[Video: an animation showing how cataract surgery is traditionally performed, using tiny surgical blades for any necessary incisions. (There are videos on YouTube of actual cataract surgeries being performed, but they’re just a little bit too, er, ick for me to include here.) My own surgery on Monday morning will be performed, as explained below, using a laser rather than the scalpel(s).]
For starters, okay: really, there’s no knife involved. (On the other hand, it sure sounds impressive, doesn’t it? Life on the edge!) There’s definitely an eye. But I am going under a laser in a couple of days. And just because I am, well, me, these last few days leading up to the experience carry with them a certain amount of drama — all on the inside, you understand. This drama falls into three categories: the procedure; the prescriptions; and the, uh, John-specific considerations.
The procedure
As family and friends have had cataracts removed, you’d think that by now I’d actually have known something about the procedure — about cataracts themselves. But no.
Oh, I knew there were cloudy… somethings in sufferers’ eyes. But how were the clouds dispelled? How could something, like, in the eye be removed? Surely not by actually cutting the eye? Aren’t eyeballs basically just flexible globes full of some liquid? (I even knew the term vitreous humor.) Surely to cut the eye would be to invite a tiny but perhaps audible “pop!” — the presumably cloudy fluid now splattered all over the lens of an observing microscope?
Obviously that hadn’t happened to anyone I knew who’d had the surgery… because, of course, that’s not how the eye is cut: there’s no, like, jabbing or poking involved. The incisions in question all involve only the lens of the eye, and its immediate surroundings.
And that was my second surprise: the lens has to be cut in order to be removed and replaced. You get an actual new — and artificial — lens.
So the procedure I’ll be undergoing will take somewhere between 15 and 30 minutes, and consist of two steps: removing the faulty lens, and inserting a new — and presumably non-faulty, haha — one in its place.
Classically, the removal is done using a tiny little scalpel, often with an offset blade like the one shown at the right. This enables a horizontal slit to be made — hence, the non-jabbing kind of cut — very shallowly in the region of the lens. This is the kind of surgery shown in the video at the top of this post.
In my case, the doctor will be using something called a “femtosecond laser.” The “femto-” prefix means “one quadrillionth”; in other words, in every second the laser pulses one quadrillion times (one followed by 15 zeroes). It makes a stitching type pattern, first around the lens and then back-and-forth across the lens, breaking it up into tiny little regularly shaped fragments which are vacuumed away. At that point, the eye in question is, well, lensless. (Apparently, during this interlude, the center of the eye turns red. This isn’t from leaking blood or anything; it’s the color of light reflected off the back of the eyeball.)
I’ve seen animations of the circular and cross-stitching path of the laser beams. The animations must be slowed waaaaay down, so you can see what actually happens. (It’s almost like watching Uma Thurman in the Kill Bill movies: swish-swish-swish-SWOOSH, and the target collapses in a pile of shards.) The idea, as I understand it, is that the beams’ paths are computer-controlled: programmed not only for horizontal/vertical placement on the surface but for actual depth of the cuts, according to previously taken, ultra-precise measurements of the eye in question.
(This is all rather dazzling, wot?)
So then once the bits of the cloudy lens have been removed, it’s time to move on to the next step: inserting the artificial replacement.
My ophthalmologist gave me a choice of two recommended (and both fairly recently introduced) lenses. One is a trifocal-type lens — basically with three different facets to give me near, middle, and far-sight focus. A problem reported by (some? many?) wearers of the trifocals: at the “edges” where one facet transitions to the next, the lenses seem (especially at night) to create glittery halos of light.
The alternative is more like a so-called “progressive” eyeglass lens: a single convex smooth arc, finely tuned for the patient’s need. This lens — the brand name is “Vivity” — is shown at the left, in its pre-inserted state. (As I understand it, the two thin “arms” extending out to the side are flexible — springy — the tension of which holds the lens in place, nestled in its shallow pocket in the center of the eye’s surface.) I’ll be getting a Vivity lens on Monday.
As far as how the new lens is inserted, the doctor will use a tool actually called an injector. It behaves similarly to a hypodermic: the “payload” — the Vivity lens in this case — is placed into a small cylinder, and as something like a plunger at one end is depressed, the lens squeezes through a narrow opening at the other end, into the space at the front of the eye previously occupied by the old, cataracted lens. Those two skinny arms on either side of the lens don’t quite make a “sprong!” noise as the lens settles in, but the effect is more or less the same, and then it’s all over but the shouting… and, of course, the post-op.
Which brings us to…
The prescriptions
Aside from the new lens itself, multiple prescriptions are involved: three for the post-operative period itself, and one… well, let’s say that is a longer-term issue.
The ophthalmologist prescribed three types of post-op eyedrops:
- Prednisolone (brand name Inveltys, bottle with a pink or white cap): to be used 3x daily (breakfast, lunch, dinner)
- Ketorolac (Prolensa, gray cap): 1x daily (breakfast only)
- Ofloxacin (no brand name specified, tan cap): 4x daily (breakfast, lunch, dinner, bedtime)
During the times when I’m taking more than one of those, I’m to wait a few minutes between each kind of eyedrops before moving on to the next.
The drama here really has nothing to do with the prescriptions themselves, but with getting them filled at the pharmacy. Because at this point, naturally, the question of medical insurance rears its head.
I’ve got very good Medicare coverage, including a prescription supplement. This does not mean, however, that every drug — that is, every drug brandname — is covered equally by my insurance providers. Specifically:
- The ofloxacin: no problem. Covered, with a cost to me of around $10.
- The ketorolac/Prolensa: “covered,” but the insurance would at first cover only about 10% or so of the total cost. This would mean, out-of-pocket, about $350 of my own money. After I contacted the drugstore, they substituted a non-branded generic… at a cost to me of about $58.
- The prednisolone/Inveltys: boom! the insurance hammer came down. My insurance would not cover this at all. I had no idea what to do at first — I mean, evidently I did need the prescription, right? I still don’t know what the issue was, but once the ophthalmologist contacted the insurer, all was eventually well. It cost me $30-something out-of-pocket.
The longer-term prescription I’m referring to here is my existing eyeglass prescriptions. I have three of them, for both eyes: a pair of progressive-lensed glasses; a pair of reading glasses; and a pair of progressive-lensed sunglasses.
Here’s the potential issue: after Monday’s surgery, I am expected to need no glass(es) at all for my right eye. Continuing to use my existing glasses will therefore not work, for that eye… although it will for the left eye. So — this seems to be a recurring theme — I’ll have two choices.
The first is just to replace the right lens in each pair of glasses with a lens of plain, non-Rx glass. (Or, I guess, replace the eyeglass frames with a left-eye-only monocle. Unlikely, but possible.)
On the other hand, as it happens, I have a “smaller,” less advanced cataract in my left eye as well. So in a couple-three weeks, I can choose to have the lens of that eye replaced as well, with (yes) another Vivity lens…
I don’t know yet what I’ll do to resolve this all. The cataract in the left eye will almost certainly get worse over time. If I simply postpone surgery for it until it does become a problem, then who knows where I’ll be when I do get it done — and having it done by a different ophthalmologist, at a time when (who knows?) maybe I won’t still be able to get the same kind of Vivity lens… It’s all a bit of a crapshoot, innit?
And on yet another hand, damn, these things are expensive, even with good insurance…
Answer (haha) hazy. Try again later.
I’ll save the third type of drama — the “personal” type — for a later post, tomorrow or even after the surgery; this one is already long enough. Appreciate your patience with it all, though. I’m pretty sure I’m working out my own anxieties, not asking you to share them!
Shirley Gilmore says
Had this done 5 years ago when I went on Medicare. It was a pain for a few weeks afterwards with my glasses. I still needed them but at a much, much lower prescription. However my surgery was different because back in the early1990s, I had had radial keratotomy surgery on both eyes where they make slits in both eyes like spokes on a wheel. It was to correct near-sightedness. And then I repeated the surgery in 2002 with Lasik. So I had all that scarring from previous surgeries. So for the cataract removal and replacement, the doctor had to go between the scars which made it a little more tricky.
When I had the initial RK surgery, they made a video of it. I showed it to my High School geography class when we were studying trade areas as to why I would travel 200 miles to have it done (no one locally did it). When I was showing the video, as they made the first cut, one student said, “Oh, didn’t that hurt?” I explained that it was painless and they gave me a Valium. After one cut, he said, “Oh! That one had to hurt!” I probably traumatized him for life with that video.
John says
Hi Shirley — a pleasure to meet you, and thanks for stopping by… especially to comment on this post. That RK experience sounds a bit scarifying. And I have to say I thought your ploy of showing the video with that excuse was brilliant; exactly the sort of “freak out the kids but with education nominally in mind” thing I liked to spring on my own students when I was teaching!
The right eye is also having an astigmatism corrected, for which the laser will also be used, at the same time as the lens replacement. I haven’t sought out any videos or animations about that, though. I figure I’ve lost enough sleep already, ha.
Shirley Gilmore says
Oh, and I forgot, the doc had to make 2 stitches in one eye when he did the cataract surgery. Can you imagine a stitch in your eye? I was more worried about having him take out the stitches than I was about the initial surgery, but it turned out not to be bad at all.
Michael Simpson says
As you – especially – are aware, cutting/knives,/stabbing in any way causes me great angst. Somehow, I screwed up my nerve back in 2014 to make this happen for both eyes (roughly 6 weeks apart – a product of my Doc’s and my schedules). given that my vision was going rather rapidly…in both eyes. Not scary at all given that I make my living in a “vision-based” profession. I found some kind of Zen state to get it accomplished. The surprises to me were:
1. I was nearly the youngest patient, by decades, in the doctor’s office @ 57. I had my surgery years before our Mom, my mother in law, and big brother ;-).
2. My choices for the various variable focal distance options was limited due a scar I had not recollection of getting, in my cornea. The variable focus lens options could have potentially been stuck on focusing on that flaw in my cornea. So a single focus was required, as you are receiving.
3. The surgery was simple, short and I literally walked out of the operating room. Really reassuring for the next eye.
4. Seeing things in a “rose-colored” way for several days. An after effect explained to me as a reaction of my retina to the “green” laser that was used. I’ve never checked that out. It sounded a reasonable description to me.
5. Being told at my second follow up visit after the second eye surgery (weeks later) that it was likely that the cataracts would come back. I’m still not sure whether I was more shocked that the cataract condition could return in decades (the logic is reasonable – due to my age at the time of the surgery, and the genetic material that makes up the “lens sac” being very similar to the lens itself), or that it was such an “oh, by the way” by my doctor. Never mentioned before hand.
6. My reverse “donor” card that I received afterward.for each surgery. Something that identifies that I have “interocular” lenses in each of my eyes. I carry these next to my drivers license.
7. I got to look like a gray haired Roy Orbison for several days. However, I did not pick up his guitar skills.
Cynth says
Well, Brother, I certainly understand your worries. I think all our siblings have that gene that prevents us from accepting that perhaps things will NOT be as bad as we anticipate, but instead will be just as scary as we had expected. I will relate that when our own mom had this done, she walked out rather chipper and seemed to be fine. And since I was the one there who drove her home I know of whence I speak. But the anticipation is what just about kills us. Take heart…we’re with ya!
Tracie Hall says
I was SO averse to the idea of anyone playing around in my eye, especially with a KNIFE that I waited a year to do this with the right eye. It was extremely annoying however to be staring at the computer all day with just one eye. The cataracted right eye saw light and shapes but it was, as you may know if it’s gotten this far for you, like looking through a Vaseline or mist covered window. I was afraid to drive because if something went in my left eye, I’d see nothing. So when pandemic days were over and the college library insisted on my presence, I decided to bite the bullet. I too read up, but avoided videos or pictures. I was aware of all that could go wrong, but by this time any kind of sight was worth the risk.
So, as of September, I’ve been thrilled with being able to see again without glasses! (I use them though, for the left eye’s far-sighted vision issue). I poked the lens out of the right side until the optometrist visit. They insisted on a full exam even though I’d just had one at the ophthalmologist, before agreeing to redo a prescription for glasses.
I don’t want to make this too long, as I’m inclined to do–but want to mention I did the Pantonix lens. I suspect the doctor sells which ever lens he prefers to install. He gave no warnings, but I’d read about them. The only halos are at night around bright lights, but they are not distracting. Nothing as wicked as those halos you see with a cataract. Then, yeah, if you have “a little” cataract in the left eye, I’m betting it’s VERY little. No way was I going to let that doctor sell me on a second surgery based on favorite fear tactics.
Yes, prescription costs were hideous. I had three to take three times a day and one to take once a day. And it started before the surgery. One was 100.00 and the doctor’s office girl said I could have gotten the generic and avoided the cost. They just don’t think about those things at doctor’s offices. The others weren’t expensive.
The actual surgery is quick. You follow the light of the surgical tool with your eyes and that helps the doctor get to the part he needs to get to. At least with the Pantonix. I didn’t even hear about the one you are getting. No doubt my doctor wanted to reduce my options so I’d pick his favorite. It was the old fashioned one distance near or far choice or the amazing three distance. Of course I picked three distance–especially since at that point I hadn’t read about the halos. But I’m happy with the choice.
Best of luck tomorrow. I’ll be holding good thoughts for your speedy healing and satisfaction. (The eye heals in three months, but it’s good to go within about a day. Just don’t lean forward or do heavy lifting.)
Tracie Hall says
Oops. I lied. I checked my pharmacy records because I didn’t trust my memory. I too had three medications (not four): $60.00 Prolensa (3ml); $200.53 Durezol (5ml) and $5.00 Gatifloxacin (2.5ml.) But I think yours are different so I suppose this isn’t helpful.
What *might* be helpful is a caution to make sure you are not mixing up the three times a day one with the one time a day one. (My doctors office wanted to look at them and did not return them to their matching boxes.)
I also thought I’d mention that I too had an astigmatism in the same eye as the cataract and was told the material of the Panoptix (sorry, not Pantonix) lens was so firm that it would correct that.
I forgot to mention that while the doctor had said that the Panoptix lens would likely give me perfect vision at all three distances, it didn’t. My distance vision with that eye is not perfect. I can no longer recall what it was before the cataract developed, but my left eye has always had great distance vision, so glasses are optional. I don’t mind letting the left eye do the work, so am thrilled to replace the former progressive glasses with non-prescription sun glasses–something I was never in the habit of wearing because I never wanted to spend the dollars on a prescription.
Just had to make those minor adjustments to my previous post. Thanks for reading–I’ll move to your new post for the well wishes. :-)