On my first visit with my ophthalmologist, he added “Cataracts” to Ben Franklin’s quote about the certainty of Death and Taxes in this world.
I have known for about a year that I have cataracts. My optometrist confirmed it at my last annual eye exam. This is a diary of my experience of lens-replacement surgery to share with those of you who are facing the same procedure.
The Decision To Proceed with Surgery
It was obvious that my vision was deteriorating, but the situation that motivated me to act was driving at night. The enormous flares from oncoming headlights were blinding. I realized I was only guessing where the center and side of the road were. Only the fact that this was a familiar road with little traffic made it possible to drive after dark. The confidence in my ability to drive safely, after driving for 55 years, was gone; at least after dark.
I told my wife Carrie that I was no longer able to drive at night. We scheduled a visit with the ophthalmologist our optometrist recommended.
Appointment 1 of 9
This initial visit was to confirm the clouding of my lenses was severe enough to warrant surgery (it was), and to learn about the process and procedure. We also were left with a choice of the type of replacement lens I would get.
The Process:
There would be 8 more appointments and a month of multiple-times-a-day eye drops for each eye. The next appointment would be to measure my eyes and receive the pre- and post-op care instructions. Following that would be an appointment for the left eye surgery, two follow-up visits to assure all was well, right-eye surgery, two more follow-up visits to assure all was well, and a final visit to check both eyes and determine the prescription for my new glasses. The doctor predicts I will no longer need correction for distance, but will continue to need glasses for reading.
The choice of lens was between single focus and multi-focus (think bifocal glasses). As I will probably need reading glasses regardless of the lens choice, I opted for the single focus version. If you are eager to eliminate having to wear glasses, the multi-focus may be the way to go. But the doctor warned that it is not possible to accurately predict outcomes. Lens-replacement surgery will get rid of the haze and light flares and flashes, and will improve your vision, but it will probably not correct it to 20/20. Note: at this writing, insurance companies are not covering the additional cost of multi-focal lenses, so consider the extra expense in your decision.
The Procedure:
This part amazed and reassured me. The surgery lasts about 15 minutes. Out with the old lens, in with the new lens. Done. The procedure is done under sedation and there is zero pain. Surgery was scheduled at a nearby outpatient surgery center.
Appointment 2 of 9 – Pre Op
This visit was pretty routine. As mentioned above, they measured my eyes, confirmed my medical history, walked me through the instructions for the month of eye drops, the specifics of what to expect on surgery day, and the post-op activity constraints. The constraints included not sleeping on the same side as the eye involved in the surgery, no lifting anything that weighs over 20 pounds, limit bending over (keep your head above the level of your heart).
Appointment 3 of 9 – Left Eye Surgery
Carrie drove us to the Surgery Center for the 8:10AM appointment. After signing a half dozen forms, we were in the waiting room just a few minutes before I was escorted to the surgery prep area. Even for an outpatient procedure, this was pretty casual. I stayed in street clothes. They put a surgical gown over my shirt, booties over my shoes and a cap on my head. Nurses inserted an IV in my hand for the sedative and attached heart monitors to my chest and arm. They noted with a marker on my forehead which eye was to get a new lens, and gave me an eyedrop to dilate my eye. As we waited for that to take effect, the doctor stopped by to say hello, confirm my readiness, and add his own reminder note to my forehead with a purple medical magic marker. The doctor in charge of administering the sedative also checked in and spoke briefly of the drugs used and what I was to expect.
Soon after, I was fetched via a wheelchair into the operating room where I climbed up onto the table.
So for this part, I am told that peoples’ experience varies. As the operation only lasts minutes, the dosage of the sedative is accordingly light. Some people are aware of and remember nothing, most people remain vaguely aware of what is happening, but are so out of it they don’t care. I fell into that latter group. During the actual surgery, I was aware of images only, no other physical sensations. And the images were just light, colors and geometric shapes. Out with the old lens, in with the new lens and I was soon back in the wheelchair on my way back to the prep area where I had a late breakfast of coffee and animal crackers. A clear perforated shield was taped in place to keep me from inadvertently rubbing my eye. Carrie was alerted to my pending departure and met me as a nurse walked me to the car. We were home before 12:30, so the end-to-end duration was less than 4 hours.
Post-Surgery at Home: The remainder of the day included eye drops every three hours and lounging about as Carrie made sure I didn’t violate any of the post-op care instructions, which included keeping the shield in place until the following morning. I was more bothered by the light sensitivity resulting from my eye being dilated than any aftereffects of the lens replacement. The hardest part was sleeping on my right side as instructed (I usually alternate sides during the night). But Carrie propped a row of pillows against my back to dissuade me from rolling to my left.
Appointment 4 of 9 – Post Op
We were scheduled for a post-op check-up the very next day after surgery. I’ll admit to a moment of panic when I woke up not being able to see anything with my left eye. Once I was in a better-lit room, I was able to see with my left eye, but not as well as I had the previous day. Carrie noted that my left pupil was tiny compared to the right.
At the ophthalmologist’s office, the nurse checked my vision and the doctor checked the pressure in my eye and looked for signs of infection. All was well. The doctor explained that the track of change in pressure in my eye (which is directly related to first a worsening, then the improving vision) follows a bell curve. I hadn’t crested the curve’s peak. Also, the medication in the eyedrops served to counter the increase in pressure with a corresponding constricting of the pupil. So yes, I was night-blind. But all according to plan. The doctor assured me I should expect marked improvement by next week’s appointment.
Appointment 5 of 9 – Post Op Again
The doctor was right. A week later my vision had improved greatly. Images are sharper, with less blur than my right eye. I am now eager to complete the right eye surgery.
Milestone: I was able to drive myself to the ophthalmologist; no dilation, just a check-up one week after surgery. The doctor is happy, as am I. He declared that I have no restrictions on activities, I just need to continue the eyedrops. He signed a note for Carrie to let her know I can use the chainsaw.
Right-eye surgery is two weeks from today.
Appointment 6 of 9 – Right Eye Surgery
Three things were different this time. First, anxiety was lower after having “left-eye” experience. Second, I was more aware of my surroundings during surgery and participated in a discussion the doctor and nurse were having about breakfast cereals. And third, the outcome was a little different with less night blindness but a bit more blurriness.
Appointment 7 of 9 – Post Op
This was the next-day post-op checkup; same routine as with the left eye. All was well.
Appointment 8 of 9 – Post Op Again
One week after surgery. Also same experience as with the left eye. Swelling is down by about 75%. Only mild blurriness remains. I am released to resume normal activities with no restrictions. Today is the last day for drops in my left eye. Right-eye drops continue.
The doctor asked about the note he wrote to reassure my wife I could use my chainsaw one week after the left-eye surgery. I shared that a note would not be needed this time.
Appointment 9 of 9 – Final Checkup
Three weeks after right-eye surgery. This was the final check of both eyes, the determination of my new eyeglass prescription, and the decision on what glasses are appropriate. All was well. No sign of inflammation. Lenses were centered properly and eyes had healed. As a result, the doctor exempted me from completing the last week of eyedrops.
My distance vision has improved greatly. The haziness is gone as are the flares from oncoming headlights that triggered my decision to proceed with surgery.
I continue to need reading glasses, and there is still some astigmatism in my right eye that will benefit by some correction in the glasses I will wear mainly while driving. For that, I ordered bifocals with no correction in the upper left, some correction in the upper right and magnification in the lower half of both lenses so I can read dashboard displays.
At my doctor’s suggestion, I bought a pack of cheap generic readers to keep strategically placed for use when I am in the garage or barn and otherwise don’t need my bifocals.
Back To Normal
I am happy to be back to full duty and am very pleased with the outcome. For everyone involved, other than the patient, cataract surgery is very routine. Turns out in hindsight, it was pretty routine for this patent as well, once I got over that creepiness of having surgery on my eyes while awake and somewhat aware. And yes, I wish I had done this about a year earlier.
