Nathan and Jack Marks

At first sight

Nathan Marks was born with congenital cataracts, so he and his wife, Jessie, knew their children may be at risk of being born with the same condition.

The Marks’ daughter, Penny, now 6, was given a clean bill of vision health when she was born. But when doctors couldn’t detect son Jack’s red reflex—the reddish-orange reflection of light from the eye’s retina, observed when using a ophthalmoscope or retinoscope—during a vision screening shortly after his birth in August 2013, Nathan knew what was wrong.

 “From the time they said he didn’t have that reflection, I knew he had it,” recalls Nathan, of North Liberty, Iowa. “It was just the way they said it, I knew he had cataracts.”

Jessie also could see something was wrong.

“He just wasn’t looking at me in the same way Penny did, the way you expect your newborn to look at you,” she says. “I had a really hard time with that.”

Jack’s cataract surgeries were done at 5 and 6 weeks old. At 8 weeks old, he started wearing contact lenses.

Things went well for the next two months until pressure started building in one of Jack’s eyes. Tests confirmed what the doctors suspected: Jack had glaucoma.

“We knew that people who have cataract surgery will have glaucoma at some point in their lifetime,” Jessie says, “but Nathan got it when he was in his 30s. To see Jack with it at 4 months old was scary.”

Jack’s parents knew he would need another surgery. Wallace Alward, MD, the Frederick C. Blodi Chair in Ophthalmology and director of the glaucoma service at UI Hospitals & Clinics, confirmed their fears.

Congenital (present at birth) cataracts aren’t common. When very young children, like Jack, have cataract surgery, about half will develop glaucoma. Performing surgery on a young child is more difficult than on an adult, according to Alward.

“There is not room to put a drainage tube in the front of the eye, so we need to remove the vitreous gel and place the tube deep in the eye,” he says. “It takes two surgeons. Dr. [Culver] Boldt removes the vitreous gel and I insert the drainage tube.”

Alward says he and Boldt perform the combined procedure just a few times a year.

“There are not many places in our region that do this—certainly not in Iowa,” Alward says. “We are lucky because Dr. Boldt and I can arrange our schedules to be in the OR together.”

Now 4 years old, Jack wears contacts as well as glasses to help improve his vision. While he may need some minor procedures in the future, Jack’s parents don’t foresee any significant issues.

“He should be able to drive, and he should be able to play sports. He should be able to do all of those things as he gets older,” Jessie says.

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