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So I'm off for cataract surgery...

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So in another chapter in the ongoing tale of my eyes, I'm going for cataract surgery today.  Today is the left eye, in a few weeks we're doing the right eye.

It's not entirely clear why I've got cataracts at this young an age, but I do.  We suspect it's the steroids I've been using for my asthma.  It's particularly odd since the more advanced cataract is in my "good" eye, i.e., the eye I did "not" have a retinal detachment in a few years back (the retinal surgery put me at an increased risk for a cataract in that eye, but not the other).  Though the "bad" eye has one too.

Interestingly, it was my cute French doctor, Julien, who spotted the nascent cataracts three years ago - no one believed him, and no one else spotted them for a good long time thereafter.  I noticed a change in color perception in that eye, a sudden decrease in my prescription, and a sudden sensitivity to light.  In retrospect those are classic cataract symptoms, but I went for loads of tests before anyone figured out it was a cataract.

Cataracts are funny things.  At first, they simply made my prescription worse (in addition to making colors a bit less vibrant).  I'm already pretty nearsighted - I think my glasses prescription was at about a -10 and -11 before the cataracts (which is pretty bad).  Now they're something on the order of -11 and -14.  But in addition to the cataracts progressively making your prescription worse (which can be corrected with expensive new glasses or less expensive new contacts), eventually they start to blur your vision all together - and in a way that can't be corrected by new glasses or contacts.  That's the stage I'm in now.

My left eye has been blurry for about a year - it's beyond the point of simply getting a new prescription - and the right eye was doing fine until just recently when it too started to go blurry.  At this point, I use my right eye exclusively when working on the computer, the left image is just a blur, but oddly permits me to read up close pretty well (meaning, if I'm trying to read the fine print on a bottle).

Now, when you get cataracts the doctors are loathe to tell you WHEN you need surgery.  It's not entirely clear why.  It's almost as if they're afraid to give you advice.  They say "you'll know when you need surgery."  Not really.  Now, why not get it done immediately?  Because it still is surgery, and there still are risks.  Of infection.  Of even a retinal detachment that could leave you blind.  It is common surgery, it does tend to go well, but it's not without risk.  Especially when you're as myopic as I am, and when you have a previous history of retinal detachments, which I do.  Then your risk of a detachment during the five years following the surgery is not insignificant.  Now, that doesn't mean you'll go blind if your retina detaches.  Mine detached while I was in Paris 3 years ago, and after emergency surgery my vision is really no worse for the wear.  My sister, however, had a detachment and she lost the vision in a quarter to a third of her one eye.  Others have detachments and lose their vision in that eye permanently.  So the risk of a detachment shouldn't be taken lightly, and it's definitely on my mind.

But at the point where you can't use your left eye for work, and your right eye is starting to go, it's time to get things fixed.  And as my eyes have never tolerated contact lenses well, I can only wear them for a few hours at a time, out socially, not for close up reading or computer work, I'll be getting both eyes done (the usual option is to get one eye done and then wear a contact lens in the second eye until it too needs surgery).  There's usually a surgical delay of 1-4 weeks between eyes.

What is a cataract?  The lens in your eye gets cloudy and has to be removed and replaced with a new clear artificial lens.  It's out-patient surgery, takes about half an hour.  While you may have good vision in a few days, you might not have optimal vision (to really determine how well the surgery worked) until 6 months or so after.  Though usually about a month after the doctor takes a final prescription for glasses etc.

Which raises the issue of "will you need glasses after cataract surgery?"  The goal is "no."  But it depends.  Most of my bad prescription is in my lens that will be replaced.  So in principle the new lens will fix by bad prescription.  But.  It depends on where exactly implanted lens settles after six months of healing.  It could move a bit, and any slight movement could affect my prescription for better or worse.

Then there's astigmatism, a problem related to the cornea of your eye.  It too affects your prescription, and changing the lens won't affect your astigmatism since the problem isn't in the lens.  Well, that's not entirely true either.  I found out that the surgery to take out your old lens and implant the new one can change your astigmatism for the better or for the worse.  It depends on the specific details of your astigmatism, and how the doctor does the surgery.  In my case, the surgery should, by simple dumb luck, cancel out perhaps 80% of my existing astigmatism.  So, we hope that I won't need glasses for distance vision after I get both eyes fixed.  (They do have what are called toric lens implants that can fix astigmatism, but insurance won't pay for them.  In my case it doesn't matter since the surgery should fix much of my astigmatism anyway.)

Reading is another matter.  The kind of lenses I'm getting are fixed-focus lenses, meaning, the lenses are optimally focused at a fixed distance - kind of like the old cheap cameras that had an optimal distance of maybe 12-15 feet.  Too close, they were blurry.  Same thing goes for the lens implant.  I'll need reading glasses after.  A thought I loathe.  I really think our generation is the first to spend so much time on the computer AND on our phones and other mobile devices.  I check my iPhone 100 times a day for mail and more.  It's going to be a pain to constantly look for reading glasses - and, as a guy, without a purse, where do you put such glasses when you go out in the summer?  I'm probably going to buy some cool bifocal sunglasses I saw online.

There is another option, multifocal lens implants, that let you see distance and close up.  Thing is, a lot of people have been seeing glare and halos using these lens - a LOT.  And apparently, the glare and halos are horribly annoying, to the point where people are regretting getting these lenses.  I'm told that some doctors think the numbers of patients seeing these halos and glare are much higher than people realize - I was basically warned off of getting them.  Keep in mind, once this thing is in your eye, that's it - it ain't coming out, can't be fixed, etc., so if they get it wrong... (I believe they could do another surgery to try to fix it, but you're entailing some serious risks doing that. It's not "easy" like the initial surgery.)

And the final option is mono-vision.  Basically you get one lens for distance vision in one eye, and the second eye gets a lens for near vision, so you can read with that eye.  Your brain in principle fuses the two together, and this way you won't need glasses even to read.  I've tried monovision the past few years with my contacts (intentionally) and my glasses (unintentionally).  I hate it.  I feel like there's veil over my left eye.  My mom has monovision lenses implanted in her eyes and doesn't mind the monivision.  At the hospital they told me that women tend to adjust to the monovision well, men not so well.

I've worn glasses for 42 years now.  I'm dying to lose them if I can.  I think I'm willing to opt for reading glasses - which everyone pretty much needs eventually - in order to ditch the glasses for distance after this much time (even though I did get some awfully trend burgundy Danish eyeglasses when I was in France the other summer - figures that the age I finally get the nerve to get cool glasses, I'll no longer need them (will probably turn them into reading glasses or something).  And the other cool thing is I can now get those coolio and cheapo Warby Parker glasses that up until now wouldn't make lenses for people as nearsighted as I.  With the new prescription, if there is a new prescription, I can at least get those.  So all is not lost, barring other complications.

So, in a few hours I'm off to the hospital in Chicago where my specialist works (I'm going to a specialist because of my past retina issues) and should have the surgery on my left eye around 730pm central time tonight.  If all goes well, they'll do my right eye in a few weeks.  I have no idea if I'll be blogging at all tomorrow - I've already warned the boys that I may not even be able to see my computer (but I think I may poke the left lens out of my glasses and try anyway).

I'm curious to hear from any of you who have had cataract surgery.  How did it go?  If you had glasses before were you able to get rid of them?  Any problems with insurance?  Did you have insurance?  Fortunately, mine seems to cover 90% of the surgery, even though I'm "away" from my usual network in DC.  Weigh in in the comments, particularly if you've had the surgery (but not exclusively).

Hopefully I'll be reporting in tomorrow.  Fingers crossed.  JOHN

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