So yesterday I went in for a routine eye exam — only to have my new Ophthalmologist, Dr. R, tell me I have cataracts.
In particular, Posterior Subcapsular Cataracts.
This is not the usual sort of cataract anyone who lives to a ripe enough old age is likely to get; this is a cataract on the back
of the lens, which tends to develop rather more rapidly than the usual sort and is commonly associated with steroid use, extreme farsightedness, chronic iritis
and diabetes. (Of which the first three pertain to me. Though at this point I'm rather a lot more interested in what to do about it than in why it happened.)
(I should mention here that I have amblyopia
. It was diagnosed when I was 8; they tried patching my good eye, but by then the window of opportunity for that neurological development was closed. I'm not clear on the physiological details of amblyopia (and indeed, I'm not sure ophthalmology as a profession is), but what I know of eye anatomy and what I see from that eye are consistent with the idea that the fovea in that eye never developed. At any rate, while I have normal peripheral vision in my bad eye, for all practical purposes — driving, bicycling, reading, watching TV or movies — I only have one eye. That weighs heavily on any decisions I make about eye care: It is, for instance, why I have never seriously considered laser vision correction: the risk of a bad outcome is less than 1/1000 — but for me, the benefit comes nowhere near outweighing the potential risk. It is also why well over half the Emergency Room visits I've made in my life have been for something wrong with my eye: If I fall and my leg hurts so much I can't put any weight on it, I may decide that will wait til my Doctor's office hours; if my good eye hurts or is secreting something or I got something in it that artificial tears won't wash out, it's off to the MEEI
ER right now
This is also why I likely to be speaking in the singular below: I'm not strictly certain that Dr. R even mentioned
a cataract on my bad eye, and I really couldn't care less.)
One of the main symptoms Posterior Subcapsular Cataract is glare: the cataract essentially causes light to bounce around inside the lens of your eye. I've been increasingly annoyed by oncoming headlights in recent years, which I had mostly been attributing to the advent of projector beams and other types of headlights that are brighter than what I grew up with; there have been a couple of times recently when I was so blinded by oncoming headlights that the only thing I could think to do was pull to the curb and stop. In the conversation with Dr. R yesterday, it became clear that those externalities have a lot less to do with it than I thought. I've also been less tolerant of glare on computer screens lately.Cataract surgery
is the most commonly performed type of surgery in the US, with a very high success rate. Currently, my cataract is still small, and it does not yet get in the way of light passing through my lens to my fovea. That means I have time to do some research, but not necessarily much — because when it gets there, my ability to perform my normal day-to-day tasks will be impaired.
Googling around today, I've determined that there are a lot of options: The state of the art procedure, Phacoemulsification
, involves making a small incision in the eye, using ultrasound to break up the cataract and lens, vacuuming them out, and inserting a plastic replacement lens. There is a variety of equipment for performing the procedure, and a variety of lenses available. This is the procedure Dr R performs, using some of the most recent equipment available. But he only operates one day a week, and I don't even need to do any research to know that this is one of those procedures where my best odds of a good outcome lie in finding a surgeon who does them all the time
. But since I'm not in a hurry, I think my best strategy would to first consult with an expert (in a perfect world, I'm imagining the cataract version of Claes Dohlman
, the world-class cornea expert who treated me at MEEI in 2003) who's vendor-neutral and has a good overview of the state of the art. In order to find that person, I'm hoping some of you know a good Ophthalmologist you'd recommend I talk to. (Yes, I do plan on asking the Dr. R — but he's new in town and didn't go to medical school here, so I'm not sure how plugged-in he is.)
[Edit, 2010-01-05 20:30: Perhaps I should make it clear that I am not especially worried about this. Yes, I want to research the problem, and yes I want to do everything I can to improve my odds. But as I explain in a reply to an early comment, if I did nothing further, took Dr. R's advice, and signed up to have him perform the surgury next week, my chances of a bad outcome would be the same order of magnitude as those of my dying in a car crash this year. I am merely intending to research the problem and to do the most productive of those nerdy things I can to improve those odds — just as I wear my seatbelt, drive with my lights on, back into and pull forward out of driveways, scan the road and my mirrors, stay off the roads around bar-cloisng time, and do dozens of other things to improve my odds behind the wheel.]