THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, October 19, 1995 TAG: 9510190363
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
DATELINE: NORFOLK LENGTH: Long : 194 lines
For a baseball player, the eyes are crucial.
Can't hit the ball if you can't judge where it's coming from.
Can't catch a pop fly if you can't see the angle from which it's falling.
Can't steal a base if you can't see who has the ball.
So when Brett Hudson, a star Little Leaguer from Chesapeake, began striking out last year, his parents knew something was wrong.
Unfortunately, the solution wasn't as simple as a prescription for glasses.
Brett, now 11, had developed cataracts. They were, his parents knew, a result of medication following the bone-marrow transplant he'd had eight years before to cure a rare form of leukemia.
For a year, his eyes got progressively worse, the world ever more blurred. Then Maria and Byron Hudson learned about a Norfolk doctor and the cutting-edge procedure he performed on kids with cataracts - the intraocular lens implant.
Six weeks ago, pediatric ophthalmologist Earl R. Crouch Jr. operated on Brett's left eye.
On Wednesday, he operated on the boy's right eye.
And Saturday, if all goes well, Brett will be able to clearly see his beloved Atlanta Braves play in the first game of the World Series.
Brett Hudson is not complete without his identical twin, Cameron. The two are each other's best friends. Brett plays soccer on the team Cameron captains. But although genetically they may be identical, physically they look different. Chemotherapy and radiation have slowed Brett's growth, and he's about 4 inches shorter than his brother. It also caused him to lose his hair, which grew back wavy instead of straight, like Cameron's.
But both brothers have the same color hair - sandy brown. The same quick grin. The same obsession with soccer and baseball. And both have beautiful hazel eyes.
Nine years ago, Cameron's bone marrow helped save his brother's life. Brett had contracted ``acute myelogenous leukemia,'' a cancer of the white blood cells typically found in adult males. At the time, bone-marrow transplants were new and still experimental - especially when performed on children. Brett and Cameron were the youngest identical twins to undergo the procedure.
Brett survived. Four months after the transplant, when the twins were home again, Maria Hudson looked down at her sleeping toddlers and was struck by how different the boys looked. Brett - bald, thin and pale. Cameron - stocky, with a full head of hair. And she realized the nightmare wasn't over.
``Brett is going to be just fine,'' whispered a voice in her head. ``Until he turns 9.''
And he was. Just a typical active little boy. Played second base. Star hitter.
Then, about three months after his ninth birthday, Maria and Byron Hudson picked the boys up from basketball camp. Brett was dragging his left leg. The Hudsons rushed him to a hospital where they learned that the massive doses of radiation Brett had received had weakened his hip. He needed an operation to insert a bolt into it.
Since then, he's had surgery on the other hip and will eventually need staples in both knees.
In the past two years, the Hudsons have faced one problem after another. Now it was cataracts.
The Hudson twins have the ``surgery system'' down to a fine art. Brett undergoes the operation. Cameron brings the stuffed animals and worries.
So while it is still dark Wednesday morning, Cameron gathers his own favorite animal, Tramp, and Brett's Mickey Mouse, to take to Children's Hospital of The King's Daughters. Both would go into surgery with Brett.
By 8:30 a.m., when the surgery was to have begun, the nurse was just putting drops into Brett's eyes to numb and dilate them. The drops sting, and Brett fruitlessly tries not to rub his eyes as he lays his head down in his lap.
``It's all right,'' Maria says leaning over to put her arms protectively around him. ``Everything is going to be all right.''
But Brett, overly sensitive to pain, remembers the blinding headache he'd had when he came out of surgery before. And the pain. And besides, his eyes hurt now. He nervously shuffles his feet, clad in Sylvester-cartoon slippers, on the cold tile floor and looks miserable.
A few more hugs from his parents, a couple of manly pats on the shoulder from Cameron, and it is time for Brett, Mickey and Tramp to enter Operating Room 9.
Cataracts typically develop as we age, with 60 percent occurring after age 60. They happen when the normally clear, aspirin-sized lens located behind the iris (the eye's colored part) becomes cloudy, kind of like a smear of Vaseline on a camera lens. Gradually, vision becomes more and more blurred; eventually glasses and contacts don't help. Without surgery, blindness results.
One in 1,000 children also develop cataracts, either as the result of an eye injury, disease or, like Brett, as a side effect to medication. Brett's cataracts occurred because of the steroids he took after his bone marrow transplant to prevent rejection.
In adults, intraocular lens implants have revolutionized the treatment of cataracts. Instead of the heavy, thick glasses or contact lenses people used to wear after a cataract was removed, now a tiny plastic lens is permanently implanted in the eye.
But the Food and Drug Administration has never approved the lenses for children. Donna Lochner, chief of the FDA's intraocular corneal implants branch, said manufacturers haven't submitted the detailed clinical studies necessary to garner such approval. So official approval is a ``ways away,'' she said.
Doctors, nevertheless, can use their own judgment; Crouch and a handful of other surgeons around the country have begun using the lenses on children anyway. Without them, children's long-term prognosis for cataract surgery isn't very good, because it's hard to get kids to wear the contact lenses required after surgery, Crouch said. Brett's eyes are so dry he couldn't wear contact lenses anyway.
Without constant use of the contacts, children's vision deteriorates rapidly after cataract surgery.
Crouch, who is also chairman of the ophthalmology department at Eastern Virginia Medical School, began performing the lens implants on children in Mexico in 1990 and here in '91. This summer, he and an associate in Idaho published their first paper on the procedure. Their results from 34 operations showed an 85 percent success rate - success being vision of 20/40 or better. Conventional cataract treatment in children has about a 50 percent success rate, Crouch said, mainly because kids won't wear the contacts.
Before Wednesday, Crouch had operated on 50 eyes. Brett Hudson's right eye was his 51st.
The nurses at King's Daughters call operating room nine the ESP room - Earl's Sight Pavilion. This is a room designed especially for Crouch's kind of surgery with a ceiling-mounted operating microscope. Two television monitors bracket the operating table. They depict the surgery, magnified 10 times. They also provide a permanent record of the operation to be used as a teaching tool.
It is very quiet here. Crouch talks in a barely audible voice, softly requesting the instruments he needs. Easy-listening WFOG radio is piped in over the speakers. The steady ``hiss, hiss,'' of the respirator is the loudest sound.
Sterile drapes cover every part of Brett except his right eye. Crouch, sitting just above Brett's head, peers down through the operating microscope, and Brett's hazel eye fills the screens of the two monitors. The eye is propped open with what looks like an unbent paper clip, a ``lid speculum,'' and the pupil is so dilated it fills the entire iris. Every minute or two, resident Shannon McCole squirts some saline solution into the eye to keep it wet.
With a very sharp, fine knife Crouch cuts into the ``sclera,'' the white part of the eye, until he gets to the point where it meets the cornea.
Two more incisions take him into the ``anterior capsule,'' or the pouch that holds Brett's now-clouded lens. With a thin syringe, he injects a solution into the pouch which will keep it open like an inflated balloon even after he removes the lens. With another needle, he squirts saline solution onto the lens to soften and loosen it.
The room is dark, the only light coming from the television monitors and the bright spotlight illuminating Brett's eye.
``Aspiration, please,'' Crouch says softly. ``You can turn the light on.''
In the sudden, blinding glare from the fluorescent lights, he uses a tiny nozzle, the opening of which is about the size of a pencil tip, to suction out the cataract. Globs of it are drawn into the aspirator, leaving behind a clean, empty space.
``Lights out, please.''
Again, darkness. A nurse holds open the sterile tray in which the lens resides. With steady tweezers, Crouch picks up the miniscule piece of plastic. It is 5 millimeters around - half the size of a dime. Two hair-thin pieces of plastic extend from each end. They will embed in the eye's tissue and hold the lens in place - ideally for another 80 or 90 years.
Another half-hour of stitching up the small incision, a patch over Brett's eye, and he's ready for the recovery room.
In the surgery waiting room, the Hudsons sit surrounded by books and magazines. Maria jumps up when Crouch enters the room, still dressed in his surgical scrubs.
``How's he doing?'' she asks.
``We're all finished. Everything went just fine.''
Maria lets out a deep breath and reaches over to rub her husband's shoulder. Cameron's tense face relaxes. The entire family seems to sag with relief.
And then Maria gives in to the fear she wouldn't express Tuesday during the pre-operative visit. Without the surgery he would have been blind, she says. ``If we'd had to wait until he was 18, it would have been too late.'' ILLUSTRATION: [Color Photos]
BILL TIERNAN
The Virginian-Pilot
Maria Hudson comforts her son, Brett, 11, at Children's Hospital of
the King's Daughters moments before surgery.
BILL TIERNAN
The Virginian-Pilot
ABOVE: Dr. Earl R. Crouch Jr. worked for more than an hour to remove
a cataract from Brett Hudson's right eye and to insert an
intraocular lens.
BILL TIERNAN
The Virginian-Pilot
Left: Crouch adjusts an ophthalmology microscope in a surgical suite
at Children's Hospital of the King's Daughters Wednesday in
preparation for eye surgery on Brett.
by CNB