Where’s Deborah?

You may have noticed that I’ve been posting less frequently, especially my book reviews. Fear not, I have not departed for illiterate climes. I value our community. And I do have things to say about the books I’ve been enjoying. I just have been reading and writing much less.

In mid-May, I experienced a sudden, severe decrease in the visual acuity of my dominant eye. I’ve been to three doctors so far, including a retinal specialist, and they can’t find the cause. The good news is that they’ve been able to rule out the Big Bads, which is reassuring but frustrating. I’ve tried wearing an eye patch, which gives me better vision through my non-dominant eye, but the loss of depth perception drives me crazy. (Who knew how much depth perception matters when reaching for a mouse?) Meanwhile, my time at the computer is limited (ditto piano, unless I’m playing from memory). Eyestrain headaches set in after only a short time. Hence…

Audiobooks to the rescue!

I discovered the delights of recorded books when they came on reel-to-reel and then cassettes. And then CDs. I still have a collection of my favorite novels and classes. Fast forward a number of years to oh joy! I can not only check out physical audiobooks from my local library, I can borrow digital editions, too! I got into borrowing through the discovery of many podcasts featuring stories read aloud (my favorite was “Phoebe Reads A Mystery”). Alas, these were usually one chapter per episode, liberally laced with ads. Not so the library editions (which also pay royalties to the author and narrator through the price the library pays for its copies).

I’ve worked my way through most of Alexander McCall Smith’s books (especially the “Lady Detective Agency” series), Tony Hillerman’s mysteries, and Anne Perry’s Thomas and Charlotte Pitt mysteries.

What have I been listening to recently? Read my most recent audiobook reviews this Friday for the scoop!

Cataract Journey 7: Settling in

It’s been several months (August) since my cataract surgery, and I’m adjusting to my new vision. My eyes have recovered from the surgery and my vision seem to have stabilized. It hasn’t changed noticeably over the last month or so.

So far, my experience continues to be positive. It’s amazing to open my eyes in the morning and be able to see clearly. I haven’t experienced the halos or other visual distortions that some patients with accommodative lenses report. My eyes had gradually become drier and scratchier over the years, and that is slightly improved, although I’m not sure why, maybe all the eye drops I used after the surgery. I’ve talked to other folks who’ve had cataract surgery and reported increased scratchiness afterward (to be fair, once I shared with them my optometrist’s protocol for dry eyes, they said it helped tremendously).

Here’s where I landed, vision-wise. I’ve gone from being incredibly near-sighted to being only slightly near-sighted. I had expected to be able to see clearly at intermediate (computer screen) and distance (driving) ranges, and to need reading glasses for close activities, but that turned out to not be the case. My vision for working at the computer and playing piano is excellent. I can’t remember seeing the piano music so crisply before. I can also read, unless the type is really small or I have to hold the book really close, so I use low-power over-the-counter reading glasses for reading in bed. My distance vision is not so great, especially in my weak eye. I can see well enough to drive places I already know how to get to, but reading street signs requires me to be fairly close to them (the letters and symbols of traffic signs are big enough, so that’s not a problem). I’d likely not pass the driver’s license vision test with my weak eye.

Now it’s time to decide what, if anything, I want to do about the residual near-sightedness.

Cataract Journey: Post-Op #2

By the time of my second cataract surgery, I was readier-than-ready. I was so tired of not being able to see clearly out of both eyes, which made depth perception – necessary for driving, pouring water from a pitcher, etc. -- impossible. I was excited rather than anxious, an interesting way to approach eye surgery. My first surgery had been quick, painless, and even a little bit fun, especially the psychedelic lights during the femtolaser portion. The gap was only two weeks, so all the surgery prep was still fresh in my mind. By prep, I mean chatting with the anesthesiologist, starting antibiotic and steroid eye drops several days before, fasting the night before. I strongly dislike sedation and had asked to not be sedated the first time. In the past, it’s taken me a solid week to feel really clear-headed after receiving the drug they use. This time, I was able to tell the second anesthesiologist (a different one) how well it had gone and to reiterate my preference. Very often, patients don’t realize their opinions and prior experiences matter, especially when it comes to medication. Just because the “usual” protocol includes a specific drug doesn’t mean it is required. Often, there are alternatives with fewer of the obnoxious side effects.

The second surgery went just as smoothly as the first and I was soon home, sleeping it off. I was struck, as I have many times in the past, at how powerful sleep is in recovery, whether it’s from surgery, an injury, or an illness. Lying quietly is more effective than sitting up, but there is something about sleeping that is even more potent a restorative.

Cataract Journey: Interregnum

in·ter·reg·numˌin(t)ərˈreɡnəm/. noun. A period when normal government is suspended, especially between successive reigns or regimes. An interval or pause, as in, "the interregnum between the discovery of radioactivity and its detailed understanding."

After cataract surgery on my first eye, I entered a bizarre period in which that eye had excellent vision at intermediate distances (computer screen, conversation) and the other was a total blur. I’m very near-sighted (as in -15 diopters), so there was no possibility of fusing images. So the world looks blurry and sharp at the same time, and I have to use parallax (shifting my head) for any kind of depth perception. Needless to say, I do not feel safe driving. Or pouring water from a pitcher, unless I can brace the lip of the pitcher against the glass – we found this out in a somewhat spectacular fashion.

One solution might have been to wear a contact lens in the nonsurgical eye, and I had worn hard or RGP (rigid gas permeable) lenses for over 50 years. But a couple of years ago my eyes, which had become drier over the decades, flatly refused to put up with contact lenses. I tried all sorts of lubricating drops, but was never able to wear my lenses more than a few (2-4) hours a day. If I did any work on the computer, that time dropped to an hour (people blink less often while staring at a computer monitor, hence increase in scratchy, red eyes). Finally, earlier this year, I lost one of my lenses. This has happened maybe half a dozen times over  the years. I looked everywhere (if you wear contacts or are close to someone who does, you know the crawling-around-on-the-floor routine) and eventually concluded that after I had cleaned them the night before, the lens had stuck to my finger instead of sliding off into the soaking solution. Since then, I had washed my hands and tidied up the counter area. So, no hope. I’d been wrestling with spectacles ever since.

My next idea, which friends have tried, was to pop a lens out of my spectacles, so that my nonsurgical eye sees through the remaining lens. Great idea, right? And it worked – so long as I covered one eye, didn’t matter which. When I tried to fuse the equally-clear images, however, my brain went nuts. It turned out the images were of sufficiently different sizes, too disparate for my brain to turn them into one. This might not have been the case with a person less near-sighted than I am. So, rather than putting a patch over one eye – toss a coin as to which one – I’ve been wandering around in this visually bizarre state.

Cataract Journey: Countdown

As part of my preparation for cataract surgery, I’ve begun talking with my eyes. Or rather, talking to them. I say, “Eyes, something exciting and perhaps a bit perplexing is going to happen to you. But don’t worry, it’s like a hip replacement. It’ll help you see even better than before. I’m going to make sure you are safe (antibiotic eyedrops) and comfortable (steroid and anti-inflammatory drops). And we will have such fun seeing bright colors and sharp detail for many years to come.”

They don’t have a lot to say in response. But…

A week or so ago, I started dreaming about the surgery. It was the usual showing up without clothes or without having attended class or without having memorized your lines. In this case, I arrived at the surgery center, having forgotten I was supposed to fast. There was much hoo-ha and calculation of what I had eaten how long ago.

This last weekend, I drove our van down to LA to help my older daughter move in with us. The drive down was in daylight and the only visual problem I had was seeing the street signs while looking for hotel and then her apartment. But (for various reasons, you know the drill) we did not get started back until 7 pm. I am normally an early-to-bed person and ended up consuming as much caffeine as I usually do in a year, I’m sure. I was painfully aware of how stressful and difficult night driving has gotten to be. Almost all the freeway driving was in darkness. I have never appreciated trucks so much – all those lights made them easy to discern, much more so than the lane markers. Daughter and I took turns leading as we caravaned along, too.

I could imagine my poor eyes saying, “We’re trying, mom! This is the best we can do!”

“I can’t ask for more, eyes. I’m going to get you some help real soon now.”

So now I am taking my pre-op eyedrops four times a day. Fortunately, I’ve been using lubricating drops for so long, I’m used to putting drops in my eyes. After surgery, I’ll add two more. I have to wait two minutes in between each medication so it doesn’t wash out the one before. Other surgeons may have different protocols. I’m observing this one meticulously. I’ll be taking these for a while, because I’ll still be on some of them when it will be time to start full doses prior to the second surgery. 

I am considering dubbing this season The Summer Of The Eye Drops. 

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.

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 3^rd 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.