Deborah's Journal

By the time of my second cataract surgery, I was readier-than-ready. I was so tired of not being able to see clearly out of both eyes, which made depth perception – necessary for driving, pouring water from a pitcher, etc. -- impossible. I was excited rather than anxious, an interesting way to approach eye surgery. My first surgery had been quick, painless, and even a little bit fun, especially the psychedelic lights during the femtolaser portion. The gap was only two weeks, so all the surgery prep was still fresh in my mind. By prep, I mean chatting with the anesthesiologist, starting antibiotic and steroid eye drops several days before, fasting the night before. I strongly dislike sedation and had asked to not be sedated the first time. In the past, it’s taken me a solid week to feel really clear-headed after receiving the drug they use. This time, I was able to tell the second anesthesiologist (a different one) how well it had gone and to reiterate my preference. Very often, patients don’t realize their opinions and prior experiences matter, especially when it comes to medication. Just because the “usual” protocol includes a specific drug doesn’t mean it is required. Often, there are alternatives with fewer of the obnoxious side effects.( Read more... )

I had my first cataract surgery a few days ago. It began, of course, with fasting and the usual pre-op check ins. I'd already begun using antibiotic and steroid eye drops.* In addition, I used an eyelid scrub, a little moist towelette with a coarse texture, the night before. I don't wear makeup, so that wasn't an issue, and my hair is dry enough so skipping a shampoo the night before (they're afraid you'll irritate your eye) wasn't a problem, either.

The surgery took place in a surgical center associated with a hospital, and clearly it was cataract surgery morning. Nonetheless, I appreciated the care everyone took with me. The nurses were great -- but I think nurses are great, anyway. It takes me a long, long time to feel clear-headed after Verced, usually used as a sedative, so the anesthesiologist and I came up with a different plan. I'm old enough to remember the days when you got what they gave you no matter what you said. How wonderful to be listened to!

Once I was hooked up to an IV and my eye was dilated, it was time to begin. The first step was a femtosecond laser to break up the cataract and make an incision for its removal, at the same time correcting my astigmatism. This was not only painless, but an amazing light show. Gorgeous colors, flashing lights, snowflake mandala patterns...and the laser makes funny noises as if it's singing to itself.( Read more... )

Phase two was the removal of my lens and implantation of the artificial corrective lens. After talking with my surgeon (and my financial advisers!) I opted for accommodative lenses, which should give me great distance and intermediate (computer, piano, social) correction. I'll still need reading glasses, which is okay.

This is the phase that disturbs most folks. They envision (excuse the pun!) pointy metal instruments coming at their eyes. I saw nothing but lights! The lights were not as entertaining as those produced by the laser, but they were quite benign. Before I knew it, my doc was saying it was over and was placing a clear, perforated plastic shield over my eye.

I spent a little while in recovery, not so much from the surgery as the anesthetic, and then my husband drove me home. The surgical center folks were adamant (a) that I not drive; (b) that I have someone at home in case of need. "Need" amounted to eating a light lunch and sleeping most of the afternoon. The next day I had a follow-up exam with the surgeon, who was very pleased by how everything is healing, and was allowed to take off the shield except for sleeping. Oh joy, I get even more eye drops four times a day!

I had thought that I'd be able to pop a lens out of my spectacles to correct the nonsurgical eye, but alas that didn't work. So I toddle around with one still-dilated eye that can see intermediate distances just fine -- far distance will come as everything settles and my eye muscles learn how to flex the lens -- and one utterly myopic eye. Needless to say, I can hardly wait for the 2 weeks to fly past so I can get my second eye done!

It is amazing to open my eyes in the morning and have (one of them) see clearly. Also, the brilliance of the colors astonishes me. I had no idea how much my cataracts "grayed out" colors. I feel like Dorothy, stepping from black and white Kansas into Technicolor Oz.


*My doctor's protocol; yours may have a different one.

With my diagnosis of cataracts (in both eyes), I began to consider my alternatives. The simplest, which is to do nothing and rely on eyeglasses for increasingly inadequate visual correction, was not very appealing, especially since lens replacement surgery was now “medically necessary.” Medicare, like most insurance plans, covers only the bare minimum: a single focus (“monofocal”) artificial replacement lens, usually for distance, with the natural lens being removed and the new one inserted by scalpel. Monofocal lenses give most people excellent distance vision, although they do not correct for astigmatism, and usually require the use of glasses for reading and intermediate distance work.

These are not the only lenses available. Lenses can be toric (astigmatism correcting), or can correct for more than one distance. Multifocal lenses can provide a full range of vision (or so the literature says), including presbyopia, the difficult in reading that comes with age, but they can also result in halos around street lights and other visual difficulties at night. They also don’t come in all powers of correction. Accommodative lenses can correct for distance and intermediate vision, which means that glasses may be needed for reading; they flex like a normal, healthy lens. Who knows what new developments are yet to come?

Then there are choices as to how the surgery is done, the traditional scalpel, or femtosecond lasers. The benefits of the laser are that it is more precise and it can correct mild astigmatism at the same time. (Astigmatism arises when the cornea is shaped like a football instead of a soccer ball, resulting in multiple focal points; in pain speech, everything, near or far, is blurry.)( Read more... )

More fascinating news summaries - the role of the X chromosome in sperm production, the average penis size, how writing about an abusive experience seems to help women survivors, sex addition (not), PTSD and prior trauma, and more. Check it out!

News Roundup: July 2013 - Open Minded Health

Web MD reports a study that shows a woman's blood cholesterol changes with her ovulatory cycle. If your doc has urged you to begin medication for high cholesterol, you might want to be re-tested. Source was The Journal of Clinical Endocrinology and Metabolism.