Cloudy With a Chance of Northern Lights
Brightening the World
It’s been hard to write about normal life since October 7. Anything other than the wars in Gaza and Ukraine and the terrorist massacre in Israel seems trivial. A bit like relaxing on a beach with a novel while a swimmer is drowning in front of you.
Yet mundane life goes on. And after months of following disaster news, and wishing I weren’t so helpless to change the world, I need to lighten up a bit.
And lightening and brightening the world is exactly what my eye doctor is telling me he’ll do. This is not what I expected. I’ve gone to see him only because my vision has become a bit fuzzy in one eye. I’m sure I just need a change in my glasses prescription.
The ophthalmologist peers through his magical lenses.
“You have cataracts,” he pronounces. I’m taken aback.
“Are you sure? I didn’t at my last examination.”
“Well, you do now,” he says.
How can this be? Of course I trust him, but…
So I look him in the eye.
“Maybe you need glasses!” I say, joking.
Now, I thought telling an eye doctor that he needs glasses was funny. But his smile is forced.
“I recommend surgery in both eyes,” he says. “You’ll see better after they’re operated on.”
Photo: Bombybamby
The Assembly Line
There’s a hum of efficiency in the cataract surgery assembly line as six or eight of us patients are processed through. We answer the questions of the registration clerks, sign consent forms, hand in our credit cards. An intake nurse asks more questions—re-checking our names, birthdates, which eye is being operated on, then sends us to another nurse who asks the same questions. There will be no embarrassing mistakes in this surgery centre. Nurse #2 cheerfully puts in several kinds of drops in our eyes, and sends us to yet another nurse who puts in our IV lines. “Would you like a mild sedative in your IV?” asks nurse #3. “No, thanks.”
The anesthetist, an older man in scrubs, approaches holding a clipboard. He sits on a stool beside me, barely glancing at my face. On his clipboard is the health questionnaire I’ve filled out. Without looking up, he reviews my answers. I marvel how he avoids eye contact. As a doctor-patient, I know it’s because taking his eyes off his paperwork—going beyond the standard questions, and actually engaging with the patient—would slow him down.
How distant from the values family medicine aims for. To me, the subspecialists running this assembly line have strangely narrowed practices. They would flunk a residency in family medicine where they would have to deal with the whole person. I hope they don’t work exclusively here, in this setting of repeated routine. Here they appear merely like expert technicians.
Yet I am enormously grateful for their specific expertise. My surgery is laser-assisted, preceded by lying flat on a table under a laser mounted overhead. I’m told to to lie motionless, and look directly at the intense beam. For a moment I try to remember the physics of lasers, the stimulated emission of photons from excited atoms, but I quickly give up—I’m too worried about possibly coughing, and it’s crucial to lie perfectly still.
The ophthalmologist is simultaneously chattering to me and directing the technicians. His energy matches this high-energy beam: “Great, perfect alignment, wow! Stare straight ahead, right at the light, don’t move, wonderful, look right at the light, just 60 seconds more, fantastic.”
The laser is painlessly burning perfect incisions in my eye, then breaking up my cataract. I see bright, beautiful colours in swimming shapes. A dazzling Aurora Borealis.
The rest is anticlimax. I get off the laser table, walk to the next room, lie down on the OR table. The eye doctor resumes his patter, rapid and reassuring: “You’re doing great, everything’s going perfectly, fantastic.” I see more changing colours. No pain.
After the operation a nurse offers me some juice and biscuits: next to the Northern Lights, the highlight.
Back home, the operated eye feels sandy and gritty, and for a few days it’s like looking through vaseline. But it’s soon healed, and two weeks later I return to have the same operation on the other side. The new anesthetist is warm and friendly; she looks me in the eye.
Mind and body
In medical school, I saw patients after cataract surgery lying in hospital beds with patches covering both eyes, and sandbags pressed against each side of the head so they couldn't move. In those days it was crucial to immobilize the head so as not to disturb the eyes’ healing. People lay in bed, noggins inert between the sandbags, unseeing, for five days.
Some of them ended up with mental delusions and hallucinations. They were temporary psychoses, caused by horrendous sensory deprivation.
Medical marvels
There have been revolutionary changes since then. In a previous post, Medical Flip-flops: Is It "Flip" to Call Them Flops? I wrote about shakeups in medicine. Later, in Leeches, Lobotomies, and Learning the Hard Way I ventured into some real medical flops. But in eye surgery, the historical flip-flop was fabulous. The invention of intraocular lens (IOL) implants allowed the eye’s cloudy, natural lens to be replaced by an artificial one, greatly improving vision.
“Coke-bottle” glasses. Photo: rubylane.com
Before about 1979, when IOLs were introduced to make up for the removal of the eye’s own lens, patients needed chunky glasses. My grandmother was given glasses so thick that they looked like the bottom of classic, old-fashioned Coke bottles.
Cataract removal is also much easier today. It’s a 15-minute, in-and-out, day surgery with no stitches. Those awful five days of lying motionless between sandbags, unseeing, and sometimes hallucinating, are no more. Technology has come a long, long way.
(You may be thinking that bedside manner and the “human touch” haven’t quite kept up with the technology, and you’re right, but that’s a topic for another day.)
The surgery is also being done at younger ages. I didn’t have to wait until my lenses clouded up to the point that my vision was dim. Even so, the changes in my vision are remarkable.
I no longer need glasses, and I marvel at the clarity that unfolds before me. It’s like upgrading from standard definition to an eye-popping 4K screen, in three dimensions. Colours are more vibrant, details sharper.
Not that there aren’t complications. As with any kind of treatment, there’s a balance to consider: benefits versus potential harms. I’m left with a minor side effect called dysphotopsia, a bright streaking that emanates from lights. It can be easily treated with a laser. But the treatment for the side effect has its own possible side effect: it might leave me with visual “floaters”, for which there’s no cure. So I’ll just leave things be.
I am currently in the mountains of central Mexico, in Guanajuato, a UNESCO World Heritage site, university and cultural centre. In this colonial gem, built along the sides of canyons, pink and fuchsia bougainvillea spread luxuriously over old, deeply textured stone walls. Houses are painted in shades of blue, green, yellow, and pink. My now-sharpened eyes are taking in stunning vistas of sun-soaked colour.
I have been returning to this magical place for years, but those colours now pop out like never before.
Outside the lovingly preserved city centre, though, my eyes take in an uglier landscape. Strewn over the hillsides is a world of litter. I walk along roads lined with plastic bottles and candy wrappers glinting under the intense sun. There are cans, glass, scattered plastic containers of every description, discarded construction debris. Vivid images of crystal-clear trash vie with the vistas for my attention.
Treatments that wondrously cure us can also have side effects; in the marvels of modern medical magic, even clear vision has pros and cons.
The ophthalmologist who performed my cataract surgery some years ago was a friendly guy who always looked me in the eye. So I didn't hesitate to ask him questions as he went about his task. What are you doing now? Wow, what are those colours? Finally, he paused for a moment and said, "I find I can either chat or work. Right now I'm working." The surgery itself was a miracle. The very next morning I noticed things I hadn't noticed for a very long time, and some I'd never seen before. Like the wrinkles in the face that greeted me in the mirror!
As usual a great piece, to be shared with future cataract patients