hardly a pirate.
I haven't really discussed it on here, but five months ago I was diagnosed with cataracts in both eyes, which is very unusual for someone my age, unless you happen to have been taking high dose steroids for a few years, a category I am fortunate enough to fall under. But not only do steroids cause cataracts, they cause what is clinically referred to as "superduper cataracts;" upon diagnosis, I was told that my cataracts would develop much, much faster than typical cataracts, and that the "elective" lens replacement surgery would no longer be elective by roughly this summer, as by that point they would be so far advanced that I would be considered legally blind.
So, the last few months have been dedicated to studying the procedure of lens replacement, learning about the strengths and weaknesses of various types of IOL's (interocular lenses, the plastic lenses that replace your natural ones, which are permanent replacements), and consulting with various ophthalmologists in a desperate effort to discern the one best qualified to install my new IOL (as I repeatedly read that, depending on the IOL in question, the quality of one's surgery directly determines the quality of the resulting vision).
To be brief, this has been an exhaustive process on all fronts, stressful to the point of nausea at times. But I finally learned all the details, mechanics, and terminology relevant to discuss the procedure, picked the IOL I considered best (as they all have their own pros, cons, and unique risks), and found a qualified ophthalmologist extremely experienced with my IOL (this last task having been the most difficult). And today I had my right lens replaced.
Prior to surgery, which is performed on a conscious patient under local anesthesia, I was handled by a nurse and an anesthesiologist in a pre-operative room. This wasn't anything special; vitals were taken and dosages applied and whatnot. The only confusing thing was a 40-some inch widescreen tv mounted in the corner of the room. At first I had no idea what it was displaying, as the image was completely still but indistinct, and I couldn't for the life of me make out what it might be. After a few minutes, though, a closeup of somebody's eye filled the entire screen, and as it did so I realized that I was watching a live feed. Even watching this large, brown, dilated eye move back and forth, it wasn't until the scalpel appeared on screen that I realized I was watching a lens replacement being performed live on the patient ahead of me.
This would prove the most traumatic moment of the day. I watched as the steps I had studied in such great detail and with relative academic detachment were executed live, one by one, in remarkable detail, knowing that my own eye would undergo the same process in ten minutes time. This eye thrashed about wildly, at first, and it seemed almost as through it were trying to escape the prison of its socket and its own forced exposure at the hands of foreign metal hooks, which suspended the lid. It then calmed abruptly, and moments later I saw the scalpel slice across the eye, creating the incision through which to operate. The subsequent bleeding this caused ran down and across the white in thin, distinct trails. A dull, ultrasonic vibrating utensil was inserted, which then proceeded to prod and crush the natural lens into a mess of tiny porous pieces. There was then an interjection by a suction tool of sorts, which thoroughly vacuumed up the mashed bits of lens. This was followed by the insertion of the new lens, a non-threateningly round piece of plastic with sinister hooked arms, through the narrow incision (a feat which seemed to me impossible by all metrics). Finally, this display ended in each of the IOL's strange hooks being driven into the eye, one by one, locking the lens in place, cementing the installation.
This is probably not a thing they should broadcast live in the pre-operative room, especially since I see no benefit to doing so. I wonder if some old man watched my own lens replacement and was similarly horrified.
After this, as part of preparation, my eye was dilated and then smeared with some sort of clear anesthetic gel, which removed my need to blink, but simultaneously made me unable to do so. This combination distorted my vision so very badly that I could only really discern bright lights and vague silhouettes of people, both of which were tremendously warped. Lights I knew were florescent white often appeared a strange hue of purple or red. This effect turned out to be the saving grace of the procedure.
As I had studied lens replacement over the months, and particularly as I had watched it performed on television like some sort of sick entertainment piece, I'd developed a certain amount of anxiety. Not about the surgical procedure itself, nor the possibility of surgical complications, nor the possibility of pain, but rather, about being conscious.
When I very first discussed the procedure, I asked my initial ophthalmologist if this was performed under general anesthesia. He laughed. He told me that in the thousands of lens replacements he had performed in his time as a doctor, he'd only used general anesthesia once, and it had been on an elderly woman with Parkinson's disease so that she would be still enough to operate. So for months I have pictured what it must be like to have your eye held open with metal hooks, watching as instrument after instrument approaches and then cuts, pulverizes, and otherwise maims your eye. Local anesthesia or not, this seemed like a pretty traumatic thing to witness, particularly coupled with the fact that you would literally be forced to watch on by virtue of the fact that your eye was the subject of the procedure, while keeping it as still as possible for fear that movement might interfere with the process.
The dilation and gel removed most of that concern. Everything was so blurred and distorted that I couldn't make out instruments, the doctors, the staff, or basically anything except a few lights, though I could always tell what step was being performed when, based on an amalgamation of what little I could see through the eye (for instance, the lens being broken apart was fairly visually apparent, as was the inset and adjustment of the new lens, even though I was just looking up at a series of badly warped lights), the discussion between doctors and staff (particularly asking for utensils, but general chatter as well), and a talking computer that was narrating various things, like "Initialization sequence complete," in the most stereotypically droning, sci-fi female-computer voice I have ever heard in real life. Seriously, I cannot overstate how much it sounded like I'd boarded a sentient spaceship from the year 21xx. In hindsight, I have no idea what that computer was even doing, unless it was simply there to entertain me.
I had thought it would be difficult to keep my eye still during the procedure. I was right in a sense, but not how I expected. It was actually pretty easy to keep from moving my eye myself, even a little, particularly since I had remarkably little visual sense of what was going on. But as various tools worked against my eye, it was pressed in all sorts of directions, forcing me to often forego my focal point, then reset it between surgical steps.
The whole affair was mostly painless and only took about fifteen minutes. This was as expected, but still pleasant.
I was told weeks ago that, afterward, I would have an eyepatch for a day. Naturally, I spent the last couple weeks going around telling people that I was going to have a badass eyepatch and be a pirate for 24 hours after my surgery. Pictures were promised. I was therefore disappointed when a huge amount of gauze was quickly slapped under a huge clear plastic shield, and then crudely paper taped across my face. Maybe they'd think it was funny if I drew lightning bolts on it before I come back in tomorrow. I am probably going to go do that, actually.
If you ever have to choose between having one eye or two, let me come down staunchly in favor of two. In my case, it doesn't help that my left eye is 20/40 or worse from its cataract, but generally speaking, the combined lack of depth perception and halved field of vision (with little peripheral vision toward the nose) is a nasty affair. Just in case you ever find yourself playing with a BB gun, running with scissors, or otherwise deciding how many eyes you think you'd like to have for the rest of your life.
My real concern with this entire process, though, is what my resulting vision will be like. Save these cataracts and harsh chronic dry eye, I've had pretty sharp vision all my life. Most people see very well through my IOL, the crystalens (which is in my opinion a technical marvel I will spare you the details of here), many seeing with better vision than I had prior to surgery even (my ophthalmologist, at my behest, showed me what I could reasonably expect using a written document similar to an eye chart, and most of what he pointed at, I was barely able or completely unable to read, even through my better eye). But there are plenty of horror (or slight irritation) stories around as well, ranging from minor blurriness, correctable by prescription, to total inability to see near or far, to complete night blindness, to halos, starbursts, and glare coming from all light sources. There are no real indicators of how any IOL will work for someone prior to implantation, so with such a wide range of outcomes, it feels like a real crapshoot. The point, I suppose, is that even though I had the actual surgery today, tomorrow is the day I've actually been inwardly dreading for months.
Now, if you'll excuse me, I'm going to add some extreme(ly childish) decals to my paper tape eyepatch.
So, the last few months have been dedicated to studying the procedure of lens replacement, learning about the strengths and weaknesses of various types of IOL's (interocular lenses, the plastic lenses that replace your natural ones, which are permanent replacements), and consulting with various ophthalmologists in a desperate effort to discern the one best qualified to install my new IOL (as I repeatedly read that, depending on the IOL in question, the quality of one's surgery directly determines the quality of the resulting vision).
To be brief, this has been an exhaustive process on all fronts, stressful to the point of nausea at times. But I finally learned all the details, mechanics, and terminology relevant to discuss the procedure, picked the IOL I considered best (as they all have their own pros, cons, and unique risks), and found a qualified ophthalmologist extremely experienced with my IOL (this last task having been the most difficult). And today I had my right lens replaced.
Prior to surgery, which is performed on a conscious patient under local anesthesia, I was handled by a nurse and an anesthesiologist in a pre-operative room. This wasn't anything special; vitals were taken and dosages applied and whatnot. The only confusing thing was a 40-some inch widescreen tv mounted in the corner of the room. At first I had no idea what it was displaying, as the image was completely still but indistinct, and I couldn't for the life of me make out what it might be. After a few minutes, though, a closeup of somebody's eye filled the entire screen, and as it did so I realized that I was watching a live feed. Even watching this large, brown, dilated eye move back and forth, it wasn't until the scalpel appeared on screen that I realized I was watching a lens replacement being performed live on the patient ahead of me.
This would prove the most traumatic moment of the day. I watched as the steps I had studied in such great detail and with relative academic detachment were executed live, one by one, in remarkable detail, knowing that my own eye would undergo the same process in ten minutes time. This eye thrashed about wildly, at first, and it seemed almost as through it were trying to escape the prison of its socket and its own forced exposure at the hands of foreign metal hooks, which suspended the lid. It then calmed abruptly, and moments later I saw the scalpel slice across the eye, creating the incision through which to operate. The subsequent bleeding this caused ran down and across the white in thin, distinct trails. A dull, ultrasonic vibrating utensil was inserted, which then proceeded to prod and crush the natural lens into a mess of tiny porous pieces. There was then an interjection by a suction tool of sorts, which thoroughly vacuumed up the mashed bits of lens. This was followed by the insertion of the new lens, a non-threateningly round piece of plastic with sinister hooked arms, through the narrow incision (a feat which seemed to me impossible by all metrics). Finally, this display ended in each of the IOL's strange hooks being driven into the eye, one by one, locking the lens in place, cementing the installation.
This is probably not a thing they should broadcast live in the pre-operative room, especially since I see no benefit to doing so. I wonder if some old man watched my own lens replacement and was similarly horrified.
After this, as part of preparation, my eye was dilated and then smeared with some sort of clear anesthetic gel, which removed my need to blink, but simultaneously made me unable to do so. This combination distorted my vision so very badly that I could only really discern bright lights and vague silhouettes of people, both of which were tremendously warped. Lights I knew were florescent white often appeared a strange hue of purple or red. This effect turned out to be the saving grace of the procedure.
As I had studied lens replacement over the months, and particularly as I had watched it performed on television like some sort of sick entertainment piece, I'd developed a certain amount of anxiety. Not about the surgical procedure itself, nor the possibility of surgical complications, nor the possibility of pain, but rather, about being conscious.
When I very first discussed the procedure, I asked my initial ophthalmologist if this was performed under general anesthesia. He laughed. He told me that in the thousands of lens replacements he had performed in his time as a doctor, he'd only used general anesthesia once, and it had been on an elderly woman with Parkinson's disease so that she would be still enough to operate. So for months I have pictured what it must be like to have your eye held open with metal hooks, watching as instrument after instrument approaches and then cuts, pulverizes, and otherwise maims your eye. Local anesthesia or not, this seemed like a pretty traumatic thing to witness, particularly coupled with the fact that you would literally be forced to watch on by virtue of the fact that your eye was the subject of the procedure, while keeping it as still as possible for fear that movement might interfere with the process.
The dilation and gel removed most of that concern. Everything was so blurred and distorted that I couldn't make out instruments, the doctors, the staff, or basically anything except a few lights, though I could always tell what step was being performed when, based on an amalgamation of what little I could see through the eye (for instance, the lens being broken apart was fairly visually apparent, as was the inset and adjustment of the new lens, even though I was just looking up at a series of badly warped lights), the discussion between doctors and staff (particularly asking for utensils, but general chatter as well), and a talking computer that was narrating various things, like "Initialization sequence complete," in the most stereotypically droning, sci-fi female-computer voice I have ever heard in real life. Seriously, I cannot overstate how much it sounded like I'd boarded a sentient spaceship from the year 21xx. In hindsight, I have no idea what that computer was even doing, unless it was simply there to entertain me.
I had thought it would be difficult to keep my eye still during the procedure. I was right in a sense, but not how I expected. It was actually pretty easy to keep from moving my eye myself, even a little, particularly since I had remarkably little visual sense of what was going on. But as various tools worked against my eye, it was pressed in all sorts of directions, forcing me to often forego my focal point, then reset it between surgical steps.
The whole affair was mostly painless and only took about fifteen minutes. This was as expected, but still pleasant.
I was told weeks ago that, afterward, I would have an eyepatch for a day. Naturally, I spent the last couple weeks going around telling people that I was going to have a badass eyepatch and be a pirate for 24 hours after my surgery. Pictures were promised. I was therefore disappointed when a huge amount of gauze was quickly slapped under a huge clear plastic shield, and then crudely paper taped across my face. Maybe they'd think it was funny if I drew lightning bolts on it before I come back in tomorrow. I am probably going to go do that, actually.
If you ever have to choose between having one eye or two, let me come down staunchly in favor of two. In my case, it doesn't help that my left eye is 20/40 or worse from its cataract, but generally speaking, the combined lack of depth perception and halved field of vision (with little peripheral vision toward the nose) is a nasty affair. Just in case you ever find yourself playing with a BB gun, running with scissors, or otherwise deciding how many eyes you think you'd like to have for the rest of your life.
My real concern with this entire process, though, is what my resulting vision will be like. Save these cataracts and harsh chronic dry eye, I've had pretty sharp vision all my life. Most people see very well through my IOL, the crystalens (which is in my opinion a technical marvel I will spare you the details of here), many seeing with better vision than I had prior to surgery even (my ophthalmologist, at my behest, showed me what I could reasonably expect using a written document similar to an eye chart, and most of what he pointed at, I was barely able or completely unable to read, even through my better eye). But there are plenty of horror (or slight irritation) stories around as well, ranging from minor blurriness, correctable by prescription, to total inability to see near or far, to complete night blindness, to halos, starbursts, and glare coming from all light sources. There are no real indicators of how any IOL will work for someone prior to implantation, so with such a wide range of outcomes, it feels like a real crapshoot. The point, I suppose, is that even though I had the actual surgery today, tomorrow is the day I've actually been inwardly dreading for months.
Now, if you'll excuse me, I'm going to add some extreme(ly childish) decals to my paper tape eyepatch.