Linstrum
01-23-2011, 08:28 PM
Part 2
I chose the very early morning to have my surgery so the surgeon would be fresh. I am a night person and I got up six hours before my surgery so I was fully awake and functioning by the time I went in for my surgery. When I arrived I was informed that I would be out in 45 minutes and to be sure to have my ride ready to take me home. I paid for the surgery in full (not required, arrangements can be made in advance to do otherwise), signed a surgery consent form, had my patient rights explained to me, acknowledge that my left eye was the one to be worked on and had my left eye labeled with an adhesive sticker stuck on my eyebrow, signed the form explaining I wanted the solid lens implant, and then was given another brief physical exam. While I was having my blood pressure, blood oxygen level, and heart checked a medical technician put booties over my shoes, put a gown over my clothes, and put gloves on my hands. All protective gear was sterile disposable plastic and paper. Outside the operating room I was put on a gurney where my blood pressure, blood oxygen level, and heart rate were checked again by a surgical technician, and then the eye drops were put in to numb and dilate my eye. I was not the first patient even though it was 6:30 in the morning. After about twenty minutes when the eye drops were working pretty good the previous patient came out and the surgeon cleaned up to get sterile again for my surgery while I went to the bathroom. When I came out two surgical technicians led me into the operating room. I was wobbly from the anesthetic eye drops, they are quite strong. I was put on a four lead heart monitor with electrodes taped to my chest and a surgical technician talked to me to find out my frame of mind. I had my arms immobilized at my sides by having an electric blanket strapped over me and then the team of surgical technicians prepared my eye and face for surgery by taping my left eyelids open so I couldn't blink and then covering my face with a towel in case I sneezed or coughed I would not contaminate the open surgical wound in my eye. As soon as my eyelids were immobilized one of the surgical technicians began irrigating my open eye with normal saline and an occasional drop of anesthetic. They told me to wiggle my hands and say something if I was going to sneeze so they could prepare for it, sneezing is a very common occurrence during surgery because some people sneeze a lot when bright lights are in their eyes, including me. Fortunately the anesthetic eye drops numbed my nose as well, so I never did sneeze. The surgeon came in and the bright operating lights were turned on. I could only close my right eye and the brightness was more than I could tolerate, so I told the surgeon if there was any way he could put a shadow across my eye when he wasn't working to please do so, so he did. Unfortunately most of the fifteen minutes that the surgery took he needed the bright light to see down inside my eye, so I clenched my fists and my toes and it was all I could do to keep from turning my head away from the light because the intense pain the bright light was causing even though the intensity of the light is below what is known to cause damage, such as looking directly at the sun. I found out that the degree of discomfort I had from the light is unusual, most people find it only mildly annoying. There were five people working on me; the surgeon, three technicians, and the surgical nurse. They were listening to a selection of classical soft rock music as they worked, which I also liked.
The surgical technique is called a "temporal corneal incision". That is a cut made on the eye where the white color of the eye meets the iris or colored part and is opposite the nose on the temporal or outside of the eye. The incision follows the edge of the colored iris and is very short, about 1/8 of an inch long. The incision is just large enough to insert the folded-over new synthetic lens implant through as well as insert the phacoemulsion tool through to reach under the cornea of the eye into the pupil or dark center, which is a hole that leads to the lens under the colored iris. Because the pupil is fully dilated the hole is quite large, about 6 mm or 15/64 of an inch in diameter (.243 caliber), and the surgeon is able to reach through the hole with a tool that chops up the soft rubbery Jello-like lens into tiny pieces and phacoemulsifies the pieces into a soupy mixture that is vacuumed out through a very tiny siphon hose. Phacoemulsification is a process where the chopped up lens pieces are liquified into a soupy mixture and then sucked out through a tiny hose. The tool is like a tiny jackhammer and is driven ultrasonically, and while it was being used I could hear the sound it made quite plainly. It sounded like an electric organ playing a series of high pitched notes, which is actually what the sonic generator was doing that drives the little "jackhammer" tip that stirs the pieces of lens so violently they blend into a soup. Once the diseased lens is liquified and sucked out, the surgeon inspects the lens capsule for damage. In back of the lens is a "window" that is the posterior part of the intra ocular lens capsule that the lens sits in that is made from the same material as the natural lens and it often develops an opaque cataract as well. I had this besides the lens cataract and unfortunately the window cannot be replaced like the lens is. But fortunately a neodymium-doped yttrium-aluminum garnet infrared laser can be used to puncture hundreds of holes through the opaque part and that will clear up the window so it doesn't interfere with vision. When the surgeon was using the laser to puncture the opaque part I could see the flashes of light it generated even though the primary output is invisible because the heat it generated caused the matter it punctured through to momentarily glow white hot. All very interesting! When the surgeon was done preparing my eye to receive the intraocular lens implant I could tell when the new lens was inserted because I could suddenly see! There wasn't much to look at yet, but as soon as the folded-over-like-a-taco lens was inserted through the slit incision in my eye and un-folded it did its job of focusing light in my eye again. I could see! What I noticed immediately was how blue everything was, which was from the cataract being yellow so that I had not seen a correct amount of blue light for several years. The surgeon used a single suture to hold the incision closed and as soon as he was done the team of surgical technicians unstrapped my arms and helped me sit up while all of the taping on my face was removed and an aluminum eye cup was taped firmly over my eye. I was led out of the operating room to the patient waiting area and my blood pressure, blood oxygen level, and heart rate were checked one last time while all of my protective over-clothing was removed and placed in a biohazard container. That was it, I was done with the surgery part for one eye, one more eye to go! I made an appointment for the next day and went home to get some sleep. I had a lot to do for the post-surgical follow-up, though, I had to place cortisone and antibiotic drops in my eye every two hours for the next day, which tapered off to once a day over the next month.
The surgical procedure for my right eye was nearly identical including requiring another brief physical exam because thirty days had passed from the time of my first one. The lens in my right eye was replaced in exactly two weeks, which was two weeks sooner than normal because my left eye had healed extremely quickly, which is unusual for this kind of surgery. The waiting period between eyes is in case there are complications from the first surgery that may impair vision. It is better to have one eye with a cataract than to be blind in both. Even though it has been five months I am still not out of the woods yet. Even though the rate of long term failure of intraocular lens implant surgery to correct cataracts is very low, it does happen even years later. But the risk is worth the results, if I had not had the surgery I would now no longer be able to drive, read, use a computer, shoot, reload, enjoy sunrises and sunsets, and appreciate nature. It was worth it and anyone who is faced with the prospect of impaired vision from cataracts, have the surgery, like I said it is not as bad as having a tooth pulled. I had two teeth pulled six months before my eye surgery, and it was far worse than this!
Once the aluminum eye protection cup comes off and the repaired eye is put to use, the increase in visual acuity is apparent right off, especially how colors look. Most cataracts taint the vision so everything has an olive brown tinge to it. Living in a dirty, grimy, sepia-toned world has a subtle affect on mental health, so one immediate benefit is an increased sense of well-being. But the most immediate and strikingly noticeable thing is how intensely blue the world suddenly looks once the brown filters are removed!
Before obtaining eye glasses, I had to wait for the four week course of post-surgical prednisolone anti-inflammatory treatment to finish. For the day of the surgery only, I started out with prednisolone drops along with Vigamox antibiotic drops in my eye every two hours, then for the next week every six hours. After the first week the antibiotic drops were discontinued and just the prednisolone continued on for another three weeks, making four weeks of prednisolone treatment altogether before having my vision checked for getting corrective glasses or contact lenses. Both of my eyes came out slightly near sighted as intended and I do not normally need glasses for reading a newspaper or book. However, my far vision is a bit blurry and although I can drive during the day no problem, I need corrective lenses for driving at night and stargazing.
One last thing about having cataract surgery done, even though it is minimally invasive, the eye is nonetheless cut open and part of the inside of the eye is removed and a foreign object is implanted inside. This can sometimes lead to extremely serious problems and although the vast majority of cataract surgery patients live out the rest of their lives without any trouble whatsoever, complications sometimes develop, even life-threatening problems are not unknown. People have become blind as a result of the surgery, which is what the patient was originally faced with. Also, infections may develop, an allergic or immune response to the lens implant may occur even though the lens material is deliberately chosen for its benign properties, other changes to to the eye can happen that cause vision problems including a detached retina and glaucoma. The incidence of these problems is quite low, estimates run between 2% to 5% of patients have some kind of problem with most being quite minor, which means that more than 95 out of 100 people have zero trouble at all. I weighed these odds and since I was rapidly approaching the point of being legally blind I was impatient to have the surgery done, I really wanted to get it over with! One thing I no longer do, though, is shoot any rifle larger than .223 Remington with the butt held directly against my shoulder because of the risk of developing a detached retina from recoil shock. I still shoot my Garand rifles and a Grizzly Big Bore .50 BMG rifle, but I don't hold the butts directly against my shoulder. I use about 15 pounds of spent tungsten carbide lathe tool bits in a heavy leather recoil bag that straps to the front of my shoulder to take all the thump out of the recoil.
So, if you have diminished vision due to cataracts, having them evaluated and your eyes repaired is now a very fast, easy, and relatively painless procedure. If you are worried about paying for it, some health insurance covers it. If not, for repairing both eyes it costs about as much as a really good used car. In a period of about six months my vision deteriorated from being able to read, run my machine shop, drive, and shoot to the point of requiring assisted care living. With ninety minutes of surgery I had my vision restored, and that in turn restored my life!
rl916
I chose the very early morning to have my surgery so the surgeon would be fresh. I am a night person and I got up six hours before my surgery so I was fully awake and functioning by the time I went in for my surgery. When I arrived I was informed that I would be out in 45 minutes and to be sure to have my ride ready to take me home. I paid for the surgery in full (not required, arrangements can be made in advance to do otherwise), signed a surgery consent form, had my patient rights explained to me, acknowledge that my left eye was the one to be worked on and had my left eye labeled with an adhesive sticker stuck on my eyebrow, signed the form explaining I wanted the solid lens implant, and then was given another brief physical exam. While I was having my blood pressure, blood oxygen level, and heart checked a medical technician put booties over my shoes, put a gown over my clothes, and put gloves on my hands. All protective gear was sterile disposable plastic and paper. Outside the operating room I was put on a gurney where my blood pressure, blood oxygen level, and heart rate were checked again by a surgical technician, and then the eye drops were put in to numb and dilate my eye. I was not the first patient even though it was 6:30 in the morning. After about twenty minutes when the eye drops were working pretty good the previous patient came out and the surgeon cleaned up to get sterile again for my surgery while I went to the bathroom. When I came out two surgical technicians led me into the operating room. I was wobbly from the anesthetic eye drops, they are quite strong. I was put on a four lead heart monitor with electrodes taped to my chest and a surgical technician talked to me to find out my frame of mind. I had my arms immobilized at my sides by having an electric blanket strapped over me and then the team of surgical technicians prepared my eye and face for surgery by taping my left eyelids open so I couldn't blink and then covering my face with a towel in case I sneezed or coughed I would not contaminate the open surgical wound in my eye. As soon as my eyelids were immobilized one of the surgical technicians began irrigating my open eye with normal saline and an occasional drop of anesthetic. They told me to wiggle my hands and say something if I was going to sneeze so they could prepare for it, sneezing is a very common occurrence during surgery because some people sneeze a lot when bright lights are in their eyes, including me. Fortunately the anesthetic eye drops numbed my nose as well, so I never did sneeze. The surgeon came in and the bright operating lights were turned on. I could only close my right eye and the brightness was more than I could tolerate, so I told the surgeon if there was any way he could put a shadow across my eye when he wasn't working to please do so, so he did. Unfortunately most of the fifteen minutes that the surgery took he needed the bright light to see down inside my eye, so I clenched my fists and my toes and it was all I could do to keep from turning my head away from the light because the intense pain the bright light was causing even though the intensity of the light is below what is known to cause damage, such as looking directly at the sun. I found out that the degree of discomfort I had from the light is unusual, most people find it only mildly annoying. There were five people working on me; the surgeon, three technicians, and the surgical nurse. They were listening to a selection of classical soft rock music as they worked, which I also liked.
The surgical technique is called a "temporal corneal incision". That is a cut made on the eye where the white color of the eye meets the iris or colored part and is opposite the nose on the temporal or outside of the eye. The incision follows the edge of the colored iris and is very short, about 1/8 of an inch long. The incision is just large enough to insert the folded-over new synthetic lens implant through as well as insert the phacoemulsion tool through to reach under the cornea of the eye into the pupil or dark center, which is a hole that leads to the lens under the colored iris. Because the pupil is fully dilated the hole is quite large, about 6 mm or 15/64 of an inch in diameter (.243 caliber), and the surgeon is able to reach through the hole with a tool that chops up the soft rubbery Jello-like lens into tiny pieces and phacoemulsifies the pieces into a soupy mixture that is vacuumed out through a very tiny siphon hose. Phacoemulsification is a process where the chopped up lens pieces are liquified into a soupy mixture and then sucked out through a tiny hose. The tool is like a tiny jackhammer and is driven ultrasonically, and while it was being used I could hear the sound it made quite plainly. It sounded like an electric organ playing a series of high pitched notes, which is actually what the sonic generator was doing that drives the little "jackhammer" tip that stirs the pieces of lens so violently they blend into a soup. Once the diseased lens is liquified and sucked out, the surgeon inspects the lens capsule for damage. In back of the lens is a "window" that is the posterior part of the intra ocular lens capsule that the lens sits in that is made from the same material as the natural lens and it often develops an opaque cataract as well. I had this besides the lens cataract and unfortunately the window cannot be replaced like the lens is. But fortunately a neodymium-doped yttrium-aluminum garnet infrared laser can be used to puncture hundreds of holes through the opaque part and that will clear up the window so it doesn't interfere with vision. When the surgeon was using the laser to puncture the opaque part I could see the flashes of light it generated even though the primary output is invisible because the heat it generated caused the matter it punctured through to momentarily glow white hot. All very interesting! When the surgeon was done preparing my eye to receive the intraocular lens implant I could tell when the new lens was inserted because I could suddenly see! There wasn't much to look at yet, but as soon as the folded-over-like-a-taco lens was inserted through the slit incision in my eye and un-folded it did its job of focusing light in my eye again. I could see! What I noticed immediately was how blue everything was, which was from the cataract being yellow so that I had not seen a correct amount of blue light for several years. The surgeon used a single suture to hold the incision closed and as soon as he was done the team of surgical technicians unstrapped my arms and helped me sit up while all of the taping on my face was removed and an aluminum eye cup was taped firmly over my eye. I was led out of the operating room to the patient waiting area and my blood pressure, blood oxygen level, and heart rate were checked one last time while all of my protective over-clothing was removed and placed in a biohazard container. That was it, I was done with the surgery part for one eye, one more eye to go! I made an appointment for the next day and went home to get some sleep. I had a lot to do for the post-surgical follow-up, though, I had to place cortisone and antibiotic drops in my eye every two hours for the next day, which tapered off to once a day over the next month.
The surgical procedure for my right eye was nearly identical including requiring another brief physical exam because thirty days had passed from the time of my first one. The lens in my right eye was replaced in exactly two weeks, which was two weeks sooner than normal because my left eye had healed extremely quickly, which is unusual for this kind of surgery. The waiting period between eyes is in case there are complications from the first surgery that may impair vision. It is better to have one eye with a cataract than to be blind in both. Even though it has been five months I am still not out of the woods yet. Even though the rate of long term failure of intraocular lens implant surgery to correct cataracts is very low, it does happen even years later. But the risk is worth the results, if I had not had the surgery I would now no longer be able to drive, read, use a computer, shoot, reload, enjoy sunrises and sunsets, and appreciate nature. It was worth it and anyone who is faced with the prospect of impaired vision from cataracts, have the surgery, like I said it is not as bad as having a tooth pulled. I had two teeth pulled six months before my eye surgery, and it was far worse than this!
Once the aluminum eye protection cup comes off and the repaired eye is put to use, the increase in visual acuity is apparent right off, especially how colors look. Most cataracts taint the vision so everything has an olive brown tinge to it. Living in a dirty, grimy, sepia-toned world has a subtle affect on mental health, so one immediate benefit is an increased sense of well-being. But the most immediate and strikingly noticeable thing is how intensely blue the world suddenly looks once the brown filters are removed!
Before obtaining eye glasses, I had to wait for the four week course of post-surgical prednisolone anti-inflammatory treatment to finish. For the day of the surgery only, I started out with prednisolone drops along with Vigamox antibiotic drops in my eye every two hours, then for the next week every six hours. After the first week the antibiotic drops were discontinued and just the prednisolone continued on for another three weeks, making four weeks of prednisolone treatment altogether before having my vision checked for getting corrective glasses or contact lenses. Both of my eyes came out slightly near sighted as intended and I do not normally need glasses for reading a newspaper or book. However, my far vision is a bit blurry and although I can drive during the day no problem, I need corrective lenses for driving at night and stargazing.
One last thing about having cataract surgery done, even though it is minimally invasive, the eye is nonetheless cut open and part of the inside of the eye is removed and a foreign object is implanted inside. This can sometimes lead to extremely serious problems and although the vast majority of cataract surgery patients live out the rest of their lives without any trouble whatsoever, complications sometimes develop, even life-threatening problems are not unknown. People have become blind as a result of the surgery, which is what the patient was originally faced with. Also, infections may develop, an allergic or immune response to the lens implant may occur even though the lens material is deliberately chosen for its benign properties, other changes to to the eye can happen that cause vision problems including a detached retina and glaucoma. The incidence of these problems is quite low, estimates run between 2% to 5% of patients have some kind of problem with most being quite minor, which means that more than 95 out of 100 people have zero trouble at all. I weighed these odds and since I was rapidly approaching the point of being legally blind I was impatient to have the surgery done, I really wanted to get it over with! One thing I no longer do, though, is shoot any rifle larger than .223 Remington with the butt held directly against my shoulder because of the risk of developing a detached retina from recoil shock. I still shoot my Garand rifles and a Grizzly Big Bore .50 BMG rifle, but I don't hold the butts directly against my shoulder. I use about 15 pounds of spent tungsten carbide lathe tool bits in a heavy leather recoil bag that straps to the front of my shoulder to take all the thump out of the recoil.
So, if you have diminished vision due to cataracts, having them evaluated and your eyes repaired is now a very fast, easy, and relatively painless procedure. If you are worried about paying for it, some health insurance covers it. If not, for repairing both eyes it costs about as much as a really good used car. In a period of about six months my vision deteriorated from being able to read, run my machine shop, drive, and shoot to the point of requiring assisted care living. With ninety minutes of surgery I had my vision restored, and that in turn restored my life!
rl916