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Congenital cataracts

Medical ConditionGlaucoma

Abstract

This 58-year-old patient was born with bilateral cataracts. He had surgery on one eye at age 3. Eventually he developed near blindness in that eye and severe vision loss in the other. He suffers from constant eye discomfort, frequent headaches and tearing. He uses edible marijuana for prolonged mydriasis, which improves his vision and relieves his other symptoms.

Symptoms

Vision loss, eye pain, tearing.

Gender

Male

Age

55-64

Brief history and target symptomatology

This 58 years old man was born with bilateral cataracts. At age 3 he underwent surgery on his left eye, suffered postoperative complications and progressive loss of vision; he developed retinal detachment, then glaucoma and became legally blind in this eye around age 35. His right eye was not operated on but also suffered progressive loss of vision with a visual acuity of 20/80 currently.
The patient was a software programmer for several years however his deteriorating vision forced him to switch from actual programming to a consulting role. He uses on occasion the common mydriatic agent Cyclogyl to maximally dilate his pupils, allowing him his best possible vision but prefers edible marijuana because its effect is longer-lasting. Marijuana also relieves a constant discomfort associated with his vision, which he calls "eyestrain" and which may progress to frank headache.

Previous and current conventional therapies

Surgery. Mydriasis with Cyclogyl (generic name: cyclopentate HCl).

Clinical response to Cannabis

Improved vision. Relief of associated "eyestrain" and headaches.

Additional Comments

Congenital lenticular opacities (cataracts) are rare, estimated at 5 per 10,000 in the US. Most are idiopathic, many are familial, some are due to intrauterine infections or metabolic and genetic disorders. Visually significant cataracts are in the center of the visual axis and greater than 3 mm in diameter. For these, surgery is the treatment of choice; outcomes have improved over the years with the development of new techniques and new intraocular lenses (although use of the latter in infants remains controversial). To ensure minimal or no visual deprivation, surgery should be performed when patients are younger than 4 months. Even with aggressive surgical and optical treatment, visual deficits are common: amblyopia ("lazy eye"), nystagmus and strabismus in childhood, and glaucoma and retinal detachment years after surgery.

References:
Bashour M. Congenital Cataract. Medscape 2014; Retrieved at http://emedicine.medscape.com/article/1210837
Yorston,D. Surgery for Congenital Cataract. Community Eye Health 2004; 17: 23–25.

Usual method of Cannabis administration

Ingested

Frequency of Usage: Time Per Day

4

Frequency of Usage: Days per Week

7

Contributing Physician

Stefan Arnon M.D.