Archive for March, 2011

The Road Ahead — Chapter One: Cataracts

Sunday, March 13th, 2011

Almost two years ago I realized that I was not seeing as clearly as I once did – that maybe I was getting cataracts, especially in my left eye. If you can’t read highway signs on interstates (as ‘became clear’ to me later), you’ve got a problem.

After consulting “Dr. Google,” my first problem was my ophthalmologist of almost 40 years, who shall remain nameless. She’s also the mother of a high school classmate of Lindsay’s at Sidwell. I put off calling her for almost a year, but finally telling her of the cataracts, and telling her I was going to go to the Wilmer Eye Clinic at Hopkins in Baltimore. I had to tell her I thought she was too old at 65 to operate on my eyes. This was hard; she, of course, does cataract surgery all the time – her practice has aged along with both of us. But I did it…

I emailed my internist at Hopkins, and asked her if she had any recommendations for a surgeon at Wilmer. She replied immediately – that Dr. Oliver Schein was “the go-to guy” at Wilmer. I asked, and she said that if SHE had to have cataract surgery, she’d go to Schein without a moment’s hesitation. I looked him up (Hotchkiss and Princeton — sigh) and made an appointment.

By now I’d learned that there are several kinds of plastic lens that they can insert after they take out the clouded lenses. There are lenses that give you great distance vision (hey, that’s what you get with presbyopia anyway – distance vision), and there are much newer lenses that offer some degree of bifocal vision. I asked myself – do you kinda pretend to look down, and then you can read? The other option discussed is to have one eye for distance, one eye for closer up, and then wear reading glasses.

I didn’t think that the bifocal lenses sounded workable, and having two different focal lengths seemed a road to confusion. So I went to my first appointment with Dr. Schein with distance vision firmly in mind. That was my vision, anyway.

Dr. Schein offered a third alternative, “toric” lenses. The good news about toric lenses is that they correct for astigmatism. The bad news is that they are an additional $1500 per eye at Hopkins. Another part of the bad news is that in order to keep them from rotating they have little prongers that stick into your eyes. Oooh! I voted against toric lenses.

I learned from Dr. Schein that I had TWO operable cataracts (one in each eye…) and that the two procedures are done about a month apart, so that the one eye can heal, be seen to be healing properly, and so forth. So for a month, I’d be without a left lens in my glasses. Then I’d get a replacement for that one, and then have surgery on my right eye, not have a lens on that side, wait a month, and then “get well.” There was also a 1 or 2 percent chance something terrible would go wrong, and that should happen one eye at a time. I agreed…

Soon I was at Hopkins, prepped, and on my way into surgery. There I was offered another option – a lens that wouldn’t be as focused on the far distance, thereby making my interim month less confusing. I turned that option down as well, opting for better vision for the longer term. Deferred gratification is always a good thing…

I had the surgery, it was successful, Susan drove me home for a LONG nap, and I gradually got accustomed to seeing a fuzzy distance view out of my left eye. I’ve got a fair degree of astigmatism in both eyes. Sure enough, after a month I got a good lens for the left side of my glasses, and the lens is progressive, if not liberal. I can see very well.

So of course it was time for the right eye surgery, less than a week after I got my replacement lens. Off again…

The second surgery was uneventful (I have grown to like “uneventful”), and another month went by.

I do have to say that in some sense my world “narrowed” during the two months that my vision was degraded. I found myself a bit more cautious, less likely to take on new tasks and perhaps new ideas as well. It’s disconcerting to see the world differently out of your two eyes, and while it may be necessary, I can’t really recommend the experience.

There are other limitations as well – no heavy lifting, no swimming, shouldn’t drive for a few days, gotta remember to put in both antibiotic and steroidal eyedrops according to a complex schedule for the month, and all that. And your eye looks like you were poked in the eye with a sharp stick – but it was really a sharp knife.

I’m sitting here typing with both new lenses in place – and it’s a big improvement. I got the second lens last night, and had two odd experiences. First, while they were fitting the lens to the frames, I drove off without wearing glasses. That’s probably the first and ONLY time I’ve ever driven without glasses. It was quite safe – I’ve now got 20/10 vision in both eyes. That’s one of the benefits of going ‘bionic.” And 20/10 vision is the best that Wilmer can measure with their equipment – they may be even better! Call me “Hawkeye.”

Second, it was raining quite hard when I left the shop. I was careful to use my hand to protect my glasses from the rain – but I wasn’t WEARING glasses! This was a really odd experience for me, being out in the rain and not worried about my glasses getting wet!

As it stands, I’m not convinced that the right lens is as well measured, or as well installed perhaps, as the left one is. I’ll be just waiting a month or two to see how I like/adjust/tolerate the second lens, and how the two work together. Wilmer is known for its excellence at surgery, and NOT for its excellence at refraction. And I went to our local eyewear shop for the grinding and installation, rather than to the shop in DC I’ve been going to for eons.

Of course, if I decide I’ve got to get a better prescription, and better glasses, I’ve got to call my DC ophthalmologist of long standing, and see if she’ll take me in. That’ll be a tough day.

But it was a successful venture. I’m on my way to being bionic, and I thought I’d share the story. You may be next…

Senior Cousin Bob

March 11, 2011