Saturday, June 13, 2015

Cataract Journey 1: Diagnosis

For some years now, maybe a decade, I’ve complained about my “old eyes.” I’ve never had good vision without corrective lenses. I think I started wearing glasses in 3rd grade. I remember getting contact lenses in 1960. They were hard lenses, of course, and required a long period of getting used to, all the while putting up with light sensitivity and scratchy, red eyes. They did, however, get me out of having to play softball – which I was so bad at, it was embarrassing – in high school; the first windy day blew so much dust into my eyes, the school let me switch to swimming. For some reason, maybe the steepness of my corneas, the lenses stayed put in water. As a result, I learned to swim.

For a long time, hard (“rigid gas-permeable”) lenses were a great solution for me. I don’t have issues about handling my eyes, and best of all, they gave me great correction. My brain thought the world had sharp edges. And so it went for many years.

Eventually I ran into one situation or another where I needed glasses. For some strange reason, hospitals want you to take your contacts out. So I got them, even though years would go by without using them. And then, of course, I’d need a different prescription. I got a pair just for reading in bed, part of my night time ritual.

Fast forward a number of decades. Dry, scratchy eyes became more of a problem, especially when working at the computer, and often it seemed as if the lenses couldn’t quite settle (and give me good correction), no matter how many times I blinked. I’d take them out and clean them, and sometimes that would help. Driving at night became more tiring. I could no longer see the night sky clearly, and I was pretty sure I’d been able to, once upon a time.

Eventually, my eyes decided they’d had it with contacts. After a painful bout with “contact lens over-wear,” I was never able to wear them for more than a few hours every day. Then I lost one (a very rare occurrence for me) and decided that was the universe’s way of shutting the door. I got new glasses, both for intermediate (computer, piano) distance and far distance. Night driving got even more difficult, and I noticed I was staying home rather than tackling the twisty mountain roads in my area on rainy nights. Street lights appeared surrounded by soft haloes that did not change when I took my glasses off. Often it would seem that the lenses were dirty or smeared, but they looked okay when I checked.  Although my distance glasses corrected me enough so I could drive safely, I had trouble reading street and highway signs at a distance.

During a routine annual visit with my optometrist, I complained about my various visual difficulties. I’d been writing off so much as “these old eyes” or the challenge of getting good correction for someone as horrendously near-sighted as I am (and astigmatic, to boot). “You’ve got cataracts,” he told me. “They’re not severe, but Medicare might pay for the surgery. Here’s my referral.”


Suddenly, everything made sense. I felt elated to find an explanation for the deterioration of my vision. But were my cataracts “ripe” enough to justify surgery? A month later, I hied myself over the hills to the specialist. The materials his office sent me explained a few things:
  • Cataracts are an inevitable part of aging. Everyone who lives long enough will get them.
  • Cataracts are a clouding of the eye’s lens, treated by replacing the lens with an artificial one. That artificial lens can correct visual problems!
  • Once upon a time, it was thought that you had to wait until you were practically blind to qualify for the surgery, but this is no longer the case.

Not only do I have cataracts in both eyes, one worse than the other, but I have choices. While Medicare pays for only the medically necessary monofocal (usually distance) replacement lenses, there are elective extras available to me: multi-focal or accommodative lenses, laser instead of scalpel surgery, methods for treating my (mild) astigmatism. I’ll talk about these in the next installment.

The painting is by George Cope, 1879.

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