Cataract Journey 2: Choices

With my diagnosis of cataracts (in both eyes), I began to consider my alternatives. The simplest, which is to do nothing and rely on eyeglasses for increasingly inadequate visual correction, was not very appealing, especially since lens replacement surgery was now “medically necessary.” Medicare, like most insurance plans, covers only the bare minimum: a single focus (“monofocal”) artificial replacement lens, usually for distance, with the natural lens being removed and the new one inserted by scalpel. Monofocal lenses give most people excellent distance vision, although they do not correct for astigmatism, and usually require the use of glasses for reading and intermediate distance work.

These are not the only lenses available. Lenses can be toric (astigmatism correcting), or can correct for more than one distance. Multifocal lenses can provide a full range of vision (or so the literature says), including presbyopia, the difficult in reading that comes with age, but they can also result in halos around street lights and other visual difficulties at night. They also don’t come in all powers of correction. Accommodative lenses can correct for distance and intermediate vision, which means that glasses may be needed for reading; they flex like a normal, healthy lens. Even more technological innovations are in the works, especially as baby boomers age and demand better solutions.

Then there are choices as to how the surgery is done, the traditional scalpel, or femtosecond lasers. The benefits of the laser are that it is more precise and it can correct mild astigmatism at the same time. (Astigmatism arises when the cornea is shaped like a football instead of a soccer ball, resulting in multiple focal points; in pain speech, everything, near or far, is blurry.)

My first reaction was that the price of the special lenses and the laser surgery was beyond my budget. I considered going with just what Medicare would cover, which would mean using glasses for reading or computer work, and also to correct my astigmatism. I hadn’t even considered that I might be able to see clearly without glasses (except for really close-up stuff like removing splinters, where it makes sense to use magnification). Once I started to imagine that possibility, especially in view of the likelihood that I will have this surgery only once in my lifetime, I saw how I was automatically giving privilege to money over quality of life. I allowed myself to consider what I wanted, instead of the cheapest alternative. I had to practice saying, “You’re worth it,” and “You deserve the best,” things I had said so many times to other folks but rarely to myself.

My husband, dear soul, immediately agreed with me. I talked with our financial advisers about how big a bite this might take out of our retirement funds. Then, when least expected, we got a windfall from a couple of sources. I joked that the universe wanted me to be able to see clearly. I remembered a line from Julia Cameron’s The Artist’s Way: “Leap and the net will appear.” This wasn’t exactly leaping, not with all the number juggling and planning, but I appreciated the reminder to dream beyond limitations.

The next step was a series of precise measurements of my eyeballs and a discussion about what plan would give me the best visual outcome. I knew I wanted the laser surgery because it would correct my astigmatism and offer the possibility of a special lens. My ophthalmologist recommended the accommodative lenses, which he felt might give me good reading vision as well as midrange and distance, with less risk of problems driving at night. An additional advantage to this combination is that if there is any “fine tuning” by LASIK necessary, that will be included in the fee.

I’m scheduled for August, one eye at a time with 2 weeks in between, and I have a huge bag of different kinds of eye drops and a complicated regimen to follow, beginning 3 days before the first surgery. The interval will be difficult, as I will still need correction in the non-surgical eye, so I’m hoping my optometrist can pop out the lens on the surgical side and things won’t look too, too weird. But I’m prepared in the event that they do.

Stay tuned!