[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!