A cataract-surgery journal: Part I


A NOTEI’m scheduled for cataract surgery soon.  The right eye, my worst, is to be done on April 21, the left on May 5.    The following account is a work in progress.   Part I deals with events leading up to surgery.  Park II deals with surgery and recovery, or in the words of the medically hip, post-op. 

Iris - eye anatomy

   AN EXPLANATION:  Cataract surgery is the removal of the crystalline lens (seen on the left) and replacing it with a  synthetic one.  It is said to be a simple operation.  This lens is located in the inner eye, just behind the iris and helps focus light  on the retina.   A softer material, the cortex, surrounds it in a capsule-like bag and all of it is held in place by a system of tiny wires called zonules.  In the beginning the lens is felxible allowing easy focus on distant and close objects by changing shape.  As the aging process occurs, the lens hardens and changes color.  Blurriness and clouded vision set in.  The lens becomes in essence a cataract. (Drawing  from stlukeseye.com)


January 22, Saturday:  The trip to eye surgery really began today on another trip.  Nebra and I arrived at the Honolulu airport in late afternoon to begin a 9-day vacation on Oahu.   While picking up a rental car at Enterprise, I was shocked to discover I had allowed my Arizona driver’s license to expire.  I had been driving illegally since mid-September.  Normally the renewal is no big deal.  But this time it is.  I  knew that meant a vision test when I got home to Phoenix.  That worried me.  My vision had worsened considerably in the past year.  Not only was the world turning more blurry, it was darkening.  I wore only a tinted pair of strong +4 reading glasses purchased at Ace Hardware for $3.  Reading a book or the newspaper by lamp was a pain.  I needed strong light, preferably sunlight.  For some time, I had asked Nebra to do most of the night driving.  I could not read the local green and white street signs to save myself.  The thought of having my license revoked is a very real possibility.  Not being able to drive is unthinkable.

February 4, Friday:  I travel by bus to the Motor Vehicle Division office on North 51st Avenue, Phoenix, to hopefully get my driver’s license renewed.  I haven’t driven now in almost two weeks. I’d been to this place before under less foreboding circumstances.  Anxiety sweeps over me.  It is busy as usual.  I wait about 45 minutes before my number is called.  The clerk is young, arrogant and disinterested.  He fills out the paperwork, takes my check and directs me to a nearby area for the dreaded vision test.  I’m to read a sign with rows of letters.  Even the big letter “E”” on top is blurry.  I’m sent back to Mr. Arrogance.  The tester says, “He failed.”  The clerk freaks out.  He doesn’t want to redo the paperwork.  It’s like he’s getting paid by the number of applicants he handles in a day.  I’m sent back to do yet another test.   This time the sign is brighter but I struggle to read more than a few rows down.  The tester again delivers me back to the antsy clerk.  “He passed.”   A sigh of relief from the clerk and from me.  I’m given a restricted license.  Daytime driving only.  This will be a huge imposition on my life.  I’ll be dependent on Nebra and others to chauffeur me around after dark. I go home depressed.

March 11, Friday:  I visit an optometrist, Gary Shapiro, in late afternoon.  I want to correct my vision if possible so I can drive again at night.  It’s been about 30 years since I last had my eyes tested.  At one time, I wore trifocals.  I didn’t like them and soon switched to cheap reading glasses.  I started at +2.5 and worked up to the +4s.  Shapiro has a small office in a renovated house on McDowell, just west of Central.   I go through a battery of tests, first with a technician and then with Shapiro.  He tells me I have cataracts in both eyes.   I don’t know why but I’m astonished.  I didn’t think I was old enough.  Anyway, the right eye, it seems, is more clouded than the left.  Surgery is advised.  That means lens implants, a once in a lifetime procedure.  A new world of vision will open up, Shapiro says.  I’ll need eyeglasses only to read, perhaps.    Long-range vision should hit 20/20.  I’ll probably be able to drive again at night.  I’m eager to get started.   The staff makes an appointment for me with Barnet Dulaney Perkins Eye Center up near Camelback Road.  This is the place Shapiro said he sent his mother to have her cataract surgery.   I feel optimistic now, almost giddy.

April 5, Tuesday:   I report to Barnet Dulaney Perkins Eye Center in early afternoon for a preliminary exam.  The waiting room is nearly full.  Most of the patients are elderly.  Some are in wheelchairs.   I fill out a ream of paperwork, wait 30 minutes before a technician dilates my eyes with three drops from different solutions.  The drops brighten the surroundings but also makes them foggier.   Then come the eye tests.  On one, I cover an eye and try to read the rows of letters with the other.  To pass the driver’s test, the technician says, I must have 40/20 vision.  That’s the fifth line down.   I can barely see some of the letters on Line 4 even with the reading glasses.  Line 5 is impossible.  The technician voices surprise I passed the daytime driver’s test.  “You probably shouldn’t be driving at all,” she says.   I think she’s wrong.  I do very well in daylight.  Certainly I’m no more of a danger than the zillions of drivers I see on cellphones or texting. Later I meet with a Dr. Pinkert.  He checks my eyes and confirms I have cataracts and that surgery is the answer.  The surgery itself will last only several minutes.   The old, clouded lens will be removed and a synthetic lens implanted.   I choose the right eye to be done first, no particular reason.  I should see “dramatic change” by the next day, Pinkert says.  I have two options, it’s explained:  A “standard” lens or a “special” lens.  The standard corrects my long-range vision but not the close up.  In that case I likely would wear glasses for reading.  My Medicare and Blue Cross/Blue Shield should cover the entire cost, minus the anesthesia.  The special lens will correct both far and near vision but the cost is $2,500 an eye.   My insurance will not pay for that luxury.  I have a few days to decide.  I’m to see my surgeon, Dr. Perkins, in two days.  Maybe by then I can make an informed choice.  I next talk to a counselor, Wendy.  She schedules me for eight more appointments, counting surgery and post-op.  As I leave I write a check for the deductible, $60.84. 

April 6, Wednesday:  I’m back at the same place for Appointment 2, an A-Scan and a physical exam.  The A-Scan, I’ve read, measures the length of the eye and the power of the cornea via ultrasound. The test calculates the power needed for my implanted lens.  I sit in a chair, my chin and forehead resting against braces.  A technician turns on a machine.  He sits behind it facing me, punching in computer commands.  Red dots of light appear against a black background as I stare into the machine.  Later an on-end yellow rectangle appears.  The tech has a limited vocabulary.  “Blink” and “open wide” are all he says to me.  The process takes only 5-10 minutes.  I’m none too happy to read the A-Scan is only “fairly accurate”  and imprecise measurements can occur.  After another 30-minute wait, I’m ushered into a small room for a very basic physical given by a middle-aged woman in glasses.  She listens to my heart and lungs and checks my blood pressure.  I take meds for BP and think maybe I may not pass this hurdle since I have “white-coat syndrome,” that sends my pressure up 20-30 points when measured in a doctor’s office.   Just in case, I’ve taken with me two BP readings from the previous night, measured on my home monitor:  113/73 and 107/64.  Today, I measure 140/80, but I’m told, “That’s good, considering you’re in a doctor’s office.  Most people are a lot higher.”   I walk out of the building shortly after noon.  It looks good.  My meeting with Dr. Perkins is still scheduled for tomorrow.

April 7, Thursday:   I show up at 11:30 for the appointment.  First, my eyes are dilated again, this time with only a “mild” solution.  The woman assistant describes in detail what happens on Surgery Day.  In short, I will be taken back to a “preparation room” and given an anesthesia to relax me, the eye numbed and dilated.  The surgery will take only 4-10 minutes.  The cataract, the old lens, is broken up by ultrasound and washed away with fluid.  The new lens is then implanted through a small slit in the eye.  I can expect to stay at the Eye Center for 1 1/2 to 3 hours, and will need someone to drive me home.  I sign a consent form for the surgery, noting that all may not turn out perfect.  I’m directed to another room where I will meet my surgeon, Scott Perkins, for the first time.  I know only a little bit about him from a handout.  He graduated from the Temple University School of Medicine, in Philadelphia, and did his residency at Boston University Medical Center in 1989.  I read he has performed more than 40,000 cataract surgeries and his been a part of this firm almost 20 years.  A light knock on the door.  Enter Perkins.  He is slender, maybe 5-11 and looks to be 45-50 years of age.  He exudes confidence and has a pleasant personality.   “I really enjoy working on people like you because you’re going to see such a big change in your vision,” he says.  Perkins examines both eyes.  He sees a slight astigmatism in the left one, saying that can easily be dealt with during the cataract removal.  But then he finds something else in the right eye.  It is a hole in the retina, a “fairly common” condition during the aging process, he says.  For some reason it was not detected in the earlier tests.  I undergo a retina test in another room.  It is confirmed that I have a hole.  Perkins says I will need another surgery, maybe three weeks after the cataract surgery, to deal with it.  I am disappointed when he tells me I have only one option now with the cataract surgery, the standard lens.  “Save your money,” he says.  “The special lens won’t enhance your vision that much.”   I heard Perkins say something to his assistant about “macular,” but I was so focused on the cataract that I let it slide.  I don’t know that I would’ve gone for the more expensive surgery.  But to know I don’t have a choice now, that’s a little depressing.  I ask Perkins if he thinks I can drive again at night.  He leaves me a crumb.  “That’s my expectations,” he says. 

April 12, Tuesday:  Nebra returns from chorus practice tonight at Phoenix College with a cataract story from one of the other members.  This woman had cataract surgery on both eyes,, years apart, one eye for close vision, the other for distance.  Sounds crazy to me. 

April 15, Friday:  Tom, a neighbor tells me tonight about his 80-year-old sister’s successful cataract surgery a few years ago.  She now can see near and far without glasses, but chooses to wear them anyway.  She’s worn glasses most of her life and doesn’t think she looks  good without them.  

April 17, Sunday:  I’m letting my thoughts drift about cataract surgery when suddenly I remember the words spoken almost two weeks ago by Dr. Perkins.  Hole in the eye.  A second surgery after cataracts.  Macular.  Part of the aging process.   I’d been so hung up on the cataracts I forgot those words.  “Many people have them,” Perkins had said.  I had come away feeling “the second operation” was routine, no big sweat.  I Google the words.  Quickly a long list of websites appear:  “Macular hole surgery.”  The surgery is called “vitrectomy” and the hole is a  serious problem, though I have none of the distorted vision yet that I read is associated with it.  The hole can lead to blindness if untreated.  I read on.  “A macular hole,” one site says, “is a small break in the macula, located in the center of the eye’s light-sensitive tissue call the retina.  The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.”   Surgery is successful 90 percent of the time, but improved vision is the million-dollar question.  Again, I have the hole only in the right eye.  It is rare to have it in both, I read.  I go to some testimonials and find some good ones on  medhelp.org.  I begin to realize how difficult recovery can be.  The head must be kept face-down for up to three weeks.  Gas bubbles, stages 1-4, oil substitutes.  It’s more than I want to know for now.  I’ll push macular hole surgery to the background, concentrate on cataracts.  One bird at a time.

April 19, Tuesday:  I pick up a phone message in late afternoon from the Eye Center. I’m to report for surgery at 7 a.m. on Thursday.  Nebra is my designated driver.  I call her at work.  “Are you ready?” she asks.  “Yes,”‘ I say without hesitation. “Let’s get it over with and move on.”

April 20, Wednesday:  I begin taking prescription eye drops shortly after 8 a.m. in preparation for surgery tomorrow.  One of the drops is Nevanac, an anti-inflammatory.  The other is Vigamox, which fights infection.  I must instill them in my right eye, the one that is to be operated on, three times today and once more before surgery in the morning.  I’m concerned about missing the eye with a drop or two.  The drops come in small platic containers and are very expensive:  $124 for the Nevanac, $80 for the Vigamox.  For the first drops I try the so-called Ritch-Sussman Technique, used by some glaucoma patients.  I grip the container between the index finger and thumb on my right hand.  With my left index finger, I pull down the bottom of my right eye then crook the finger into a right angle.  I bring the container to a point where the knuckle of the right thumb touches the knuckle of the left index finger.  The container should be right above the eye now.  I use the technique first for the Vigamox and then five minutes later for the Nevanac, as instructed.   Splash-down.  Most of it hits the eye.  Some does not, and I roll my head to force the errant solution into the eye.  Everything takes practice.   The Vigamox creates a slight itching, and the Nevanac a slight stickiness.  My vision is unaffected.   I even take the technique an unnecessary step further.  I push down on the corner of my eye with a finger to stem the fluid from entering the rest of my body via the tear duct.  Later, it dawns on me this is the last full  day in the life my natural right lens, the one I was born with.  It has aided me in seeing many things over the years.  I know it’s silly but I feel a touch of sadness.  It’s like ditching an old friend when he’s down and out. . . . It’s almost 11 p.m., time to fast until after surgery.  Nothing to drink or eat, not a sip of water nor even a cough drop.  The warning on the instruction sheet is a stern one:   “If you have anything by mouth, we will cancel your surgery.”

April 21, Thursday:  I’m up shortly after 6 for my 7 o’clock surgery appointment at the Eye Center.  It’s about a 15-minute drive, plenty of time yet.  I put the Vigamox and Nevanac drops in the right eye.  Forget the Riche-Sussman Technique for now.  I simply hold the dropper over my eye and squeeze.  Perfect splash-down both times.  I put the Celtic cross in a front pocket of my bluejeans. Can’t wear jewelry or an undershirt.  I wake Nebra to act as my chauffeur and we push off about 6:40.  I’ll write about the surgery later, in Part II.


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