OH SAY CAN YOU SEE?

By Bill Westerman bill2w@ipa.net

My nearsightedness (myopia) was first discovered when I was in the third grade. Eyeglasses back in 1940 cost about $3.50 a pair, which represented about ten percent of my father's weekly take-home pay at that time. As a general rule, myopia progresses (gets worse) into one's late twenties or early thirties. But, as in my case, it sometimes continues into late adulthood. My sight ultimately deteriorated to where I had vision to about four inches from my nose. I was legally blind. As a result I had to wear so-called "Coke bottle" glasses most of my life. Actually being extremely nearsighted was a benefit to my profession. As a graphic artist I had constant need to observe things up close and took full advantage of my condition. Wherein my cohorts were putting on their glasses to see, I was taking mine off!

Often times when I was a kid and broke my glasses I had to do without for lack of funds since I was one of five children and we all had pressing needs. I was the only one of the five to have to wear glasses. I can recall sitting in a Saturday afternoon matinee watching the entire movie through a small shard of one of my broken lenses.

Early last year my ophthalmologist told me I was developing cataracts in both eyes. He quickly assured me that eventually I could be fitted with lens implants bringing my vision back to something near 20/20. This sounded too good to be true. Lens implants aren't exactly a new development. From a historical standpoint, the first lens was implanted in 1949 in England and a more modern type was implanted in 1958 in the Netherlands. Basically there are two kinds of intraocular lenses (IOLs). A flexible lens made of silicone or acrylic that nearly approximates the size of the original lens and a rigid lens about half the size. The flexible lens is folded for insertion through a tiny slit (<2.5mm) in the side of the cornea. Once in place it unfolds and fills the cavity. The rigid lens is held in place by two fine wires that spiral out from it. Since it can't be folded, a slightly larger slit is required. These lenses are used routinely for both cataract replacement and clear-lens replacement to correct vision.

The cause of cataracts is not known. It appears to be a natural process of aging and may have a genetic component. The eye's natural lens develops a cloudy appearance, which interferes with normal vision. The lens is then referred to as a cataract.

In the surgical procedure the cataract is dissolved through a process called by the fancy term 'phacoemulsification' then suctioned out of the lens capsule and immediately replaced with an implant. The procedure takes about twenty to thirty minutes as a rule. The patient is put under a mild anesthetic which allows him to communicate with the surgeon during the operation if necessary. As in, "I'm about to sneeze!" although the patient likely won't remember the actual event after recovering. The patient will then be seen the following day for a post-op exam followed by a couple of weeks of daily eye drops. Usually there will be a follow-up fitting of glasses if necessary to tweak visual acuity. Assuming no complications, the second procedure on the other eye, if required, is scheduled for one to two weeks later.

That's how it is supposed to happen. And that is how it happens 95+% of the time. I guess in order to make those statistics come out right someone has to take up the 5% as was my case.

During my pre-op exam it was determined that I had some tearing of retinas in both eyes. Since IOLs have the potential of ultimately causing retinal separation in high myopes it was determined that I would need to undergo laser treatment in both eyes. The upshot of this was that it delayed my implant surgery by some months while waiting for the laser treatment to heal. I took about one hundred laser zaps in the retinas of both eyes some of which were a bit painful.

Once that was settled and healed I was scheduled for surgery. During the first operation (on my right eye) things began to go terribly wrong. First of all the lens capsule tore during the cataract removal, complicating the insertion of the implant. Next there was a 'posterior tear', which allowed vitreous from the back part of my eye to begin seeping into the front of my eye. Stitches were put in place to stop the leakage. During this procedure a blood vessel was damaged flooding the anterior chamber.

I was not apprised of this so at my post-op exam when the eye shield was removed I was fully expecting to see a brand new 20/20 world. Instead I was totally blind in that eye even when a bright light was brought into my line of vision. At the time no one could tell me if this condition was going to be permanent. Over a period of three weeks I slowly regained my eyesight as the blood was drawn out by natural process and new fluids replaced it. But now, instead of the standard couple of weeks of eye drops it turned into months the effect of which was to delay my second surgery.

Another complication resulting from all this was that my iris refused to return to its natural position and remained dilated. I was told that there was a bit of fibrous material that had attached itself to the back of my iris and unless I allowed them to perform another operation to sever it my iris would remain that way. While fearful of another disaster I relented and underwent the second procedure. The result is that it didn't do the job. My iris is now permanently in the half-closed/half-open position, which means that I must wear sunglasses at all times when I am out of doors, a habit which I had never developed.

A full year from my original surgery date I was ready, albeit apprehensive, to have my left eye lens implanted. Oh, by the way, I hedged my bet by insisting on a different surgeon. I am delighted to report that everything went well and at my day-after post-op exam I had 20/25+ vision in my left eye.

For the eight months between surgeries I went around with one myopic eye and one 'normal' eye, which made for some interesting visual problems. For instance I had to close one eye when going down stairs. Also I could not look back to my right without seeing double images. Not good when you are parallel parking a car!

But now, after a year of visual hell, I have two good eyes both tracking and seeing like I never have. A couple of interesting asides, natural lenses gradually, imperceptibly, yellow over the years. Colors are now cleaner and brighter and the yellow tint to everything has disappeared! One last thing, heavy minus lenses needed to correct nearsightedness also act to reduce the size of things by a factor of about 10 to 15%. Something one gets used to. But now I see everything in its real size. For instance the ground looks a lot closer. I always thought I was tall!