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Navigating Cataracts, Rivers, and Vision-loss

Once the word cataract conjured up exciting images of river rapids and challenging waterways in my mind’s eye. I was outdoorsy, and loved to travel, and according to some, down-right adventurous. Hiking challenging trails in Red River Gorge in Eastern Kentucky, conquering the Chiricahuas of Southeastern, Arizona when I was 7 months preggers. Studying macaques on Cayo Santiago. Motorcycling through central Spain. These were some of my favorite adventures. I was no wimp.

Horseshoe Bend. Photo by Jack Finnigan on Unsplash

Flash forward thirty years.

Slow moving cataracts snuck up on me. And I am not talking about waterways with lazy currents.

Opaque Vision vs. Exploding Eyeballs

Several years ago my optometrist told me during an annual eye examine that a cataract was forming in my right eye. “Eventually you will need to have it removed,” she told me. I was in my early 50s and noted what she said but really did not give it much brain space. Narrow angle glaucoma, what I call exploding eyeballs, was a far more serious threat at the time, which I took quite seriously, and for which I had preventive surgery, a peripheral iridotomy.

The development of cataracts seemed a distant and not especially real problem. At that time, November 2014, I had no difficulty with driving at night or reading street signage; I read, watched television, and played Words with Friends® on my phone without a problem.

Creeping Blurry Oldness – No Way, Not Me

I procrastinated even thinking about cataract surgery until by the autumn of 2019 I scared the dickens out of myself driving to an evening meeting of Moms Demand Action. I almost turned the wrong way on a major street from a side street with spotty street lighting. In denial about what was wrong with my eyes, I decided I needed new glasses so off to the optometrist I went. She told me I needed to think about surgery for the cataracts as the longer I waited the more difficult it would be to remove them cleanly and simply. I took the the card of the surgeon she recommended and decided I would do something about it in the new year. Within a few months I noticed I could not easily read the channel guide from more than a couple feet away from the TV or media screen, I hated being in rooms with bright directional lighting, then I realized I really had no business driving at night, and I really had to see an eye surgeon.

No Elective Surgery During a Pandemic

This all dawned on me as the first wave of the Corona virus swept across the US. Elective surgeries disappeared.

By the time a year and a half later passed and hospitals were doing elective surgeries again, when the speed of vision loss was progressing at a frightening rate, I was able to schedule the needed cataract removal and IOL implant surgery. Every routine action had acquired some sort of adjustment to accommodate my failing vision. The progressive loss of acuity was steady but slow enough so as to not be glaringly apparent, just inconvenient.

I was kidding myself. After removing the patch and shield a day after the the first cataract surgery I was aghast at how vivid and bright everything was when I looked out through the eye with new lens, an IOL.

Before and After

The following two images are as close as I have been able to come to showing the difference between the vision through my new lens and vision with the cataract still clouding my natural lens.

Iridotomy Impact on Cataract Formation

I have to admit that I wonder what impact he 2014 procedure had on the development of cataracts. Shining a light bright enough to slice away tissue into your eyes must have some general impact beyond the creation of a tiny drainage hole. There has been a significant amount of professional discussion about peripheral iridotomy procedures increasing the rate of cataract formation but no definitive consensus among professionals exists.

Once a system is perturbed, changes result. To me, it seems unlikely there would be no impact. But given the danger of loss of vision due to rapid pressure build up (narrow angle glaucoma) weighed against an increase in the chance of developing a cataract, well, I will take the development of a cataract.

So What Was Cataract Surgery Like?

Really the last two months have not been bad at all.

I was frightened before the first surgery. I admit that. The idea of having someone slice my eye open, pulverize my lens, suck it out, and then put in an IOL, was a bit intimidating. But really, the whole out-patient procedure was like any other procedure.

  • Restricted food and fluids before surgery, eye drops the day before
  • Removed all my rings and decorative or descriptive accoutrement
  • Registration desk interaction
  • Waiting in waiting room with husband who remained in waiting room during procedure – except for when he snuck out, bless him, and got an iced latte for me to guzzle after being released
  • Nurse escorts me through double swinging doors asking, “Who are you, what procedure are you having done, and what is your date of birth?”
  • Guided back to pre-op prep with rolling bed, monitors, tract-attached hospital curtain, behind which they attached monitors to me after I put on a funky gown (and thank heavens got to keep my pant on) and the stupid looking surgery cap
  • then a half hour to 45 minute long parade of professionals began – pre-op nurse, surgery nurse, anesthesiologist, and surgeon – who measured various pulses, pressures, and levels, put an IV portal in the back of my hand, and occasionally had me sign paperwork (which seemed sort of bassackwards as I did not have my glasses to read what I was signing and I was going in for freaking cataract surgery)
  • I’m told I will be awake during surgery but will be unable to remember anything from the surgery — which is true but also very, very weird
  • I am wheeled toward the OR and remember nothing until after being wheeled out, not even them putting the bandage and shield on, except for going past some shelving units and wanting to say, “Whee,” or “Zoom,” which I really hope I was just thinking and did not actually say
  • Rest, no lifting of 20 lb. items, a trip back to the Dr. to have the bandage removed the next day and have a post op exam
  • Steroid and antibiotic drops for a couple weeks, sleeping with the guard on for a week
  • Then after last check up, I did the whole thing over again for the second eye

And How Did It Go?

Well, my vision is not perfect. I was born with instamatic rather than Nikon® quality eyes. I did not opt for multi-focal lenses as it seemed like some acuity is lost when optimization is split for two different depths of field, and my pre-diabetic status means that some of the newer whiz-bang lenses, such as those that correct for astigmatism are not recommended for me. One eye is great, better than when I was young. I will go for a new driver’s license and will not need to have the eye correction required notice on my license. The second eye will probably require some follow-up laser blast surgery as not all the cataract could be removed through surgery. Remember earlier in this piece when I recounted the optometrist telling me I needed to think about surgery soon as the longer I waited the more difficult it would be to remove them cleanly and simply? Essentially, the older cataracts are the tougher they are and the more they adhere to the lens sac. That is also why there is color distortion. So I will return for a five month check up and they will schedule a bit of laser “tidying up” at that time. In my estimation everything went wonderfully. I can see! There were no SNAFUs.

Modern medicine is amazing.

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