Cataracts, Part 2

So, the first part of this two part series described my adventures in cataractland. This part will be much more opinionated, describing lessons learned. Note that this just me, non-MD talking, and my impressions and conclusions may be wrong.

Scheduling: It took the equivalent of one academic quarter to get through all the hoops. Most of this time I was fully functional, although it sometimes took an effort to do the work. My eyes felt tired, and often gritty. There’s drops for that. I could have taught school while this was going on, but there were times when it wouldn’t have been any fun.

Eye tuning: Cataract surgery essentially turns your infinite focus eyeball into a fixed focus opto-mechanical system. They can tune the focus of each eyeball, but when they’re done, you’re stuck. It’s an irrevocable decision. Squinting won’t help. In broadest terms, your choices are Near, Intermediate, and Far.  Near is good for reading all but the small print. Intermediate is good for getting around indoors, and Far is focused on infinity, so you can be the outdoorsman you always wanted to be.

Many people decide on Far for both eyes, or Near for both eyes. When they do that it means they will require glasses for reading (Far) or for driving (Near). Some people decide on Far for one eye, and Near for the other, so they can operate in any situation. I’m not particularly outdoorsy, so I decided on Intermediate for one, and Near for the other. Probably wrong, but I think my doctor did me a favor and fudged a little — he set the Intermediate range long enough that I could pass the WA state drivers exam without glasses. First time in my life.

Despite being “fixed focus”, you do have a range of focus in each eye, what is called depth of field. You can see this in a camera. Think of a group portrait. You focus on the person in the middle, but those in front and in back are still in focus. The trees behind them might not be. With a camera you can increase the depth of field by narrowing the f-stop. With your eyeball you can do the same thing by narrowing the pupil. You do that by working in a brighter light.

A key concept is, you see with your brain, not your eyes. The eyes are just sensors. Infants born with cataracts and who don’t have them removed until they become adults have had trouble seeing, because their brain doesn’t know how to interpret the input. They can’t tell that it’s the same dog when seen from the front or the side. They can’t deal with the sight of a moving car. It’s the brain that does the work.

So, one issue is, can your brain properly fuse two differently focused views and give the appropriate priority to the view that is most in focus? My speculation is that one might have the hardest time if the eyes were equally balanced, if there was no dominant eye. Or maybe if they were highly unbalanced, and one eye wanted to hog all the processing. I don’t know. It’s a key consideration, and one you will want to talk over with your doctor.

Personal Experience: I’m having to learn some new habits. I can’t just jump into bed, take off my glasses, and start to read with the book held up close. If I’m reading without glasses, the book has to be almost at arms length, and if the font is too small, then I have to wear reading glasses. A very bright LED reading light helps. On the other hand, my new standard glasses (bifocals) still require arms length reading, but render the smaller fonts readable, so I jump into bed and don’t take my glasses off.

On the other hand, I pretty much have to wear a separate pair of computer glasses. Yes, I can work the computer with no glasses, and yes, I can work it with my standard glasses, but either one of those is a pain, because they require I position my head closer than my posture likes.

On a day to day basis, I still do a Harry Potter-style fumble for my glasses every morning, but it’s not as important as it once was. When I’m reading things, or looking at the PC with my standard glasses, I can feel my eyes hunting for the right balance. One kindof down side is that my eyesight is good enough to do everything that I want, just not as well as when I was younger. So I have a tendency to wander off without my standard glasses, and miss them when I go outside. Or (and this happens often) wander off from the PC with my PC glasses on and find myself operating at 80% efficiency. Unlike the old days (last May), it’s not obvious when I get out of bed or stand up from the computer that I need to swap glasses. New habits. Hang my standard glasses around my neck like I was a librarian. Hang the PC glasses on a cup hook on my monitor so it’s obvious when they are or are not on my face, and so forth.

On the plus side, I can see more clearly than I have for years. Colors have more pop. I thought our kitchen appliances were a yellowish off-dinge color. They’re white. When I go out on the back deck on a clear dark night (admittedly hard to find around Spokane at the end of summer) I can see (or at least detect) the Milky Way. Astronomy is going to be fun again.

I should’a done this two years ago.


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