June 2013

Eyes 1

June 22, 2013 11:20

This may be a little unusual for a musical blog but most of us learn and perform music with a score in front of us and our visual acuity is a big concern.

I want to report on my experience with cataract surgery with the hope that my sample of 1 experience may be of use to others contemplating cataract surgery and also to hear experiences of others in their post operative experience.

I am 60 years old and have worn glasses since I was five. At age eight I was diagnosed as amblyopic (lazy eye) with dominant right eye. There was some attempt to patch the right eye but eight is far too late to expect results.

My correction is not extreme (-1.5 in the right eye and +3.00 in the left.) I do have astigmatism (cylinder -0.75 axis 176 in right and cylinder -3.0 and axis 147 in left). However, due to the growth of the cataract detected at least 10 years ago, my vision is only correctable to 20/30.

I decided to have cataract surgery and am now in my fourth day post-op for the right eye. I had an accommodating interocular lens (IOL) which allows focusing the eye.

The surgery was preceded six weeks earlier with a superficial keratectomy in both eyes to remove the epithelial layer of the cornea that has some clouding due to Salzmans nodules.

The surgery is painless. The lens of the eye is essentially removed with a laser that blasts it in a few seconds. The surgeon then inserts the lens through a laser incision in the cornea and places it properly in the eye. It took only a few minutes and was done in the office. I went home almost immediately and rested.

They have to dilate the eye much more than an eye is ever dilated for an exam so that took some time to wear off. While it was wearing off I came to realize that my lazy left eye did more work than I had thought. This observation has been borne out over the last several days for good and bad.

By afternoon on the day of surgery my vision for reading music was hugely improved and I could read off of my tablet and smartphone with some ease. I still had huge halos around lights but that was largely attributable to the dilation. The next morning was still quite good and continues to be good.

My only concern is that distance vision (fourth day post op) , which I assumed as a given for cataract surgery, is not yet back to my corrected 20/30 vision. My reading suggests that it may take as long as six weeks to make any assessment. The price of the surgery includes PRK for vision adjustment and fine tuning if needed.

I have had some advice from highly competent source that suggests that I should not have the second eye done until I am totally satisfied with the first. My problem with that advice is that I can see that even with my lazy eye situation my eyes operate as a system and it doesn't seem likely that one can optimize the repaired eye while one eye is still crippled. It would be like having two bad knees and having only one repaired. How would you know that one was really fixed while it was trying to accommodate the bad knee?

One thing to keep in mind is that unless you are very old and very blind cataract surgery is lifestyle surgery and the doctor's role in the decision making process is necessarily different. Based on my research some doctors rely heavily on the advertising of their products on the market and non-medical counselors in their offices to guide customers to make a choice. The doctor cannot get inside your head. Unfortunately you can't get inside your head to assess the value of the tradeoffs either.

I am happy to answer questions and delighted to hear the experience of others.

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