A Boy's Sight, and a Hospital's Vision

By John Kelly
Tuesday, December 19, 2006

A regulation hockey puck is three inches in diameter and one inch thick. It weighs about six ounces. At rest, it makes a nice paperweight or an excessively overbuilt coaster for a refreshing beverage.

Toss it in an ice rink and slap it with a hockey stick, however, and that puck becomes a wicked projectile, a black blur capable of moving at speeds exceeding 100 mph.

You take your eyes off it at your peril.

Which is why it's nothing short of a miracle that four times a week 8-year-old Mark Weinstein of Bethesda pulls on his hockey pants, shin pads, socks, shoulder pads, elbow pads, jersey, skates, gloves and helmet and then glides onto the ice to smack a puck with his teammates.

When Mark was a baby, it looked as though he might never see again. One day at 3 1/2 months old, "he wouldn't open his eyes," Mark's mother, Dorothy, told me. When he was finally persuaded to let a pediatrician take a look, Mark looked out from a left eye that was disturbingly cloudy.

The next Monday, Mark was examined by Dr. Mohamad Sami Jaafar, head of the ophthalmology division at Children's Hospital. On Thursday, Mark had his first surgery. He had been born with an ailment more common in the very old than the very young: the dangerous buildup of pressure inside the eyeball called glaucoma.

I had always thought of the human eyeball as a closed system, but in fact the fluid that fills it -- called the aqueous humor -- is continuously circulated at the front of the eye. When this fluid can't drain properly, pressure builds up. The eyeball swells, putting stress on the bundle of optic nerves at the back of the eye that sends visual information to the brain. Too much pressure, and darkness eventually closes in.

"Most adults are treated with eyedrops," said Dr. Jaafar. "Most of them do well; on occasion a small percentage will ultimately need surgery. It is the reverse in children. The main treatment is surgery."

Dr. Jaafar operated three times on Mark's left eye and once on his right, carefully slicing between the cornea and iris to create the drainage channels Mark was born without.

The operations were just the beginning of Mark's treatment. For years Dorothy and her husband, Jay, carefully administered eye drops and made sure that Mark wore a patch over his better eye.

Young eyes are malleable, and the connection between eye and brain was still being forged in Mark. The danger with pediatric glaucoma patients is that they will favor their good eye. If they do that, the brain never learns to process information from the poorer eye. By age 10, it's too late to establish that connection.

Today, Mark has 20/20 vision in his right eye and 20/40 in his left. The glasses he wears aren't any different from those worn by other third-graders.

The eyes are our window on the world. But the eye is also the world's window onto us.

"It is the only part of the brain that you can look into," Dr. Jaafar said.

The eyes have an almost spiritual power, allowing us to communicate with a glance emotions too powerful for words.

Said Dr. Jaafar: "It's extremely disturbing to a parent when they have a newborn baby and they smile and coo to the child and the child just does not respond back to them, doesn't see the expression of the adult."

And so he and his colleagues at Children's Hospital work to lift that barrier, to give sight to those headed toward blindness.

One evening last week, Mark skated with his Montgomery Blue Devils "Mite B"-division teammates at the Rockville Ice Arena, his father gliding nearby, his mother watching from the stands.

"I never would have guessed this eight years ago," said Dorothy.

His practice over, Mark said he hopes Dr. Jaafar will come watch him skate one day.

Making a Difference

Your tax-deductible donation to Children's Hospital will help ensure that even poor kids will be able to receive the same care and treatment as Mark.

To donate, make a check or money order payable to "Children's Hospital" and mail it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

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