Linstrum
01-23-2011, 08:28 PM
This is for those of you who are going blind from cataracts.
Five months ago my vision got so bad I could no longer shoot.
Back seventeen years ago I was diagnosed with the beginnings of cataracts in both eyes. A cataract is where the lens that is inside the front of the eye just behind the iris, or colored part of the eye, becomes cloudy and otherwise no longer clear. Cataracts are usually inherited from one or both parents like hair and eye color, but thankfully they usually don't show up until old age.
http://en.wikipedia.org/wiki/Cataract
The eye's natural lens is made from an optically clear soft rubbery carbohydrate material called hyaluronan produced and used by the body in many places besides the eye that has a texture a bit like stiff Jello and in people susceptible to cataracts their natural hyaluronan lenses will start to get fibrous with a cloudy yellow color after about 45 to 50 years. Cataracts usually take awhile to develop to the point where they interfere with vision, but once they appear the prognosis is they almost always progress slowly to total blindness. People with blue or light colored eyes and those who work outdoors on water or in bright sunlight a lot are known to be more susceptible, and working around large red-hot objects a lot, such as in a steel mill, also seems to be a factor in developing one form of cataracts. There are several kinds of cataracts and not everyone gets them, but they still occur often enough so that a fairly standardized procedure using highly specialized ultrasonic and laser tools for treating them has been established. Fortunately, cataract surgery is usually a fairly simple outpatient surgical procedure. Despite being simple and fairly inexpensive, the "cure" is a quite recent development and before the modern treatment method, synthetic lenses, and the specialized tools were developed, the earlier methods to correct cataracts always lead to impaired vision that by recent standards would be unacceptable.
Back in 1993 when I was diagnosed with early cataracts, my eye doctor informed me that the cataracts probably wouldn't cause any problems for quite a long time and not to worry about them. But "quite a long time" went by awful darned fast and about two years ago I began having problems seeing things clearly at a distance during the day and I couldn't make out words on road signs anymore except at night when cataract impairment is less bothersome due to the physics of how the eye handles light. I also couldn't see fine details up close, like making out the dates on coins, and being a part time machinist I couldn't read my micrometers or otherwise see clearly enough to continue working without resorting to using an eye loupe and magnifying glass to do work, which is a highly annoying nuisance. My deteriorating vision also made shooting pretty difficult because I got so I could not make out target details and find my spent brass on the ground. I don't hunt anymore, so I didn't worry about that, although there is this big wapiti up on the mountain that I hear every once in awhile calling my name ;>) but with my vision the way it was he was pretty safe from becoming an occupant of my freezer. During the early summer of 2010 my daytime vision started deteriorating very rapidly and by August I could no longer drive on cloudy days because I couldn't see gray and silver colored cars, even at 200 feet. I still didn't have any problems driving at night but most stores and other places I needed to drive to were not open after dark so I became limited to shopping at my local Walmart and Walgreen's because they were the only stores open 24 hours.
Before I contacted any eye surgeons I started doing research on cataract surgery and I learned as much about it as I could online plus I asked my friends if they knew anything about it and found some people I knew who had had the recent modern cataract surgery. My father was one of the first to have the modern cataract surgery, but he passed away in 2009 so was no longer available to help me and answer questions. After a week of research I found out that for most cases of simple cataracts that the procedure is actually less difficult and stressful than having a tooth pulled and the more or less 45-minute surgery is usually done using numbing drops in the eye and the patient goes home afterward and simply takes it real easy for about four days. That includes avoiding bending over, sneezing or coughing real hard, and for a month following surgery not doing any vigorous work. A strong antibiotic and cortisone eye drops are used several times a day for preventing infection and inflammation of the tiny incision made in the edge of the cornea (clear part of the eye). To protect the eye a ventilated aluminum guard cup is taped over the eye for a few days to prevent accidentally touching or bumping the eye, especially when asleep, but after about five days that isn't necessary anymore. The eye works right away but because vision is quite hazy like looking underwater, along with the guard being over it, there is no point in attempting to use the eye, which feels pretty uncomfortable when trying to look at something anyway. The amazing thing to me is that even though the eye is cut open and the old lens removed by actually chopping it into pieces and then blending it into a liquified soup so it can be sucked out of the eyeball with a tiny tube, it doesn't hurt at all during and after surgery because one or two very potent topical anesthetics, usually carbocaine with lidocaine, are used in eye drop form for the surgery. Besides that, the part of the eye affected by the surgery is not very sensitive to pain. Any post-surgical pain is usually handled using just lidocaine drops. Discomfort is mild and bearable for the first several hours, and it diminishes very rapidly toward the end of the first day. After the second day it feels like sweat is in the eye and is handled quite well using just ibuprofen. For about 24 hours both before and after surgery, pain relievers like #3 codeine with Tylenol, Vicodin, and almost all other opiates MUST be avoided because opiates cause the pupil to close down, usually to a pinpoint. If the pupil is constricted the eye surgeon can't get to the lens in back of the pupil to remove it and implant the new synthetic lens. If the pupil closes down after surgery it can tear the incision and surrounding tissue. Before starting surgery a mydriatic drug is applied to begin dilating the pupil, which takes about half an hour. Once the dilation is well underway the anesthetic drops are applied and the surgery procedure started. Before the actual cutting started on me, I had several things I needed done first.
Before my surgery was scheduled I had to have an inexpensive brief physical exam to make sure I would not have any complications. Despite the rather mild nature of the surgery, people have died during the procedure. My physical exam entailed being weighed, having my blood pressure checked, blood oxygen level checked, ears, nose, and throat looked at, and being asked how I felt generally in the last six months. Normally, if a patient appears to be in good health and nothing suspicious shows up in the brief physical exam, then the patient is green-lighted for surgery. Because I had lost a lot of weight recently my surgery was postponed until the source of my weight loss could be verified as the result of a deliberate weight loss program. I also had blood tests done for thyroid and liver function, and to check for diabetes. All came back normal so I was green-lighted for surgery. The tests that I had are not normally part of the brief pre-surgery physical and most people do not go through the extra procedures and rather long wait like I did. The physical exam is good for 30 days and I had to take another physical exam before my other eye was repaired, which is normal since there is usually a waiting period between the two eye surgeries in case something goes wrong several weeks after the first surgery. The next pre-surgery procedure is having both eyes very thoroughly measured and examined so the surgeon knows what to expect. The cataracts are examined and classified as to type and extent, the dimensions of the eyes are determined so the correct replacement lenses are used. The eye surgeon usually tries to get the eyes to come out slightly near sighted so that glasses or contacts aren't needed for reading at 11 inches and doing other general kinds of work at arm's length. Two types of synthetic replacement lenses are available, fixed focus and flexible focus that are soft so that the eye muscles can focus them the same way as the natural lenses by compressing them. The flexible lenses are not recommended because they cost three times as much and they don't always work. I decided to get fixed focus lenses and then use glasses for seeing at distance and driving. My father did get the flexible lenses and they did work quite well for him, he could focus on the end of his nose or two blocks away just like when he was young. After my physical exam and having my eyes measured all I had to do was wait until my surgery, which was three weeks. Those three weeks went by annoyingly slowly because my vision was deteriorating by the day, and by the eve of my surgery I could no longer see to drive. Patients are not allowed to drive home from surgery anyway, so that was not a problem.
End Part 1 - (don't forget to read part 2)
rl917
Five months ago my vision got so bad I could no longer shoot.
Back seventeen years ago I was diagnosed with the beginnings of cataracts in both eyes. A cataract is where the lens that is inside the front of the eye just behind the iris, or colored part of the eye, becomes cloudy and otherwise no longer clear. Cataracts are usually inherited from one or both parents like hair and eye color, but thankfully they usually don't show up until old age.
http://en.wikipedia.org/wiki/Cataract
The eye's natural lens is made from an optically clear soft rubbery carbohydrate material called hyaluronan produced and used by the body in many places besides the eye that has a texture a bit like stiff Jello and in people susceptible to cataracts their natural hyaluronan lenses will start to get fibrous with a cloudy yellow color after about 45 to 50 years. Cataracts usually take awhile to develop to the point where they interfere with vision, but once they appear the prognosis is they almost always progress slowly to total blindness. People with blue or light colored eyes and those who work outdoors on water or in bright sunlight a lot are known to be more susceptible, and working around large red-hot objects a lot, such as in a steel mill, also seems to be a factor in developing one form of cataracts. There are several kinds of cataracts and not everyone gets them, but they still occur often enough so that a fairly standardized procedure using highly specialized ultrasonic and laser tools for treating them has been established. Fortunately, cataract surgery is usually a fairly simple outpatient surgical procedure. Despite being simple and fairly inexpensive, the "cure" is a quite recent development and before the modern treatment method, synthetic lenses, and the specialized tools were developed, the earlier methods to correct cataracts always lead to impaired vision that by recent standards would be unacceptable.
Back in 1993 when I was diagnosed with early cataracts, my eye doctor informed me that the cataracts probably wouldn't cause any problems for quite a long time and not to worry about them. But "quite a long time" went by awful darned fast and about two years ago I began having problems seeing things clearly at a distance during the day and I couldn't make out words on road signs anymore except at night when cataract impairment is less bothersome due to the physics of how the eye handles light. I also couldn't see fine details up close, like making out the dates on coins, and being a part time machinist I couldn't read my micrometers or otherwise see clearly enough to continue working without resorting to using an eye loupe and magnifying glass to do work, which is a highly annoying nuisance. My deteriorating vision also made shooting pretty difficult because I got so I could not make out target details and find my spent brass on the ground. I don't hunt anymore, so I didn't worry about that, although there is this big wapiti up on the mountain that I hear every once in awhile calling my name ;>) but with my vision the way it was he was pretty safe from becoming an occupant of my freezer. During the early summer of 2010 my daytime vision started deteriorating very rapidly and by August I could no longer drive on cloudy days because I couldn't see gray and silver colored cars, even at 200 feet. I still didn't have any problems driving at night but most stores and other places I needed to drive to were not open after dark so I became limited to shopping at my local Walmart and Walgreen's because they were the only stores open 24 hours.
Before I contacted any eye surgeons I started doing research on cataract surgery and I learned as much about it as I could online plus I asked my friends if they knew anything about it and found some people I knew who had had the recent modern cataract surgery. My father was one of the first to have the modern cataract surgery, but he passed away in 2009 so was no longer available to help me and answer questions. After a week of research I found out that for most cases of simple cataracts that the procedure is actually less difficult and stressful than having a tooth pulled and the more or less 45-minute surgery is usually done using numbing drops in the eye and the patient goes home afterward and simply takes it real easy for about four days. That includes avoiding bending over, sneezing or coughing real hard, and for a month following surgery not doing any vigorous work. A strong antibiotic and cortisone eye drops are used several times a day for preventing infection and inflammation of the tiny incision made in the edge of the cornea (clear part of the eye). To protect the eye a ventilated aluminum guard cup is taped over the eye for a few days to prevent accidentally touching or bumping the eye, especially when asleep, but after about five days that isn't necessary anymore. The eye works right away but because vision is quite hazy like looking underwater, along with the guard being over it, there is no point in attempting to use the eye, which feels pretty uncomfortable when trying to look at something anyway. The amazing thing to me is that even though the eye is cut open and the old lens removed by actually chopping it into pieces and then blending it into a liquified soup so it can be sucked out of the eyeball with a tiny tube, it doesn't hurt at all during and after surgery because one or two very potent topical anesthetics, usually carbocaine with lidocaine, are used in eye drop form for the surgery. Besides that, the part of the eye affected by the surgery is not very sensitive to pain. Any post-surgical pain is usually handled using just lidocaine drops. Discomfort is mild and bearable for the first several hours, and it diminishes very rapidly toward the end of the first day. After the second day it feels like sweat is in the eye and is handled quite well using just ibuprofen. For about 24 hours both before and after surgery, pain relievers like #3 codeine with Tylenol, Vicodin, and almost all other opiates MUST be avoided because opiates cause the pupil to close down, usually to a pinpoint. If the pupil is constricted the eye surgeon can't get to the lens in back of the pupil to remove it and implant the new synthetic lens. If the pupil closes down after surgery it can tear the incision and surrounding tissue. Before starting surgery a mydriatic drug is applied to begin dilating the pupil, which takes about half an hour. Once the dilation is well underway the anesthetic drops are applied and the surgery procedure started. Before the actual cutting started on me, I had several things I needed done first.
Before my surgery was scheduled I had to have an inexpensive brief physical exam to make sure I would not have any complications. Despite the rather mild nature of the surgery, people have died during the procedure. My physical exam entailed being weighed, having my blood pressure checked, blood oxygen level checked, ears, nose, and throat looked at, and being asked how I felt generally in the last six months. Normally, if a patient appears to be in good health and nothing suspicious shows up in the brief physical exam, then the patient is green-lighted for surgery. Because I had lost a lot of weight recently my surgery was postponed until the source of my weight loss could be verified as the result of a deliberate weight loss program. I also had blood tests done for thyroid and liver function, and to check for diabetes. All came back normal so I was green-lighted for surgery. The tests that I had are not normally part of the brief pre-surgery physical and most people do not go through the extra procedures and rather long wait like I did. The physical exam is good for 30 days and I had to take another physical exam before my other eye was repaired, which is normal since there is usually a waiting period between the two eye surgeries in case something goes wrong several weeks after the first surgery. The next pre-surgery procedure is having both eyes very thoroughly measured and examined so the surgeon knows what to expect. The cataracts are examined and classified as to type and extent, the dimensions of the eyes are determined so the correct replacement lenses are used. The eye surgeon usually tries to get the eyes to come out slightly near sighted so that glasses or contacts aren't needed for reading at 11 inches and doing other general kinds of work at arm's length. Two types of synthetic replacement lenses are available, fixed focus and flexible focus that are soft so that the eye muscles can focus them the same way as the natural lenses by compressing them. The flexible lenses are not recommended because they cost three times as much and they don't always work. I decided to get fixed focus lenses and then use glasses for seeing at distance and driving. My father did get the flexible lenses and they did work quite well for him, he could focus on the end of his nose or two blocks away just like when he was young. After my physical exam and having my eyes measured all I had to do was wait until my surgery, which was three weeks. Those three weeks went by annoyingly slowly because my vision was deteriorating by the day, and by the eve of my surgery I could no longer see to drive. Patients are not allowed to drive home from surgery anyway, so that was not a problem.
End Part 1 - (don't forget to read part 2)
rl917