16 Sep 2010
ARTICLE: I’m not laughing anymore. I was one of those guys that chortled a bit, but not in a mean way, when older friends and relatives would moan about a body ache from washing their car, or having to take some prescription pill for an unpronounceable aliment that everybody seemed to discover at once, or “my back hurts” from carrying in the groceries. It’s the unavoidable lament of middle age, that those of us in our thirties think will never happen to us. Strange thing is, when you hit your forties, some of that stuff isn’t so funny any longer. It seemingly creeps up on you like your cat playing on the end of your bed, where the bedclothes are a mini-jungle for feline imagination. And suddenly, real life pounces!
For me the first signs of middle age creeping up on me, gray whiskers and all, was the difficulty losing weight. I had a bit of a weight problem as a teen, cured in my twenties by becoming a major cycling aficionado. But then, at 42 it became really hard. The yo-yo dieting starts where you lose 10-15 lbs., then gain it back over the holidays. Eventually apathy kicks in, and 10 lbs. a year decide to take up residence in your butt, chest and belly. Ugh! I’m on a diet program with a nutritionist now, but that’s another story, for another day.
Murkier and fuzzier, and bears, oh my!
The most annoying, but not unexpected, event was hitting 45 and as the year progressed; my vision became murkier and fuzzier. I had always been able to read the smallest fine print on the back of a vitamin bottle, read a book comfortably, watch TV, and only wore driving glasses for distance vision; this is called being nearsighted (or myopia). Well, I noticed that I was having to “trombone” the bottle to read small print (always makes me think of Bing Crosby in “White Christmas”), and watching TV was way less sharp. Most notably, driving became a bit of a challenge: you know something is different when you’re suddenly using 100% of your brain to drive, instead of 50%, to focus on your surroundings and mentally process what you’re seeing through the windshield and in the rearview mirrors.
Initially, I hoped this was due to simply working too long on the computer (I have two 20-inch LCDs I work on all day long, and often worked weekends on various projects). Eye strain, yeah, that’s the ticket! But, to be sure I made an appointment with an optometrist to get a new prescription, and start wearing glasses while working, and hopefully for driving as well.
I made my appointment, showed up, walked around while waiting and perused the eyewear, picked out a couple of cool frames. Then it was time for the eye exam. I had a quick eye check on some machines with an assistant who also dilated my eyes (eye drops in both eyes, then back to the waiting area). Then after my eyes were dilated I went in to see the optometrist. I knew things were not going to be a bowl of catnip when he asked me if I had been around any radiation lately. Say what now?
Somewhat cautiously, he mentioned that I had “advanced cataracts” which are not common with people my age, and that it’s more often seen with older folks (meaning over age 55) or from things like using arc welders — or equipment or environmental settings with high radiation levels. It was also more common in people with diabetes, which I knew was not an issue for me, despite gaining some weight.
The cataract is essentially “a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision.” (Concise Oxford.)
I was fairly calm at this point as it wasn’t entirely unexpected, and in the back of my mind I was really hoping this would not be the situation, but over the past few months I had a sneaking suspicion that it was a possibility. When you suddenly can’t read a magazine, or read the back of a toothpaste tube, the truth is unavoidable. The eye exam really just confirmed what I already knew deep down, but had been mentally avoiding.
So much for all that carrot juice
The simple fact is that family history, or genetics, can “pounce” at any moment. Hiding under the covers doesn’t seem to help. While I had no history of eye problems, my father and brother both had cataracts at birth, and I believe my paternal aunt did as well. They all wore bifocals, and had eye surgery as kids. On my mom’s side, folks got cataracts in their seventies. My grandma had cataract surgery in her seventies or eighties.
Somehow, I had hoped I had escaped, but it seemed to split the difference in age, and to quote a popular song: whoop there it is. Basically I was slowly going blind. So much for all the carrot juice I’d been drinking the past decade.
The optometrist told me he couldn’t even prescribe any glasses as “they wouldn’t help,” and that he was amazed I could function at all. He recommended an ophthalmologist to me as a referral and I got home and made that phone call immediately. It was a little traumatic, but I tend to put these things in the same box as having a flat tire, or a dead car battery. You can whine about it, but if you’re on the side of the road in the middle of nowhere, there’s not much else you can do but get out the jack and spare tire from the trunk. You’re not going anywhere until you do.
I have to admit I felt a little sheepish about not having been to get an eye exam for about 7 years due to not having health insurance (due to my self-employed business taking a dive right after 9/11 I had to cancel the insurance, and never got it back).
Hello doctor, hello IOL
Visiting the ophthalmologist was a bit of a similar experience initially. Make an appointment; fill out the information form and medical history sheet while waiting in the lobby. Then, go in and see an assistant to do some basic eyeball tests, and then back to the lobby to let your eyes dilate.
While an optometrist and an ophthalmologist are similar in what they can do for most people needing eye care, the latter is a full M.D. with four or more years of medical school and at least a year of internship.
I was lucky to have been referred to a capable surgeon (in my case, Dr. Raj Dugel of Torrance, Calif.), and I felt entirely comfortable with his opinions, questions, diagnosis, and suggestions. I got a good feeling about the medical practice, the office staff: an overall good “vibe” if you will.
In my case, the solution would be to get intraocular lenses (IOLs) which, simply put, are a lot like having a contact lens in your eye, but it replaces the damaged lens in the eye which is broken up with a laser during surgery.
I rarely quote anything out of Wikipedia, but the following definition appears to be accurate as is the schematic diagram of the human eye: The lens is a transparent, biconvex structure in the eye that, along with the cornea, helps to refract light to be focused on the retina. The lens, by changing shape, functions to change the focal distance of the eye so that it can focus on objects at various distances, thus allowing a sharp real image of the object of interest to be formed on the retina.
So, thankfully this is a procedure where the trail has been well broken by the aging baby boomers ahead of my generation.
The whole idea is a little scary as anything to do with my eyes has always been a touchy subject, if you’ll pardon the pun. I’ve always hated anything in my eyes, like eye drops, and have always been too sensitive for contact lenses, and if my eyelashes brush against the inside of a pair of glasses it wigs me out. So, eye surgery has always been on my list of least favorite possible things to have happen. Up to this point I’d never had a root canal for a tooth, and so I generally would say things like “I’d rather have a root canal than anything touch my eyes.”
Since I have always worked in photography, video, graphic design, and the arts in general, the concept of anything wrong with my eyes has been akin to a pianist or guitarist losing a finger.
But, to use my spare tire in the trunk of the car analogy again: you do what you have to in order to get back on the road.
The doctor gave me several options, as to having one eye be optimized for distance, and the other for close-up, which some people like, but I thought might be unnerving (you can’t exactly “try it out” in advance). So, I opted to have each eye setup similarly to me pre-existing vision, which was pre-disposed for close-up sharpness and reading without glasses, and then having to wear glasses for driving to read street signs a block away.
I thought I would need the brand new IOLs for astigmatism, but it turns out I never really had that, just near-sightedness.
The cost would be approximately $4,000 per eye which included the IOL, the surgery, and the anesthesiologist. Like many medical doctors these days, they rent out “surgical suites” which have the equipment, nurses, and recovery areas on hand. Luckily for me, I live less than a mile away from the doctor, the major hospitals here in Torrance, Calif., and the surgical suite.
The next step was to pay the moola for the first procedure and setup a surgery day and time. I would also need to get a complete physical prior to surgery, to ensure I didn’t have any medical issues that might be affected by the procedure. Luckily other than packing on some pounds thanks to mom’s side of the family, I don’t really have any allergies, I don’t take any medication, and I eat pretty well and exercise regularly.
They can rebuild me, better, stronger…
The first surgery was set for end of January, about a month after I had first visited the optometrist. The second eye would be done 3 months or so after the first, to ensure I was okay from the first surgery both physically and visually.
The main thing I had to get used to initially, prior to surgery was taking a couple of eye-drops several times a day for the couple of weeks prior to surgery, and I would then need to take drops post-surgery as well. I got the prescription filled that same day, and started the regimen. I hadn’t had to buy any medicines for quite some time, so was a bit surprised how pricey the two little containers of eye medicine actually cost (about $150).
It was actually an eye watering experience, literally, to get in the habit of putting the drops in, as my general sensitivity made me either flinch or close my eyelids the micro-second before the drops hit. So, this was a learning experience: acclimating my eyeballs to get used to anything in them other than water.
As the surgery date came closer I also suffered the indignity of my driver license needing to be renewed and, as luck would have it, this would be the time I was required to go in for an exam and eye test at the DMV. Since I could not pass that, I was required to send a letter to the DMV notifying them that I was temporarily “legally blind” as far as operating a motor vehicle was concerned. I have to admit, this was likely a good idea for my fellow drivers, and I have a little more sympathy for the aged who are no longer able to drive due to visual impairment. Considering my father, brother and aunt never were able to drive a car at all, I think I did okay all these years.
I started to think of the upcoming procedure as a bit like having a bionic eye implant, just like Lee Majors’ “Six Million Dollar Man” character of the ’70s. It’s actually pretty amazing to be able to have this done, replacing a defective eye lens with a plastic bit that lets you see again. Kind of a “living in the future” moment for me, actually.
Poke in the eye
As the surgery day dawned, I had the normal anxiety of anything like traveling on an airplane, or visiting an ex-girlfriend for lunch. Unlike surgery where you are fully “knocked out,” which I had previously experienced for getting my wisdom teeth extracted, for eye surgery you are semi-conscious, and this is so you can keep your eye looking forward and not roll back in your head (among other reasons). So, I didn’t have the common worry of “not waking up.”
Still, I had my list of emergency phone numbers in my pocket, with the staff and my friend, and if anything went wrong the “real” hospital was a block away from the surgical center. I wasn’t so worried that I had to update my living will or anything, but there was definitely the sense of adventure in the air.
A friend of mine (thanks, Dave!) drove me over to the surgical center which was packed and seemed a bit more like an airport lounge than a medical practice, but really clean. It’s a reminder just how many people live around us these days. After a little while they took me into the pre-op area, and I stepped into booties over my sock-feet, instead of shoes, and they weighed me (necessary for the anesthetic drip) and then led me to a gurney-bed to lie down and put blankets over me to keep me warm. The nurse checked my blood pressure, and then got me started on an IV drip, eye drops, and a little while later the anesthesiologist introduced himself.
The doctor came to check on me, while also checking on another patient in post-op. This was about the point you realize you’re really going to have surgery and it’s not unlike standing at the altar getting married, going on stage to perform for the first time, or anything else that vaguely resembles jumping off a cliff emotionally. It’s one of those unique moments, while being wheeled into the surgical suite, where you are fully “there” in real-time and not living mentally one foot in the past and the other foot in the future. Here and now is all there is.
Thankfully I had a really good anesthesiologist and I was out of it, but not totally out of it. So I was aware of my surroundings, but was right on the tipping over point of almost being asleep, but not quite. I remember getting little clamps for my eyelids, and then a light in my eye, and a poke and then some surgical stuff and then it was over fairly quickly. Frankly, it was almost anti-climactic after the initial poke in the eye. With the drugs time seemed slightly compressed. It wasn’t long before I was being wheeled back to the pre/post-op area.
In the recovery area, you slowly come back awake and very slowly you start to feel like somebody poked you in the eye a bit, and you have an eye-patch on. A nurse checks on you, and as you get more awake she helps put your shoes on, offers you some water, and within about 20 minutes, you’re slowly back in the real world again. Frankly, speaking from later experience, it’s less painful and less time consuming than a root canal, after all.
Once my friend got me home, I spent a couple of hours just relaxing on the couch, dozing and letting things settle – both physically and emotionally. I took some ibuprofen, called my mom to let her know I was okay. And, being the workaholic that I am, I also checked my e-mail, which was a bit interesting with just one eye available (the stronger one, thankfully) and that one with a cataract. Imagine somebody sticking their nose up to the PC monitor screen, and that would be apt mental image.
I couldn’t do a lot, so listened to music, and put all my post-op stuff on my coffee table to be ready for new eye bandage, tape, eye drops. Luckily I heal fast and don’t generally need a lot of pain killers. Eye drops were tricky, but I managed to get stuff in the eye properly. I’d had 2 weeks of daily dosing to get used to that.
Post op in living color
Over the coming weeks I had several follow up appointments with my eye doc, and took more cabs that Spring and Summer than ever in my adult life. Things looked great and vision slowly improved and clarified. It was interesting to do an A-B comparison between each eye when looking at something. One of the most shocking things was seeing colors again properly. I truly had not realized just how bad things had gotten.
With a cataract it’s not just a loss of sharpness, it’s also color and contrast you lose. The two examples that really surprised me were a wristwatch I had bought which had a blue face, but had looked black to me when I got it. Now I could see the blue. A product image I had done for a client in Photoshop, with a piece of gold and silver jewelry had looked all silver prior to surgery, and now my left eye could see the gold but my right eye could not. Two different versions of reality, and a window into what those who are colorblind see or don’t.
After the first 10 days or so, watching TV on my 1080p DLP TV suddenly jumped out at me. I realized that the cataracts had started to develop about the same time I got my HDTV, and I’d never actually seen anything in high-def due to the loss of vision. Now my left eye was becoming bionic compared to what I had been seeing the past few years – watching LOST with all the colorful scenery in Hawaii, was like seeing for the first time all over again.
As time went on, I was able to stop using eye drops on the first eye, then start the pre-op sequence on the second eye. This time around, knowing what to expect, I was actually more anxious. It hurt a little bit the second time, as I was not quite as out of it. I’m not sure if this was due to a different anesthesiologist, or me being more “amped up” and adrenaline fighting the drugs. Post op for the second eye was about the same, and so too the follow up visits to the eye doc.
So, six months after the initial visit to the optometrist I was able to see again, was able to pass my eye exam at the DMV and get my driver’s license back. And I could see everything in amazing clarity, color, and much as I had in my thirties.
The moral of this story, if there is one, is that cataract surgery is not as bad as I had expected, and the results are amazing. My one year checkup was perfect.
Clouds on the horizon
Two years later I can still see wonderfully, although it looks like I may have developed a little cloudiness behind the first implant (which is quite common, apparently). I may need a follow up laser surgery to break up what’s called posterior capsular opacification (PCO). Each follow up visit the doctor had mentioned that “you don’t have the build-up that some people get,” but two years after the second eye was done, I began to notice a very minor change, but it seems to come and go with how tired I am, almost like a more opaque “floater” right where you want to focus.
Apparently, according to the American Optometric Association, up to 50 percent of those who get the surgery can develop PCO, or a secondary cataract. The cloudiness is the result of cell growth on the back of the IOL capsule. This is fixed by undergoing a YAG laser capsulotomy that makes an opening in the clouded capsule to let light in. It’s a painless 5 minute procedure, with an hour of recovery time. However, one study I read from Kaiser Permanente stated that 1 in 50 can develop retinal detachment, leading to vision loss.
According to my doctor, he generally does the surgery when his patients begin to see halos around anything bright, or if it is impairing vision to the point of not being able to see. I’m going back in January (3 year anniversary of my original cataract diagnosis) to see if I really do need a follow up surgery, which I may not unless it gets worse.
Overall, it’s been a positive experience, and I would certainly be almost blind by now if I had not gotten the surgery with Dr. Dugel. My mother was not diagnosed with cataracts until she was 70, so I am a little bit early, but luckily technology has progressed very far in this area. I may not have a bionic eye, but it’s still pretty damn amazing.
Article is Copr. © 2010, 2011 Christopher Laird Simmons – all rights reserved. This story originally appeared on CitizenWire.com
UPDATE Jan. 10, 2011: I had inadvertently left out the name of my eye doctor when I originally wrote this article in 2010. My doctor and surgeon is Dr. Raj Dugel, of Torrance, Calif., who did an excellent job. I will be writing a follow up story once I get the YAG done on my left eye for the PCO in late January. And for full disclosure: I have not been paid any fee or compensation for writing this article. This is a genuine first person account of my own life experiences and NOT paid content in any way, for the person who sent me a snarky comment after adding my doctor’s name back into the story.