Late Effects Of Cancer Treatment : Cataracts

Hello Everyone,

 Hope you're all well!  

 A post I have been wanting to do for ages is the side effects of cancer treatment; most people assume that side effects only occur during treatment and, once the cancer is gone, your health is back on track and you can return to 'normal'. Unfortunately this is not the case as the treatment used to kill the cancer cells can have 'late effects', these are side effects that are apparent after treatment has ended. Survivors like me can experience late effects of cancer treatment years later, the three main types of treatment are chemotherapy, radiotherapy and stem cell transplant. The side effects vary from to person to person and it all depends on the type of cancer and the treatment you have received for it. In today's post I will be talking about my personal experience with one of the 'late side effects' that I have experienced; cataracts. 

 Cataracts 

Due to the radiotherapy I received as part of my conditioning treatment before my transplant, a late effect I suffered a few years post-treatment was cataracts. The type of radiotherapy I had was TBI (total body irradiation) which is basically radiotherapy to your whole body, I had to have this treatment twice a day for three days. I personally found radiotherapy the most terrifying treatment of all the ones I have experienced, I cannot put into words how awful the it was, just imagine lying in a dark, noisy room alone in a very uncomfortable position whilst  a radiotherapy machine is firing high energy rays at you. The treatment itself was not painful at all, although my arms were stiff by the end of each session from having it on my head; I was told to have my hands on my head and lay still whilst I had the radiotherapy so the high energy rays were able to target the cancerous areas of my body that needed being treated. Even to this day thinking back on my experience with radiotherapy gives me goosebumps, for most of my sessions I was in tears, not only because I was terrified of the whole process but also because I had all this time to think. I remember thinking 'What am I doing here? I am fourteen, I should be out having fun with my friends not fighting to save my life.' As hard as it was I pulled myself together and powered through it as I knew it was for the best. If you would like to find out more about my experience with radiotherapy check out my part three: relapse and bone marrow transplant post.

  Cataracts is a clouding of the lens inside the eye, causing vision to appear blurred. Normally our lens is crystal clear and its function is to focus light onto the retina at the back of the eye, however the lens of the eye is very sensitive to radiotherapy causing cataract to form, clouding the lens and prevent light being transmitted clearly and therefore causing blurred vision.

 It all sounds very complicated here but basically my vision was affected by the radiotherapy I had which meant I had problems with my vision. I was able to see everything but it was never clear which was very frustrating, especially whilst watching TV or attempting to read the board at school. Before the cataract was discovered  I suffered from severe dry and itchy eyes that got to a point I could not deal with even with the many drops I had been prescribed with, so I was referred to an eye clinic in Sutton.  At times I would go through phases where my eyes were unbelievably itchy and sore; I could not open them at all because it was that painful. Initially when I was examined at the eye clinic my cataract was not apparent and was treated with artificial tear and anti-allergy drops which were an absolute saviour! After battling with countless number of eye drops and continuously putting cold cotton pads on my eyes, finally something was helping my poor eyes recover. I was told the dryness and itchiness of my eyes were all due to side effects of the treatments I was on, and I was already aware of the potential of having cataract even back then because I was informed about all the risks and side effects of radiotherapy by my consultant before I had the treatment.

 I went to a follow up clinic every three months so my consultant could keep an eye on my progress; it was only on my third appointment she detected the cataract whilst she was examining my eyes through the microscope as usual. However this time I knew something was wrong because she took ages assessing my eyes, I'd always had a feeling that I was going to be told that I have cataracts, so when my consultant broke the news I was mentally prepared so it was not a massive shock to me. Yeah, I was quite upset knowing I have an eye condition that only mostly affects elderly people but inside I knew radiotherapy is one of the reasons I am here today and I  believe 'nothing worth having come easy'.

 My consultant left the decision of having surgery to remove the cataracts from my eyes entirely up to me which I was grateful for because previously, with all the cancer treatments I had been through I had no other option than to go through them all. It was just nice to have that control of your own body without someone else deciding for you, I am no means saying all the treatments and surgery I have been through was forced upon me but when you have a life threatening illness like cancer you place your life in the hands of the medical professionals and do whatever it takes to get better. I had cataracts in both my eyes but the right eye was worse than the left eye, by worse I mean the blurriness was more severe in my right eye compared to my left eye. After my appointment of being told I have cataracts, I had a really good think about whether I should have surgery and my lovely consultant gave me her email so I can email her anytime if I had any questions and to let her know if I want to go through with the surgery. I was also given leaflets to read about cataracts and cataracts surgery to help me have a better understanding of the condition.

 After contemplating whether to have the surgery or not I made the decision to have surgery to remove the cataracts in my right eye (worse eye). I was getting quite fed up of having poor vision which was affecting my everyday life and having to increase the strength of my glasses frequently. My consultant, being so great, booked my surgery during the October half term so I would not have to miss a lot of sixth form. On 28th October 2014, I underwent surgery on my right eye to remove the cataracts, I was a bit scared but on the whole I was pretty relaxed knowing that my consultant was going to operate on me. Before I had my surgery I had a couple of pre-operation assessments where they assess your eyes and general health to make sure I am fit to undergo surgery. Measurements of your eyes is also taken to assess the strength of the artificial lens that replaces the natural lens.

Before surgery- surgeon marked a cross on which I was having the operation on.

After surgery- Feeling very sleepy due to the anaesthetic 

 Most of you are probably wondering how is cataract surgery performed, it's actually very simple, in my case I chose to have general anaesthetic so I was asleep for my operation but it I also had the option to have it done under local anaesthetic drops, meaning you are awake but the area around your eye is numbed so you do not feel any pain.  The operation lasts around 45 minutes and it involves the surgeon making a tiny cut in your eye to remove the natural lens that has been affected by cataracts and replacing it with a plastic lens ( sorry if your squeamish!) Cataracts surgery is generally a very safe procedure, but as with all surgeries it has its risks  which I had to be aware of such as bleeding in the eye, infections etc.

Fortunately my surgery went well! It took me around 2 weeks to get my right eye vision back to 'normal', when I say normal I mean everything was much brighter and in focus which I did not have before as the cataract was preventing all of this! Recovery varies from person to person as it all depends on your visual system adapting to the plastic lens used to replace your natural lens. After the operation the surgeon put a shield over my right eye for protection and I was advised to keep it on for 24 hours and then at nights for a week. Recovery was very boring as all I could do was rest, I was allowed to watch TV, use my phone and laptop but only using my left eye as my right eye was still blurry. I was prescribed with antibiotic drops to prevent infections and anti- inflammatory drops to use for a week and I was advised not to bend or do any sort of physically straining activities to avoid putting extra pressure on my eye. 

Recovering at home 

A couple weeks after surgery I had an appointment with my eye consultant to assess how I am doing post surgery etc, she was very impressed as I could read almost all of the letter chart without my glasses! During my first appointment post surgery I also had my stitches removed from my eye, which, I'm not going to lie, was quite painful especially as your eye is such a delicate part of the body and removing a tiny stitch was a task itself for my consultant! 

I am now 9 months post cataract surgery and I am doing very well, I wear glasses for reading and distance and I now have 20/20 vision in my right eye which is just amazing! Unfortunately I still have cataract in my left eye but as I have had my right eye done it has made a massive difference that I can see clearly when I am wearing glasses. In the future if I ever need to have my left eye done I do have the option which I am grateful for. Regarding my dry eyes, I still suffer from this condition even after surgery, but it is nowhere as bad as it used to be, I still do use artificial teardrops and anti allergy drops on a daily basis to keep it under control. 

Thank you so much reading and I hope this has helped you in some shape or form! As you can see, as well as cancer treatments being life saving it can also have a major effect on you like cataract later on life. This is only one late side effect I have talked about in this post, there are many more that I will be discussing in my future posts. 

Kirushni xxx