By Christopher Lane
Eyesight is a precious gift for anyone, but particularly for a photographer. Photography is a visual art and it’s pretty terrifying to imagine your self plunged into darkness. Never being able to make another image or look at another photograph, your passion taken away. I suppose I could imagine a blind photographer shooting with the aid of a sighted assistant, but to what end? How joyless a pursuit that would be? Never being able to see the fruits of your labor, whether good or bad.
I have had mild vision problems since my early teens and I have worn glasses for most of my adult life. Recently, however, I noticed that my last pair—only a year old—seemed be out of whack. Even wearing them, I could not get clear vision with my right eye. I concluded that the lens must have been made wrong. I set the glasses aside until my annual eye exam.
When that day rolled around, a couple of weeks ago, I immediately expressed my concern to the optometrist. He sent the glasses out to be checked while he performed the exam. After going through the usual routine and looking at my eyes while dilated, he concluded that the prescription was correct and that I had cataracts in both eyes, the right one being the worst.
A cataract is the clouding of the eye's natural lens. This lens, much like a camera lens, lies behind the iris and the pupil and focuses light onto the retina at the back of the eye. Like a camera lens, it also adjusts the eye's focus. Composed of a precise arrangement of water and protein, a normal lens is crystalline and lets light pass through it. As you age, however, the protein tends to clump together which clouds a small area of the lens and left untreated it will keep growing larger, ultimately resulting in blindness. The solution is a surgical procedure where millimeter incisions are made on each side of the cornea and the lens is removed by an ultrasonic probe. The natural lens is then replaced by a tiny, lightweight, plastic lens known as an intraocular lens.
According to the optometrist, cataract surgery is very successful in restoring vision and only takes about eight minutes to perform. It is the most frequent surgery in the United States, with more than three million patients undergoing it each year. Nine out of 10 people regain normal vision between 20/20 and 20/40. As a bonus, I would not need glasses for distance vision any more.
Now, the mere thought of anyone messing around with my eyes is extremely distasteful. For that reason I have never even considered the Lasik procedure. But this is another matter entirely. Lasik surgery is elective: you can just keep wearing your glasses if you want. Here, I was faced with an unenviable choice. Either submit to the surgery or slowly go blind. Since I love photography—and seeing—I made my decision quickly, but not without a certain sick feeling in the pit of my stomach. I will consult with a cataract surgeon later this month and most likely schedule my right eye first. I’m concerned, but not scared. There are always risks with every surgical procedure, but I think the odds are very much in my favor.
In Part II, later this month, I’ll let you know how it all works out.
ChrisChristopher Lane writes about photography and digital imaging at Written by the Light.
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Original contents copyright 2010 by Michael C. Johnston and/or the bylined author. All Rights Reserved.
Featured Comment by MartSharm: "Christopher, As an optometrist, I deal with referral and management of cataract patients all the time. I consider the onset of cataract to be a normal consequence of aging and nothing unusual. Of course some patients can feel a little apprehensive regarding the surgery, but it really is very quick and painless; patients often wonder what they were worried about when they see me afterwards.
"Something you may wish to discuss with your ophthalmologist: your residual refraction (what your spectacle prescription will be afterwards). You've already hinted at this with your statement that you won't need to use distance spectacles afterwards. Most patients aren't too fussy, but as you're clearly thinking this through, it may be worth deciding what sort of vision you would like to have afterwards (the surgeon can choose what optical power of implanted lens to use; calculations using pre-operative ultrasonic biometry can predict what the final spectacle prescription will be).
"If you're currently hyperopic (far-sighted), you'll be using glasses for both distance and reading, and plano (zero residual prescription) will be a useful result. If you are currently myopic (near-sighted), you will be able to see at near without specs on; if you are corrected to plano you will lose this ability and will need reading glasses. High astigmatism is a bit more hit and miss. Some myopes prefer to be left a moderate amount myopic post-treatment (something like –1.00), so they don't have to reach for their reading specs every time to see up close. That –1.00 should enable you to see what you're doing at arm's length, and will be easy to compensate for in the viewfinder, at the expense of needing specs for detailed distance vision tasks such as driving. Just a little something to think about."
Featured Comment by Bill McFadden: "I have looked at cataracts from both sides now (with apologies to Joni Mitchell) so feel qualified to comment. I practiced Ophthalmology for 35 years and have done some several thousand cataract operations. Eighteen months ago I realized that I had to have the surgery myself, and have since had it done.
"Do not apologize for being scared. I can think of few things more frightening than having my eyes operated on—and I considered it a heavy responsibility when someone entrusted his/her eyes to me. Do not believe anyone who says or implies that there's 'nothing to it.' It is a delicate procedure on an extremely delicate organ and, as any surgery does, carries a risk (small nowadays but a risk nonetheless).
"That said. surgery today is marvelous—very easy from the patient's side, even compared to what it was 15 years ago. Results are wonderful. As 'MartSharm' commented, I chose to remain a bit nearsighted—computers and books and photographs are nice to enjoy without reaching for glasses. Find a good surgeon and go for it.
"Okay, I have also been enjoying photography since even before I began working on eyes. Yes, the commonest type of cataract is a yellow-brown filter and the restoration of color vision is great fun—before I had my second eye done I went to Photoshop and in one picture duplicated the color as seen by an eye with a cataract vs. one with a new lens. What surprised me most was that most all of my prints in the last year before surgery were terribly oversharpened. I had to go back and redo the ones that were worth it!"
Featured Comment by Patrick Snook: "Uncanny coincidence.
"I just got home from the optometrist, and with my eyes still dilated and enjoying the relief offered by the shady interior light, I woke my MacBook and read this TOP post about optometry.
"During my visit, I reported to my optometrist a recent (6-month) mild symptom, a blurriness that sometimes occurs in my right eye only, and then disappears. It was quickly diagnosed. Nothing to worry about, but I received a salutary lesson in the structure and likely degradation of the eye, and a reminder of the extremely high value and use of eyesight.
"The main lesson came after the office visit. Nothing like having eyes stuck at ƒ/1.0, and stepping out on to white concrete in the city in full sun (ƒ/16), having forgotten to bring along the ND filters (a pair of sunglasses). Shutter speed is not adjustable (eyes must remain open), and there is no adjusting the aperture (or toggling the ISO) to compensate. It is an extremely uncomfortable experience, slightly nauseating, disorienting and even physically threatening (not the most comfortable part of Philadelphia in which to find oneself blinking and staggering).
"Well, good luck with the cataract surgery—although it sounds like there's a lot of reason to take courage and have confidence in the outcome, regardless of 'luck.'"
Featured Comment by R. Edelman: "I, too, am an ophthalmologist. I do a small variety of surgical procedures, but the most common one that I do is cataract surgery. I started my residency in 1979, so I've been doing this for more than 30 years (hard for me to believe). I trained during an exciting time of transition, when some surgeons were using magnification loupes, and more progressive surgeons (such as my chief, Guy H. Chan, M.D.) were using operating microscopes. There were different methods of removing the cataract, from freezing the cataract with an ice probe and pulling it out through a large incision (hopefully in one piece), to small-incision surgery using an ultrasonic-driven probe. Over the years I have seen the procedure go from an inpatient to an outpatient procedure. Thanks to intraocular lens implants, people no longer have to wear thick glasses or contact lenses to see following the surgery. (I suspect that Ansel Adams had cataract surgery without intraocular lens implants as he wore spectacles with significant magnification in the lenses in his later years.)
"One of the heros of cataract surgery was Sir Harold Ridley, the British ophthalmologist who invented the intraocular lens implant. During the Second World War, Dr. Ridley treated RAF aviators who had fragments of the clear plastic from shattered aircraft canopies lodged in their eyes. He observed that the material, Perspex, was well tolerated by the eye. After the war, he began to work on the first generation intraocular lens, which was made from Perspex. Dr. Ridley also did important research into onchocerciasis, known as river blindness.
"Another hero was Dr. Charles Kelman, an American ophthalmologist who developed the phacoemulsifier, the ultrasound-driven probe that allows cataracts to be removed from small incisions. Kelman got his idea to use ultrasound when he was at the dentist, who used an ultrasound device made by Cavitron to clean teeth. Kelman collaborated with Anton Banko, a Slovenian-born engineer who had immigrated to the US and who worked at Cavitron, to develop the first phacoemulsifier. To this day, the procedure is often referred to by the acronym "KPE", which stands for "Kelman Phacoemulsification". Dr. Kelman also developed intraocular lens implants of his own designs.
"Although intraocular lenses were being implanted in relatively small but growing numbers from the 1950s through the 1970s, in 1980, Ralph Nader and Dr. Sydney Wolfe, of the consumer organization Public Citizen, tried to have intraocular lenses effectively banned in the U.S. by having them classified by the Food and Drug Administration as being experimental. They were almost successful. It was only after the actor, Robert Young (aka Dr. Marcus Welby), testified about his own vision (and career) being saved by intraocular lenses that Congress made sure that these lenses would be made available to the public.
"Today, the holy grail of cataract surgery is being able to restore the full range of vision, from distance, to intermediate, to near, without being dependent on glasses or contact lenses. There are many options for intraocular lens implants which you should ask your surgeon about. Research these carefully, as there are potential pitfalls with any of the new lenses.
"Patients today do not need to be burdened by astigmatism, as this can many times be corrected with adjunct incisions in the cornea, or astigmatic-correcting intraocular lenses (called toric lenses). Many of the lenses also correct for spherical aberration, so ask about these as well.
"By the way, although we began measuring the axial length of the eye using ultrasound, the more accurate way, due to its shorter wavelength, is by using laser technology. We reserve the ultrasound these days to measure eyes which have cataracts that are too dense to allow the laser light to penetrate. This is also a good reason not to let the cataract get too advanced before deciding upon surgery.
"Cataract surgery is very gratifying to do, as most of the patients experience improvement and do not experience pain. However, I never trivialize the surgery. (The definition of minor surgery is surgery that is done on someone else.) When things go bad, they can go very bad. It is delicate microsurgery, and although an experienced and skilled surgeon can make the procedure look easy, it isn't as easy as it looks. And some of the patients are having their only good eye operated upon. I have seen videos of cataract surgery done in less than 10 minutes, but I don't consider the surgery to be a horse race. Most of the time the procedure takes 30 minutes, plus or minus 10, and that doesn't include the setup and breakdown time. In most situations, the patient will be in the operating room for up to one hour. In the U.S., the fee which the surgeon receives is not limited to just the surgery itself, but also includes all routine post-operative care for 90 days following the surgery.
"As far as cost, there are places in the world which offer relatively inexpensive cataract surgery. Some of the surgeons in those countries have been very resourceful in their quest to keep costs down. Of course, those countries also have a lower standard of living, and sometimes the ancillary personnel and facilities do not have the qualifications that are required in the U.S. By the way, the actual amount of money (in other words, not adjusted for inflation) that Medicare reimburses the surgeon in 2010 is less than what was paid in the 1980s.
"So, good luck! Keep in mind that the odds are in your favor. If you had those odds in Las Vegas, you would be rich!"