A cataract-surgery journal: Part II

NOTE:  Part II deals with surgery on my right eye and post-op, or recovery.  Part I described events leading up to the surgery, a period of three months, January 22 of this year to April 21.  Part III will cover surgery on the left eye, May 5 through post-op.  I’m considering a Part IV, which would be a short, overall assessment of my experience with cataract surgery.  

April 21, Thursday:  I arrive at Barnet Dulaney Perkins Eye Center in Phoenix on time, 7 a.m., for cataract surgery.   While the rest of the building is dark and vacant, the surgery area is busy.  A half-dozen other patients sit quietly watching a color TV.   A woman behind me is attempting to photograph the eye of a friend before surgery.  Nebra tried that last night on me with no luck.  A receptionist greets me with several documents.  Initials here, signature there.  I’m startled by two items in the documents.  One, my insurance won’t cover the entire bill as I was told it would.  I produce a Visa card for the extra $385.42.  I’m too far along now to stop on a dime.  I’ll deal with it later.   Two, I’m asked to sign an agreement that I “understand”  my vision after surgery will be no better than 20/50.  That’s not good enough to pass the Arizona’s driver’s test without glasses.  No one mentioned that before.  Something to check into tomorrow morning during my first post-op exam with Dr. Pinkert.  At 7:15 I’m hustled off into a little room for testing of blood pressure and temperature.  The BP is very high for me, 163 systolic, but the nurse doesn’t blink an eye.  Guess she figures most everyone coming in for the first cataract surgery is one notch from blowing a gasket.  I’m asked to identify the eye I’m to have surgery on.   My answer, “the right one,” is not good enough.  “Point to it,” she says, and I do.   A clear eye shield is slipped over my left eye.  I’m given three eye drops:  one for dilation, one to fight infection and another, I think, to relax the eye, to keep it steady during surgery.   The surgeon, Dr.  Scott Perkins, pops in to see me.  Upbeat as usual, confident, affable.  I feel I’m in good hands.  He checks my name tag, smiles, says something and taps good-naturedly on my chest before disappearing.  It is the last time I see him in the flesh on his day.  I’m told to have a seat in a large room I call “the on-deck room.”  Two men and a woman are stretched out on gurneys, waiting for their turn “at bat” in the operating room on the far side.   A half-dozen nurses, all women, swarm the area in blue uniforms with “party hats” of blue netting.  Though pleasant, these hustling nurses seem dead serious and do not stop to chit-chat with anyone.  Soon I’m on a gurney of my own, a BP monitor hooked up to my left bicep and an intravenous “connector” stuck in the right one.  The anesthesiologist, a cool dude in his 50s, swings by to introduce himself.   He says I should be on my way home very soon “barring complications.”   I wonder what those are but he too disappears quickly.  I’m given a sedative that almost puts me to sleep.  Shortly my gurney is wheeled into the operating room under a bright light.  By now the right side of my face is numb and completely covered with a cloth.  If a hammer hit me on that side, I probably wouldn’t so much as flinch.  I can see absolutely nothing out of my right eye except gauzy whiteness.  “Doctor Perkins will be here in 2 1/2 minutes,” a nurse says.  I think, god, I really am on an assembly line.  A nurse later tells me that Perkins is doing 17 cataract surgeries today alone.  I’ve read he has done more than 40,000 in his career.  About 8 a.m. I hear the voice of Perkins nearby.  He begins work almost immediately after shifting me into better lighting.  I’m told by a nurse if I have to cough, please give warning.   The slightest unexpected movement can mean trouble.  Perkins and I chat as he cuts into the eye and takes out my old lens and inserts the new one.  He answers some of my questions:   The incision is only about 1/8 of an inch.  My cataract is apparently a large by his standards.  The new lens is inserted folded through the cut then stretches into place on its own.  The surgery will not affect my eye’s macular hole in any way, it being a long way off in Perkins’s world of eye surgery.  Less than inch maybe.   In all, the surgery lasts 4-5 minutes.  I have felt nothing.  No pain, not even discomfort. Nothing.   Science and technology have carried eye surgery a long, long way, it seems.   No telling what doctors like Perkins will be able to do in another decade.  My right eye is bandaged shut.  I can take it off in three hours.   I’m quickly wheeled into a recovery room and on my feet in no time, seated next to a nurse who is giving me detailed instructions on post-op.  By 8:20, I’m back in the reception and Nebra, my designated driver, is on the way.  We arrive back at the house at 9 o’clock.  Only two hours have elapsed since I walked into the Eye Center.   It would’ve been an hour and a half had Nebra stayed and not driven back home.  I’m eager for 11:15 to roll around.  That’s when I can take off the bandage and see what my eye has in store. . . . 11:15 a.m.  I stand in one of our bathrooms facing the mirror, slowly pulling off the bandage from the right eye and wondering what my vision will be like.  I’ve been told over and over it will take two or three days for the new lens to settle in.  I’m expecting distortion and fogginess and that’s what I get when I finally can see.  My eyes are watery.  I can see shapes but little else.  Still I all but know things will get better. . . .  11: 30 a.m.  It’s time to start the eye drops again.   Durezol,  a steroid anti-infammatory, has been added to the mix with the pre-surgery drops, Vigamox and Nevanac.  I’m to take all three, five minutes apart, every four house that I’m awake.  The drops leave a slightly stinging sensation . . . . 1 p.m.  I’m stretched out on the living room sofa, noticing how the right eye’s vision is improving.  I look out a window into the blue sky.  I close my right eye and peer out with the cataract-hardened left.  The sky is a bluish-brown.  I close the left and open the right and, voila, the sky is brightly blue.  The unclouded right eye is obviously letting in much more light. . . .2:15 p.m.  On our way out to lunch, I glimpse on a promotional card the title of a play, Nine, we’re planning to attend Saturday night.  There is something odd about the letters in white capitals, NINE.  I look at the letters with only my left eye and see the usual blurry double-images.  The right eye, I find, shows only a single image.  Blurry but single.  My double-vision, it seems,  has gone away in that eye.   2: 30 p.m.  While eating at the Athenian Express near the city center I look up into the room’s lights.  I’m dismayed to see a halo circling every light when using only the right eye.  Still, the right eye’s clarity is improving though objects appear blurry.  I look across the room at a chalkboard menu and can read the larger words  fairly easy.  That’s new for me . . . . 8 p.m.  Nebra and I walk a mile in darkness up to the Spaghetti Factory for supper.  I’m suddenly amazed at the sharpness of the right eye’s long-range vision.   9:15 p.m.  On our way back home I stare into the bright lights of the restaurant’s parking lot and see giant halos in rainbow colors surrounding the bulbs.  The purples and greens are very pronounced.  I’ll have to ask about the halos tomorrow at the post-op. Most of the day I’ve had a small headache off and on just above the right brow, a nagging condition that has yet to require a Tylenol fix.   Also at times I’ve felt a rough edge inside the eyeball.  And there has been the pink spot, very light in color and the size of a dime, that sometimes appears when I bring my right eye to focus on something nearby.  But all in all, it’s been a very rewarding day.  I feel I’m on the path back to decent vision.

April 22, Friday:  I have the post-op in late morning at the Eye Center.  It’s not with Pinkert as scheduled but with a Dr. Duony, also an optometrist.  The recovery is proceeding OK, she says.  An assistant measures the sight in my right eye at 20/50.  That’s better.  It  had been 20/70 before surgery.  Muong says I will continue to have a little blurriness for two or three days until the swelling goes away.  The top eyelid is slightly sore to the touch.  The halos may diminish, I’m told,  but likely will not disappear.  I’m given a sheet with the new eye drop schedule for the next three weeks.  I’m to use all three drops three times a day for the first week.  By Week 3 I’m taking only the Durezol once a day.  I’m seeing much better. . . . After supper tonight we drove up to a DQ, and I saw NO halos through the right eye.  Not on a street lamp, stoplight or on an open bulb.   That’s the biggest improvement over the last 24 hours. While double-vision has disappeared, distortion remains.  If I’m looking at a word, say, the middle letters are bowed and curved to the point of making them, and often the word itself, undecipherable.

April 23, Saturday:  Day 2 after surgery.  Tonight Nebra drove us out to Scottsdale to see the French film, Of Gods and Men.  It was the first time in many years that I’ve been able to watch a movie without the aid of eyeglasses.   We sat toward the back of the theater and I was able to read the English subtitles without missing a beat.  Surely once the cataract in the left eye is removed I will see even better.  And for the second straight night, no halos around lights, none.

April 24, Sunday:  Day 3 after surgery.  I read two or three pages tonight of Henning Kellman’s “The Disappointed Man” on my E-reader — without glasses!  It was painstakingly slow and I gave up after a bit.  But I read them.  Amazing.

April 25, Monday, Day 4 after surgery.  On waking, the right eyelid is sticky and won’t open easily without aid from my fingers.  My vision warms up slowly in the morning.  It’s an hour or two before it’s back to the new normal.  Using Blink, the lubricating eye drops that was in my post-op packet, seems to help.  I haven’t worn the protective shield for two nights.  It disturbs my sleep. . . . In early afternoon, I turned to switch off the overhead kitchen light.  To my surprise, it was already off.   My vision has so much more light in it now that I was fooled. . . . I’m probably unrealistic but this was a disappointing day.  No dramatic changes.  And walking late tonight, I noticed the slightest of halos around the street lamps.  Nothing like the giants of two days ago, but little halos, almost indistinct.

April 28, Thursday:  The one-week post-op.  More tests of the right eye — but the left one too — before meeting with Dr. Pinkert who says the healing is going normally.  “It looks much better than last week,” he says, “and it will continue to improve.”   I still have the “wrinkle,” the wavy distortion  in the vision of my right eye.  For the first time, Pinkert talks briefly about the more serious problem causing it.   A macular hole in the back of the eye.  It will, as Dr. Perkins said earlier, require a third operation to fix it.  I will have to see a retina specialist for that.  For now, I must deal with the cataracts.  Surgery on the left eye comes in exactly a week.  Next I talk with a scheduler.  I sign a surgery-consent form, and about a half dozen other forms.  Even one saying I had seen the forms.  Again I must pay almost $400 for the left-eye surgery.  It’s the 20 percent that Medicare won’t pay.  My Blue Cross/Blue Shield insurance should cover that.  But, the scheduler says, Medicare says I have no other insurance.  She’ll look into it and call me.

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