#it's sort of like the 'measure twice cut once' for medical adhesives

[krawdad]

Protip: learn how to remove spirit gum before gluing something to yourself or someone.

[msbarrows]

Cataracts - What Surgery Is Like

As previously mentioned, I’d developed cataracts and am now going through surgery for them, and have elected to document a bit about what it’s all like from my viewpoint. Mostly because I think it’d make a nice reference for anyone wanting to write with some degree of accuracy about what it’s like from the inside.

This post contains a description of the surgical process involved and what that actually feels like, I’m trying not to be overly graphic but I’m also not elliding over any of the grosser bits (thankfully and surprisingly very little).

First off, a descriptiong of the preliminaries. This started for me with my vision going blurry over the last couple of years, and finally getting around to visiting my old optomitrist when I happened to be in Toronto over last Christmas (as my one up north just retired a couple years ago, and I hadn’t replaced her yet). Of the several potential causes for the vision loss I was experiecing, what I had turned out to be cataracts, of the variety that occurs at the back of the lens and therefor doesn’t cause easily-visible clouding. Which I actually said “Oh, thank god!” to when the optomitrist told me, since they are the absolute easiest thing to fix, while some of the other options (detached retina, or diabetes-related macular degradation, to name a couple) are much less so. Then he gave me a reference to an opthamologist. Thanks to COVID-19, it was this fall before I was finally able to actually get to the clinic and see her.

From my point of view, the process then went pretty quickly. Note that I was at an eye institute that specializes in cataract treatment; everything is contained in one building (a nicely renovated Victorian brick house in the Annex area of Toronto). So all tests and surgery are done on premises.

First appointment there, they did the same sort of vision tests my optomitrist generally does, plus some extra inner-eye photography to get a good look at what was going on. This was done by two different people, one doing the eye-chart related tests and a different one doing the photography. Then I met briefly with my doctor, who looked over my questionnaire (which included questions like whether near, mid, or distance vision was most important to me, and was there a focal distance I particularly needed to be glasses free for, etc.), and that I didn’t need nor have interest in a lens replacement that wasn’t covered under our provincial health care.

A week later I returned for them to perform eye measurement tests, which are used as a basis for manufacturing the replacement lens. They measure the size and shape of the eye, and mostly just involved staring into various machines while photos are taken. The weirdest one, which they did last, involved dripping numbing drops into my eyes, and then lightly pressing a small sensor to multiple places both directly on the eyeballs and then on the closed lids. Something to do with viscosity I’d assume.

And now for a description of the general surgical process, which you can also find summarized (or in more detail) at a number of medical web sites. In my case, it was a pretty basic surgery being performed; the opthamologist needed to make a small slit in the outer layer of my eye, used a tiny probe to break down the lens using ultrasound waves, vacuum out the broken down lens, then use a largish needle to insert a folded plastic lens into the eye, where it would unfold within the capsular space and could be tweaked as needed into the correct position. The cut in the eye is tiny enough that it usually doesn’t even need stitching, apparently.

I was asked to arrive at a specific time, and had to start applying dilating drops to my eyes an hour, half-hour, and five minutes before leaving for the clinic. No nail polish or facial makeup. Preferable wearing comfortable pants and a loosely short-sleeved button front shirt without any undershirt or long underwear beneath it (which turns out to be a “just in case things go crazily sideways” measure; they didn’t actually need to access anything on my torso).

The first step after I arrived at the clinic was being dressed in PPE - one of their own disposable masks to be sure I was wearing a good enough one (that wasn’t coated in whatever mine had picked up outside), a hair cap, a long-sleeved thigh-length blue plasticized robe (it had thumb holes to prevent the sleeves from slipping), and booties over my shoes.

Then I was taken to their surgical floor, where a nurse began a series of eye drops. These included more dilation, an antispectic, and an antibiotic, that I can remember - multiple drops of all. She also gave me a teeny tiny pill to place under my tongue and let dissolved, which contained a small dose of a relaxant/anti-anxiety med (Sorry, she told me the name of it at the time but it’s dropped out of my memory). I didn’t notice any particular change in my mood, but then I’d been counting slow deep breaths since arriving (4 seconds in, 4 seconds out...) to help keep myself relaxed and give myself something to focus on that wasn’t omfg I’m going to be awake during this! Because yeah, not having a clue what it was going to be like was stressful. Nurse also took my blood pressure to be sure I was fine in that regards, and put a sticker on the gown to remind the doctor that it was my right eye being done that day.

After a brief wait, I was moved into one of the surgical theatres, where there was a dentist chair they sat me in, then connected a blood pressure cuff, fingertip monitor (hence the no nail polish rule) and sensors on the backs of both hands and one ankle (I’m assuming those were measuring a mix of blood oxygenation and heartbeat, with the ankle one making sure my feet were still getting blood when I was spending the surgery in what ended up as a tipped-over-backwards with head lowest position). They then rinsed my eye and the orbital area with bactine (very yellow vision while that happens), then patted the area around the eye dry.

The doctor sat at my head, and applied a medical drape with a pre-cut adhesive-edged opening over my eye, then peeled off a translucent applique that was over the hole. Then they applied medical clamps that held my eyelids in the open position (which thanks to the numbing drops, I didn’t feel at all). A brightly lighted microscope was then positioned over the eye, and I was told to stay as still as possible and stare at the red dot in the lighted area. The doctor then did the surgery as described above. From my point of view, there was very little to feel; occasional dull pressure, some random coldness that I believe was the eye being irrigated. I could hear the occasional very quiet noise the probe made as the lens was sucked away, but mostly it was just staring at the red light as well as I could while my vision distorted oddly and I continue counting breaths. Within what felt like no more than 5-10 minutes (if that), it was all over with.

They had me continue to lie there for a couple minutes while they peeled off the drape, wiped the eye area clean, and removed all the sensors, then a brief rest before having me sit up.

I blinked once or twice, and... DAMN! Sudden near-perfect vision in an eye that hasn’t seen clearly without help since I was in single digit ages. And the saturation. The detail.

Now, my left eye of course still has a cataract (it gets treated next week). I’d been telling people for a while that basically all my right eye was seeing was blur, so my left eye was doing most of the seeing, and I thought my left eye wasn’t anywhere near as bad as my right. With my right eye now seeing perfectly, I could now alternate opening eyes from side to side, and see just how badly (and irregularly) blurred and yellowed the left lens actually is. To which I can only saw, WTF, how was I even seeing anything at all!?

Then they had me sit for a while in the waiting area, where the doctor came and double-checked I was fine, and gave me a kit in a plastic bag of a card that identifies that I have an interocular lens (and info about it), a prescription for two different eye drops (antibiotic and anti-inflamatory) which was enough for both this eye and the eye getting operated on next week, and a shield to wear at night for the first five nights, to be sure I don’t accidentally rub it or put pressure on it.

Then I put on sunglasses (because hugely dilated eye) and walked out.

Side note - they won’t do your operation unless you have a ride home arranged; because that tiny pill means you’re in a slightly altered state, among other reasons. Good thing it was my brother and not, say, a taxi, since among other things it took us three drugstores to find one that actually had both kinds of eyedrops in stock, yay super fun.

Also, remember me talking about the starburst rays I was seeing around lights due to cataracts? While my eye was still dilated (which lasted until after midnight) I was seeing what I can only describe as ‘Ferris wheels’ - a burst of  rays expanding out like the spokes of a wheel, and ending in an uneven ring of dots of bright light, each wheel matching the colour of the light causing it. Looked wild at night. Thankfully that effect has now gone away.

Had a follow-up appointment this morning where they did an eye chart and the rebounce test where they puff air at your cornea, and the opthamologist says the vision in that eye tested as 20/20 (WOOO! Finally something good with that number). I can see sharply and clearly for blocks from the mid-range on out. Sadly when I try to use my computer, tablet, etc (near-range and close vision) the eye can’t focus down far enough; some of that may improve over the next month or two as the eye continues healing, and adapting to the lens. In the meantime my sister suggested I try a pair of her reading glasses and, yay, that worked. I am now planning that after my follow-up appointment for next week’s surgery on the left eye, I’ll run around and pick up 2-3 pairs of reading glasses of various strengths (which I will get will depend on what seems to work best with arm’s length and close-in viewing), to carry me through until I go back to an optomitrist in a month or three, and get my vision evaluated to see if I need actual prescription reading and/or far distance glasses.

In the meantime, apart from computer/tablet use, I am glasses free. I can’t even remember ever having such sharp, clear, and saturated vision (since I’ve been in glasses for such a long time). You know the “oh, trees are made of leaves!” effect? I am getting that with every single thing I look at. Oh, that’s how much grey is in my hair? Weird, I never noticed this wall was textured before. Oh geez, that text over there is so small and yet I AM READING IT. I mean, even with glasses I probably was never able to read that from this distance! Etc ad infinitum.

It’s just so, so nice.

And that’s with just one eye finished. I am now really looking forward to next week’s surgery. Stress? What stress!?