Sunday, 31 August 2014

At first sight: How doctors helped a blind toddler see again

Jon Paul Corman was adopted from China, and he had serious vision problems that required the complete removal of one eye and surgery on the other. Now six years old, he has 20/200 corrected vision with help from his doctors. – MCT

Jon Paul Corman was adopted from China, and he had serious vision problems that required the complete removal of one eye and surgery on the other. Now six years old, he has 20/200 corrected vision with help from his doctors. – MCT

Doctors in the United States faced many challenges in trying to restore a toddler's eyesight. 

Faye Corman was leading the little boy with the deep brown eyes across the train platform when all of a sudden he stopped, planted his feet, and refused to move.

“Come on, Jon Paul,” she urged him. No luck.

She and her husband had adopted the three-year-old from China a few months before, and communication was still tricky. There was the language barrier, sure, but also, the boy was blind – and always had been, as far as anyone knew.

He’d just had a second surgery at Wills Eye Hospital, Philadelphia, United States, but the doctors did not hold out much hope that he would see.

Suddenly, Jon Paul leaned forward, almost as though he were looking at something – looking? – and reached down to the concrete floor of the PATCO train station in Westmont.

He picked up a shiny, silvery gum wrapper. His mother started to cry.

It all started with Camille. The Cormans adopted her from China in 2005, and in a few years, they were eager to adopt again.

But in the intervening period, China and other countries had started to have second thoughts about the large numbers of children headed to the US.

This time around, the adoption agency told the Cormans that Chinese officials no longer considered them good candidates, Faye said.

The reason? Because her husband was blind.

Never mind that Michael Corman, an accomplished lawyer and pianist, was a loving father to his daughter. The foreign adoption door seemed to be closed.

Then the family learned about Madison Adoption Associates, an agency that specialises in finding homes for children with special needs. The Cormans, who live in Barrington, New Jersey, approached the agency about adopting a visually impaired child.

Dr. Alex Levin, Chief of Pediatric Ophthalmology and Ocular Genetics at Wills Eye Institute in Philadelphia, poses for a portrait on July 17, 2014 at Wills Eye Insitute in Philadelphia. Dr. Levin performed the surgery on Jon Paul Corman's left eye to remove a cataract and relocate the pupil. (Matthew Hall/Philadelphia Inquirer/MCT)
Dr Alex Levin performed the surgery on Jon Paul Corman’s left eye to remove a cataract and relocate the pupil. – MCT

“We said a lot of prayers,” said Faye, a product steward at DuPont.

It took many months of paperwork and advocacy, but finally in February 2011, the Cormans travelled to Fuzhou, in Fujian Province, a few hundred miles northeast of Hong Kong, to meet Jon Paul.

The records from the orphanage had said something about an “opacity” in one eye. But when the couple met their son, it was clear he was pretty much blind in both eyes: running into walls, feeling his way up stairs, unable to see food on his plate.

Not to worry. Michael, who in 1991 became the first blind graduate of Rutgers University law school in Camden, could help him learn to read Braille.

And his wife, thinking ahead, had already made an appointment for Jon Paul at Wills Eye, founded in 1832 as the US’ first eye hospital.

Michael had been treated there as a child for his congenital blindness, and he credits Wills Eye physicians for giving him some degree of light perception.

It was hard to know just when to make Jon Paul’s appointment because the final adoption date was uncertain, but Faye nailed it. Four days after landing on US soil, her son went to the big, curved-front building on Walnut Street.

That is when things got complicated. 

Dr Alex V. Levin never gets tired of watching that first moment when the bandages come off and a formerly blind child is able to see.

Chief of paediatric ophthalmology and ocular genetics at Wills Eye, he frequently travels abroad to perform surgery on needy children.

A month ago, he was in the Philippines, where one of his tasks was to remove cataracts from the eyes of a six-year-old boy.

“You could see the wonderment, the bewilderment in the face of a kid who had not seen his whole life,” Dr Levin said.

Increasingly, researchers are learning the brain is more plastic than once thought. Even if a child is blind for the first few years of life, it is possible after corrective eye surgery for the brain to learn to interpret the new influx of visual information.

Still, Dr Levin was not highly optimistic about Jon Paul.

The vision in the boy’s left eye was impaired by a thick, cloudy cataract, which might have been there since birth.

And his pupil was in the wrong place – at the top of his iris instead of dead centre.

None of this information was contained in the scant medical records sent by the orphanage.

The boy’s right eye – the one with the “opacity” – was even more troublesome. Shrunken and scarred, it “was essentially a dead eye,” Dr Levin said.

What’s more, it contained bits of calcium – a possible indication of cancer.

The Cormans thought they were taking their son in for a one-hour appointment. It turned into a full-day affair, and Wills Eye oncologist Dr Carol Shields said Jon Paul’s right eye would have to come out.

Four days after that first appointment, in March 2011, Dr Shields removed Jon Paul’s right eye and replaced it with an implant.

There was no cancer, fortunately. But if he was ever to have any vision, everything hinged on the remaining left eye.

Dr Levin performed the cataract surgery in June 2011, and also enlarged the pupil so at least part of it would be located at the centre – forming a sort of keyhole shape.

The next day came the gum-wrapper episode on the train platform. Faye did not know just how well the boy could see, but evidently he saw something.

Things have only gotten better since.

Unlike with adult cataract surgeries, Dr Levin did not put a new lens in Jon Paul’s left eye, as it was smaller than normal.

Instead, the boy was fitted with thick-lensed plastic glasses, which take the place of his natural lens while also protecting the eye.

The prescription has been tweaked several times in the three years since, and Jon Paul has made steady progress.

By last summer, his vision was measured at 20/200, meaning that if a person with 20/20 vision could see something from 200 feet away, Jon Paul could see it from 20 feet.

Far from perfect, but great for someone who was starting from near zero.

With a new prescription in March, he now appears to be seeing even better, said his mother – unable to tell the story without emotion.

“Miraculous,” she said.

“We were very, very blessed,” said her husband.

Jon Paul navigates the inside of the family’s cozy white house at high speed, excitedly showing visitors his toy helicopter and other playthings.

When watching a Sesame Street video on an iPad, he readily identifies the characters Elmo and Oscar, as sister Camille, nine, hovers protectively nearby.

He is learning to read print, as well as braille, and attends mainstream public school with the help of an aide.

At first, his parents were concerned he might be autistic, as he sat in one place and flapped his fingers.

It now seems that behaviour might have been a phenomenon called institutional autism, in which a child develops autistic-like behaviour in response to a lack of stimulation, as might be experienced in an orphanage.

Developmentally, he has made huge strides since, easily interacting with others.

He watches Wheel of Fortune on TV with his family, and does a dead-on impression of the announcer who calls out “Wheel ... of ... Fortune!” at the beginning of each show.

“That’s his party trick,” Michael said.

The real trick, of course, is being able to see. – The Philadelphia Inquirer/McClatchy-Tribune Information Services

Tags / Keywords: blind boy , operation , restore sight


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