deborahjross | Entries tagged with vision

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... )

in·ter·reg·numˌin(t)ərˈreɡnəm/. noun. A period when normal government is suspended, especially between successive reigns or regimes. An interval or pause, as in, "the interregnum between the discovery of radioactivity and its detailed understanding."

After cataract surgery on my first eye, I entered a bizarre period in which that eye had excellent vision at intermediate distances (computer screen, conversation) and the other was a total blur. I’m very near-sighted (as in -15 diopters), so there was no possibility of fusing images. So the world looks blurry and sharp at the same time, and I have to use parallax (shifting my head) for any kind of depth perception. Needless to say, I do not feel safe driving. Or pouring water from a pitcher, unless I can brace the lip of the pitcher against the glass – we found this out in a somewhat spectacular fashion.

One solution might have been to wear a contact lens in the nonsurgical eye, and I had worn hard or RGP (rigid gas permeable) lenses for over 50 years. But a couple of years ago my eyes, which had become drier over the decades, flatly refused to put up with contact lenses. I tried all sorts of lubricating drops, but was never able to wear my lenses more than a few (2-4) hours a day. If I did any work on the computer, that time dropped to an hour (people blink less often while staring at a computer monitor, hence increase in scratchy, red eyes). Finally, earlier this year, I lost one of my lenses. This has happened maybe half a dozen times over the years. I looked everywhere (if you wear contacts or are close to someone who does, you know the crawling-around-on-the-floor routine) and eventually concluded that after I had cleaned them the night before, the lens had stuck to my finger instead of sliding off into the soaking solution. Since then, I had washed my hands and tidied up the counter area. So, no hope. I’d been wrestling with spectacles ever since.

My next idea, which friends have tried, was to pop a lens out of my spectacles, so that my nonsurgical eye sees through the remaining lens. Great idea, right? And it worked – so long as I covered one eye, didn’t matter which. When I tried to fuse the equally-clear images, however, my brain went nuts. It turned out the images were of sufficiently different sizes, too disparate for my brain to turn them into one. This might not have been the case with a person less near-sighted than I am. So, rather than putting a patch over one eye – toss a coin as to which one – I’ve been wandering around in this visually bizarre state.

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As part of my preparation for cataract surgery, I’ve begun talking with my eyes. Or rather, talking to them. I say, “Eyes, something exciting and perhaps a bit perplexing is going to happen to you. But don’t worry, it’s like a hip replacement. It’ll help you see even better than before. I’m going to make sure you are safe (antibiotic eyedrops) and comfortable (steroid and anti-inflammatory drops). And we will have such fun seeing bright colors and sharp detail for many years to come.”

They don’t have a lot to say in response. But…

A week or so ago, I started dreaming about the surgery. It was the usual showing up without clothes or without having attended class or without having memorized your lines. In this case, I arrived at the surgery center, having forgotten I was supposed to fast. There was much hoo-ha and calculation of what I had eaten how long ago.

This last weekend, I drove our van down to LA to help my older daughter move in with us. The drive down was in daylight and the only visual problem I had was seeing the street signs while looking for hotel and then her apartment. But (for various reasons, you know the drill) we did not get started back until 7 pm. I am normally an early-to-bed person and ended up consuming as much caffeine as I usually do in a year, I’m sure. I was painfully aware of how stressful and difficult night driving has gotten to be. Almost all the freeway driving was in darkness. I have never appreciated trucks so much – all those lights made them easy to discern, much more so than the lane markers. Daughter and I took turns leading as we caravaned along, too.

I could imagine my poor eyes saying, “We’re trying, mom! This is the best we can do!”

“I can’t ask for more, eyes. I’m going to get you some help real soon now.”

So now I am taking my pre-op eyedrops four times a day. Fortunately, I’ve been using lubricating drops for so long, I’m used to putting drops in my eyes. After surgery, I’ll add two more. I have to wait two minutes in between each medication so it doesn’t wash out the one before. Other surgeons may have different protocols. I’m observing this one meticulously. I’ll be taking these for a while, because I’ll still be on some of them when it will be time to start full doses prior to the second surgery.

I am considering dubbing this season The Summer Of The Eye Drops.

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... )

For some years now, maybe a decade, I’ve complained about my “old eyes.” I’ve never had good vision without corrective lenses. I think I started wearing glasses in 3rd grade. I remember getting contact lenses in 1960. They were hard lenses, of course, and required a long period of getting used to, all the while putting up with light sensitivity and scratchy, red eyes. They did, however, get me out of having to play softball – which I was so bad at, it was embarrassing – in high school; the first windy day blew so much dust into my eyes, the school let me switch to swimming. For some reason, maybe the steepness of my corneas, the lenses stayed put in water. As a result, I learned to swim.

For a long time, hard (“rigid gas-permeable”) lenses were a great solution for me. I don’t have issues about handling my eyes, and best of all, they gave me great correction. My brain thought the world had sharp edges. And so it went for many years.
Eventually I ran into one situation or another where I needed glasses. For some strange reason, hospitals want you to take your contacts out. So I got them, even though years would go by without using them. And then, of course, I’d need a different prescription. I got a pair just for reading in bed, part of my night time ritual.

Fast forward a number of decades. Dry, scratchy eyes became more of a problem, especially when working at the computer, and often it seemed as if the lenses couldn’t quite settle (and give me good correction), no matter how many times I blinked. I’d take them out and clean them, and sometimes that would help. Driving at night became more tiring. I could no longer see the night sky clearly, and I was pretty sure I’d been able to, once upon a time.

Eventually, my eyes decided they’d had it with contacts. After a painful bout with “contact lens over-wear,” I was never able to wear them for more than a few hours every day. Then I lost one (a very rare occurrence for me) and decided that was the universe’s way of shutting the door. I got new glasses, both for intermediate (computer, piano) distance and far distance. Night driving got even more difficult, and I noticed I was staying home rather than tackling the twisty mountain roads in my area on rainy nights. Street lights appeared surrounded by soft haloes that did not change when I took my glasses off. Often it would seem that the lenses were dirty or smeared, but they looked okay when I checked.
Although my distance glasses corrected me enough so I could drive safely, I had trouble reading street and highway signs at a distance.( Read more... )

During a routine annual visit with my optometrist, I complained about my various visual difficulties. I’d been writing off so much as “these old eyes” or the challenge of getting good correction for someone as horrendously near-sighted as I am (and astigmatic, to boot). “You’ve got cataracts,” he told me. “They’re not severe, but Medicare might pay for the surgery. Here’s my referral.”

Cataracts?

Suddenly everything made sense. I felt elated to find an explanation for the deterioration of my vision. But were my cataracts “ripe” enough to justify surgery? A month later, I hied myself over the hills to the specialist. The materials his office sent me explained a few things:

+Cataracts are an inevitable part of aging. Everyone who lives long enough will get them.
+Cataracts are a clouding of the eye’s lens, treated by replacing the lens with an artificial one. That artificial lens can correct visual problems!
+Once upon a time, it was thought that you had to wait until you were practically blind to qualify for the surgery, but this is no longer the case.

Not only do I have cataracts in both eyes, one worse than the other, but I have choices. While Medicare pays for only the medically necessary monofocal (usually distance) replacement lenses, there are elective extras available to me: multi-focal or accommodative lenses, laser instead of scalpel surgery, methods for treating my (mild) astigmatism. I’ll talk about these in the next installment.