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Healthy living after treatment of childhood, adolescent, and young adult cancer

Cataracts after Cancer Treatment
Childhood cancer treatment sometimes requires the use of medications or radiation that can increase the risk ofdeveloping cataracts. Because vision can have a significant impact on daily living, it is important for survivors whoreceived these treatments to have their eyes checked regularly.
What is a cataract?
A cataract is clouding of the normally clear lens of the eye. Cataracts often develop slowly, but as the clouding increases,
vision can be affected.
How does a cataract affect vision?
The eyes are remarkable organs, allowing light to be converted into impulses that are transmitted to the brain, whereimages are perceived. Light enters the eye through a clear layer of tissue known as the cornea. The cornea bends andfocuses the light and sends it through the opening of the eye known as the pupil. The pupil controls how much lightenters the eye. Behind the pupil is the lens of the eye, which focuses the light onto the retina, the membrane along theback wall of the eye. The nerve cells in the retina change the light into electrical impulses and send them through theoptic nerve to the brain, where the image is perceived. When the lens becomes cloudy due to a cataract, the image
delivered to the retina becomes blurry.
What are the symptoms of a cataract?
Common symptoms of cataracts include:•

Painless blurring of vision•

Sensitivity to light and glare•

Double vision in one eye•

Poor night vision•

Fading or yellowing of colors•

The need for frequent changes in prescriptions for glasses orcontact lensesLens
RetinaPupilCorneaConjunctiva
Optic nerve

What cancer therapies increase the risk of developing cataracts?
Certain chemotherapy, including:•Busulfan•

Corticosteroids, such as prednisone and dexamethasone

Radiation therapy to the following areas:•Eye and surrounding tissue (orbits)•Head or brain•

Total body irradiation (TBI)

The risk for cataracts increases with:•Higher radiation doses•

Frequent exposure to sunlight•

The passage of time (the longer off therapy the survivor is)

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Healthy living after treatment of childhood, adolescent, and young adult cancer

What monitoring is recommended?
•Have an eye examination every year during your regular check-up•

See an eye specialist (ophthalmologist or optometrist) for a full eye evaluation every year if you had:–

Total body irradiation (TBI)–

Radiation to the head, brain or eyes–

A tumor involving the eye

How are cataracts treated?
Not all cataracts need treatment. In many cases, an ophthalmologist may monitor the vision closely over many years
and will recommend treatment if and when it becomes necessary. The only treatment for cataracts is surgical removalof the lens and replacement with an artificial lens. Today, cataract surgery is a low-risk procedure that is performed on
an outpatient basis and usually is successful in restoring vision.
How can I keep my eyes as healthy as possible?
•Wear sunglasses with ultraviolet (UV) protection when in bright sunlight.

•When participating in sports, be sure to select protective eyewear that is appropriate for the sport. Eyewear worn
for sports should be properly fitted by an eye care professional.

•Avoid toys with sharp, protruding or projectile parts.

•Never play with fireworks or sparklers of any kind to avoid accidental injury.

•Be careful when working with hazardous household chemicals.

•Wear protective eyewear when using a lawnmower, power trimmer, or edger, and when working with dangerous
equipment in the workshop.

•If you do experience an eye injury, seek medical attention promptly.

Written by Teresa Sweeney, RN, MSN, CPNP, St. Jude Children’s Research Hospital, Memphis, TN; and Wendy Landier, PhD, CPNP,
Children’s Hospital of Alabama, Birmingham, AL.
Reviewed by Angela Yarbrough DNP, APRN, FNP-BC, CPON®; Kayla L. Foster, MD, MPH; and Christine Yun MSN, PNP, CPON®.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’sOncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
medical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
Children’s Oncology Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.

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