OD News Articles

27th June 2011

My Cataract Experience – Notes from a baby boomer eye doc

by Cindy Murrill, OD, MPH Tacoma, Washington

I’ve had cataracts for 5 years and recently noticed worsening contrast acuity—especially in dim light. Night driving was getting harder. I could see darkly dressed pedestrians but there was a slight hesitation that was worrisome. Feeling less comfortable driving in rain, especially at night, tipped me to have surgery.

My acuity was still around 20/20, but glare acuity was 20/60 in my right eye and 20/400 in the left. We all regularly discuss cataract-related blur and glare, but loss of contrast is not mentioned in our patient education material. I hadn’t asked patients about it either. However, I now regularly bring it up as one of the earliest symptoms of cataracts.

Pre-op Decisions

My left eye measured more loss of glare acuity so, once I decided to have surgery, I had it done first. But I had some choices to make:

  • What refractive error outcome did I want? 
  • Which lens type should I select—single focus, toric or multifocal?

Quite honestly, I’m a chicken and didn’t want to do anything that would risk needing additional surgery. I didn’t have much astigmatism so I ruled out toric lenses. I’m also a type A personality and didn’t want to risk inability to adapt to multifocals and associated halos—which might make me want them replaced. I desired the least chance of needing additional intervention.

I was a 4 diopter myope and loved my nearsightedness! I wished to remain nearsighted but have more range of vision. So, after simulating refractive error outcomes with many trial SCL combinations (the night before surgery), I aimed for -.75 on my dominant right eye and -1.75 on my left. To minimize the risk of asthenopia, I didn’t want more than a diopter difference between the 2 eyes. After all the measurements were obtained, I picked my own lens implant powers. As a type A, I had to do that myself.

The last decision was whether to take the sedative we normally offer patients before surgery. PCLI doesn’t use IV sedation but patients are always offered sublingual Versed. At first I thought I should go without, simply for the experience. But my staff was saying, “No, take the Versed!” Dr. Brian Carey, my colleague and surgeon, told the nurse out of the corner of his mouth, “Give her Versed!” I’ve always been very unpushy with patients about Versed. Now, I’m much more encouraging! Within 5 minutes it took the edge off.
I don’t remember signing the surgery consent. That’s one of the reasons we have patients review the video and printed material at home beforehand.

Surgery Experience

Our pre-op staff was so good, nice, and compassionate. As I waited to be the next patient, I listened to them interacting with others and was very proud. I don’t recall much of the details of surgery except talking to the surgeon. I probably wasn’t the best patient. The staff teased me about being in trouble because of the things I did. Afterwards, my surgeon gave me a ride home—what service!

Taking Off the Tape

Patients’ eyelids are taped shut after surgery until the anesthesia wears off. When I removed the tape, I was surprised by how strange my vision was. I had double, slanted and blurry vision that was very weird. I saw lots of strange things including areas of light and dark and images of blood vessels—things that had nothing to do with the Versed. Because of this, I now emphasize to patients that they remove the tape while seated and take it easy the first night.

Second Eye Surgery

We typically encourage patients to have their second surgery 1, 2 or even 4 weeks later—whatever feels right for them. But the morning after my first surgery, I was anxious to have my other eye done. Dr. Bill Gruzensky was the surgeon that day and was happy to work me in before his first scheduled case. This time no one had to argue with me about Versed. When the procedure was over, my husband Joe, also an optometrist, took me home. After 2 surgeries in 24 hours, I was exhausted.

Temporary Glasses

Even though we tell patients that they should wait about 4 weeks to get their spectacle lenses replaced, Joe took one of my old frames to work the afternoon of my second surgery and had his lab staff make a -.50 correction for one eye and a -1.50 for the other. I had a meeting in our Chehalis office the next day and was wondering if I’d see well enough to make the 1-hour drive. The next morning, I put on my new temporary glasses and drove to the meeting without a problem.

A few weeks later, Joe refracted me and I was right on target. The temporary prescription he made worked well and was within a quarter diopter of where I’ve ended up. Now I keep that pair of glasses in my car for driving and have a pair of progressives at work. I never wear glasses at home anymore. This process has made me understand how temporary prescriptions benefit active people.

Change is Disorientating

I never thought to prepare patients for how disorienting it is changing from a -4.00 myope to spectacles as optional. I’m now legal to drive with no correction and can see everything in my exam rooms and on my computer without glasses. Even though I am convinced I made the very best refractive error outcome choice for me, this dramatic shift is like an identity change and requires adjustment. I’m still trying to adapt to my new near-working distance and the urge to push up my glasses.

Dysphotopsias

Also, I have changed how I explain the reflections patients may notice after surgery in dark conditions. I always imagined them as dark or bright rings off to the periphery, but it’s more variable and depends on the situation. I sometimes see bright rings when neon lights are off to one side. I sometimes notice a lacy see-through star or dazzle off to the side when in my exam room with one light on. Dysphotopsia appears more like a reflection than the glare, arc or crescent I used to imagine. It hasn’t bothered me much but it’s definitely different than what I used to describe. With time, it has become less noticeable—which is what we tell patients to expect.

Eye Drops

We instruct people to use their drops, but for me it was difficult to do 4 times a day. It was hard to remember because things were going so well. I’m sure I was as non-compliant as any patient I’ve ever had.

My New Vision

I’m very happy with my vision. Immediately after surgery, whites seemed to glisten. I was surprised by the brightness in colors. Even though my cataracts were mild, it’s like someone has turned the lights on outside at night. My vision is better than it has ever been. When I wake up in the morning, I can look out the window and see what’s going on and I definitely feel safer driving at night. Nevertheless, there are risks, adjustments and adaptations related to the process, as well as a bit of mental stress. My experience has reinforced what we tell patients every day—that we should choose this endeavor when symptoms impact activities of daily life.

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