to improving his vision was to have surgery, which is certainly not without risk. Although cataract surgery is commonly performed in the adult population, in the pediatric population there are additional hurdles to a successful outcome, mostly due to the fact that the eye is still growing. Even after a successful surgery, like an adult, he would need to wear reading glasses to complete his homework.

Anyone who has cataract surgery needs extensive pre-operative counseling to prepare for rigorous post-operative care. This includes frequent visits to the doctor, laborious eye drop schedules to prevent infection, restriction in all physical activities, then returning to the operating room to do it all over again for the second eye. As you can imagine, most of my patients are quite relieved to only have two eyes at this point!

Unfortunately, the formation of cataracts is not the most feared vision-related complication of diabetes, since it can be surgically corrected. That would be diabetic retinopathy, which can cause permanent blindness due to abnormal blood vessels growing in the eye. While diabetic retinopathy rates are lower in children, if it starts early enough it can be tremendously difficult to manage. 

As an ophthalmologist, it is my job to be a part of the medical team that helps children with diabetes and their families understand the gravity of managing all aspects of this disease. There are many challenges, but I love what I do because of the success we have on a regular basis. The teenaged boy who I operated on last year? He is indeed attending culinary school and pursuing his dream to become an executive chef!

Erin K. Walsh, MD, is a pediatric ophthalmologist in the Department of Ophthalmology and Visual Sciences, and Assistant Professor of Ophthalmology & Visual Sciences and of Pediatrics at Albert Einstein College of Medicine.



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