Anyone know a good Ophthalmologic Surgeon?

[xela]

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.)

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[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.]

Comments

[siderea]

At this point, maybe we should all just chip in to buy you a new body.

[yakshaver.livejournal.com]

Thing is, I really am in overall good health. Ok, s/good/fair. But most of my problems are subject to improvement with exercise (and are consequently a lot better now than they were five years ago); of the ones that aren't, most are repairable with further cyborgization, most of which is readily available today (though I'm holding off on most of those til I really need them, on the theory that the tech will be even better then). I can realistically expect to be in better shape at 55 (he says, picking a nice safe distance) than I was at 35.

[sammason.livejournal.com]

Clearly I'm not geographically close enough to help with a recommendation, but I'm so sorry to read that you have a cataract. I guess that it's very frightening and annoying. Fingers crossed that you can find the surgeon you want.

I hope it's helpful, not flip, to remark that you have a treatable condition and that the treatment has a very high success rate. You've survived illness that was life-threatening, and this isn't. I'm rooting for you.

[yakshaver.livejournal.com]

Thanks, Sam. It's not that frightening, actually. It's a lot more tractable than cancer or a stroke, and it even has an upside: I will in all likelihood see far better with my new cyborg eye than I ever did with the old one.

And for all that I will do everything I can to improve the odds, even with an average surgeon, the odds of my coming out of the surgery worse off than if I just let nature take its course are less than 1/1000. That's the same order of magnitude as my odds of being killed in a traffic accident in any given year: There are roughly 3 deaths per 10⁸ passenger miles in the US; if I go 20,000 miles in a year that's 3 × 2 × 10⁴ / 10⁸ = 6 / 10⁴. I always wear my seatbelt, and I'm a careful driver. But I'm not especially frightened of dying in a car crash. And neither am I especially frightened that I'm going to lose my sight.

[sammason.livejournal.com]

The joy of being good at maths! It sounds as though you can actually take comfort from the odds, where other people might be thinking 'oh but what if I'm that 1 in <1000? what if the sky falls on my head?'

[yakshaver.livejournal.com]

It's not that I don't worry what if the sky falls on my head? It's that recognizing that the odds of it falling on my head are roughly the same as those of something I do routinely helps me contain the worry.

Not that that always helps as much as it ought to: Much as I understand the math*, I am never at ease when someone I love is flying until I know they're safely on the ground again. (though, mind you, I am not myself afraid of flying. GO figure.)

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* Yet another aspect of how we are separated by a common tongue. By the way, when Brits refer to mathematics as maths, do you treat it as a plural noun?

[sammason.livejournal.com]

Now you mention it, I'm the same about flying! I rather like it myself (take-off feels a bit like getting drunk; those little trays of food are entertaining; my inner child simply wants to go on the big aeroplane) but it's a little scary when somebody I love is up there.

We use 'maths' as a singular mass noun. As you do with 'math', I think. Since both are short for 'mathematics' I wonder what you say when you want to use the long word.

I only learned the term 'singular mass noun' a few years ago, when I started to get criticised by senior academics for using 'data' as such a noun. This is a matter of opinion and I'm not budging on it! I don't find it more 'correct' to say 'these data', I find it pretentious and old-fashioned, the kind of thing that brings scientists into disrepute! Ok I'll stop ranting now... being English, what I need now is a nice cup of tea.

[eccentrific.livejournal.com]

I cannot say anything helpful, but I wish you luck.

[yakshaver.livejournal.com]

Thanks!

[nakor.livejournal.com]

Welcome to the club! I've lived with a non-growing cataract for over 31 years. May yours bother you no more than mine does me.

[yakshaver.livejournal.com]

Unfortunately, mine are growing. Two years ago, for my last routine exam, I saw Dr R's senior partner: an elderly gent, highly respected by other doctors (both my current and my previous primary care doctor go to him for their eye care) — but with the bedside manner of a salmon fresh from the docks (which is why I didn't want to see him again). Turns out that he noted my cataracts then, and described them in my chart — but didn't bother mentioning them to me. They've grown significantly in that time.

Also, the most recent incident of being blinded by oncoming headlights could have been far worse. The glare was exacerbated by fog and fairly heavily falling snow, but the road had recently been ploughed and, since I'm in the habit of keeping track of my escape routes should someone try to share the road with me too intimately, I knew (1) where the shoulder was and (2) that it unoccupied and safe for me to head for it, even though I couldn't see it. Had there been anyone on the shoulder, I'd have had to brake and try to stay in my lane without being able to see where I was going for a good 6 sec (and probably been rear-ended by the guy who'd just come in behind me at the last intersection and was already tailgating. I've done some experiments since Monday, and wearing flip-up sunglasses when driving at night helps a lot. But even if the cataracts were to stop growing, I wouldn't consider that an acceptable long-term solution.

[gigglefest.livejournal.com]

Turns out that he noted my cataracts then, and described them in my chart — but didn't bother mentioning them to me. They've grown significantly in that time.

Oh, that's awful and frustrating.

I also have only one good eye. I remember doing the eyepatch thing (from age 4-8, maybe?) and it may have done *some* good, but I don't really know. I've clearly learned how to compensate for any depth perception issues, say, on my bike, but one of the first times I drove at night (years ago -- I have a license but haven't driven in forever, and should take lessons again) it was terrifying.

[yakshaver.livejournal.com]

> Oh, that's awful and frustrating.

Yes. Yes, it is.

I am by instinct not litigious. And with regard to doctors and malpractice, I have a lot of sympathy: Computers are vastly more predictable than biological systems, and lord knows that I, a pretty smart guy, have made plenty of mistakes troubleshooting computer systems. So I don't really think it's reasonable to expect perfection from doctors.

But there is one case in the past where I regret not having sued,* which tempers my sympathy. And in this case, I'm really very angry. Logistically, there's probably no point in suing: it would come down to my saying he didn't tell me vs. him saying he did. But the more I think about this, the more I think I should at least talk to a lawyer.

> I have a license but haven't driven in forever, and should take lessons again

I'd be glad to help you out there. I used to drive for a living, and like to think I'm a pretty good teacher.

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* When I was getting chemo, I maxed out on the antinausea drug I was being given; the resident on shift ordered a different drug — and I went into anaphylactic shock. That's not what I should have sued over, though: This event does not appear in my chart. I should have sued as soon as I discovered this: the resident clearly left it out to cover his ass, and by doing so, has complicated my life every time in the last fifteen years I've been asked if I'm allergic to any drugs. To say nothing of the allergy testing I may need to go through if I ever have cancer again.)

[gigglefest.livejournal.com]

I'd be glad to help you out there. I used to drive for a living, and like to think I'm a pretty good teacher.

Wow, I will plan to take you up on this. Thank you!

[jered]

The good news is that we're finally at the point where your lens replacement can be an upgrade! There's some pretty wacky stuff with fresnel lenses that can give you inhuman depth of field.

[yakshaver.livejournal.com]

I hadn't run across those, but there are clearly a lot of options.

Dr R told me I would no longer need distance vision correction but would still need glasses for reading. One of the first things I learned after I got home and hit Google is that 't'ain't necessarily so — hence my desire to talk to a neutral expert. (Shortly before I cancelled my cable, I happened to catch a Charlie Rose interview with Jerome Groopman about his (then new) book, How Doctors Think. My own experience had already made me aware that doctor's advice can be skewed by their available tools; the interview (I really should read the book) left me convinced that any time a doctor recommends a procedure, I want a second opinion. It took less than five minutes for Google to bear that out in this case.)

[narya.livejournal.com]

Ugh, I'm sorry you have to go through any kind of surgery.

[yakshaver.livejournal.com]

Thanks. Though as surgery goes, I'll take an operation I can walk away from that afternoon over some of the things I've done in the past.