Cataract removal – left eye
Day 1 11/11/2016
At 7:15 am I checked into Mayo Clinic Gonda Desk 7 for my cataract
surgery. Some forms to fill out and then
15 minutes waiting.
I visited with a
woman, probably in her 40s who was having the first of two cataracts done. “I can’t see well enough to drive now, and should
have done this earlier, but was scared to do it. However, Dad had his done recently, and he
said it was wonderful, and pushed me into getting it done.”
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| Some of the pre-cataract surgery eye exam machines |
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| Bed side monitoring machines |
A member of the surgery
team then took me to the back to a small room—sort of a hospital bed room, but
smaller. I sat in a chair that was both
chair, hospital cart and hospital bed—my home for the next hour and a half.
After the id check (state your name and birth date) affixing
a wrist band, connecting heart monitoring electrodes (the ones that stick over
your chest hair and act as hair removers when they are detached), and an IV
opening, I had a few minutes alone, so
got out of the chair and watched the heart monitor and blood pressure
monitor. Heart rate was 72, with an
occasional skipped or abnormal beat (something I have had for 30 year and is
considered normal), and blood pressure was 136 over 115. The 115 is too high, and I can hear my family
doctor rattling me about losing weight, exercising and taking some BP medicine
when I see her in three weeks for my annual lecture on healthy living.
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| Prepared for surgery with eye numbing gunk oozed into the eye and taped over to hold it there |
The nurse who hooked up the IV tried the left hand for a
vein, then the right hand, sticking me each time (these sticks are hardly
noticeable as the needles are very small) and finally got one in the left
arm. Flabby veins or something like that
was the comment.
The anesthesiologist came in, someone as old as I am, and
got some more info and told me I was going to be given a local cream based
numbing agent that would deaden the whole area around the eye, as well as a
mellowing agent through the IV as I would be awake and somewhat alert during
the procedure, but they didn’t want me too alert.
He said “I think I must have worked with you back in the 80s—at
least Russ Hanson sounds familiar.” I
wasn’t quite in my best memory mode so couldn’t make the connection, but later
realized that a group I worked in at that time had a project to computerize the
anesthesiology surgery record – and likely bumped into him then. Still a little vague though. I spent 25 years at Mayo and was in a lot of
projects and am much more memorable to others than they are to me, as I was
always involved in projects that brought change (computers) and folks were
generally rather intimidated by changing to computers in those days. And things
that happened 30 years ago are not quite as clear to me nowadays anyway.
Dr. Kanna, my surgeon dropped in, now making about 5 folks
in the small room and marked a dot above the left eye with a Sharpie pen to
make sure the left eye was the right one to operate on. Then he marked the orientation of the lens
---“have to get it in right as it has astigmatism correction—so there is a top,
bottom, and angle to measure.” More
black marks around the eye -- sort of like
a bullseye with crosshairs (I actually couldn’t see them, but they may show up
after I get the patch off).
The preliminaries all done, the chair was wheeled to the
surgery area. “How many cataracts in a
day done here?” I asked. “About 24 today (three surgeons working today) and as
high as 32 on busy days.” I think they
do two surgery days a week most of the time.
Scott, in the waiting room, said
he watched a steady progression of folks going in with glasses and coming out with
eye patches.
The Mayo building and the Gonda building are two buildings
that appear as one inside. Seventh floor
on the Mayo side is the eye doctor side, and on the Gonda side is the surgery
side. Some of seventh is for urology, so
I made sure the nurse pushing my chair aimed towards the eye surgery area.
The operating room was the size of a large living room, lots
of instrumentation, and machines. I was
tilted flat, the chair becoming a bed, and the hovering folks began to
hover. One kept the IV (anesthesia)
dripping and monitored my vital signs; a couple were the surgery assistants,
and some others were there to save any removed parts in case of an
autopsy.
“If it is alright with you, I am going to video the
procedure today. Monday I am giving a
talk to the folks in the eye area about cataract surgery and want to show them.
Most of the staff never get back to the operating room,” said the surgeon.
“Sure” I said, hoping I might get a copy of it for
myself. However that does not appear to
be likely as I asked him about it after the surgery. “Not even sure it recorded OK, and then we
have to edit it before the talk.”
However, I will nudge him on this again in 3 weeks when I see him for
the progress report.
My guess is he chose me for the model patient for the staff
to see as my photogenicity is really quite high.
As I had ask him to describe what he was doing during the
surgery so I could understand it, and that fit with the video, I got the blow
by blow details. Although I was mildly
sedated, I think I can remember the gist of it all.
I was in my street clothes, with only my glasses off and some
blue paper shoe covers. No removal of
belts, shirts, or anything, but a hospital gown over my shirt. Then my head was
completely covered with a blue tarp (not Menards), with a hole cut out so to
the operating staff, and the movie camera, I was an eye peering out of the sea of blue plastic.
The rest I am going to write as if the doctor said it, but
as I was a little woozy and of course I can’t remember exactly, you have to
accept there is likely some missing, added, and misstated parts.
“First we open a tiny hole in the edge of the eye to insert
the ultrasonic probe into the lens. Then,
with my foot pedal (speed control?) I use the probe to make four pie slices of
the round sort squashed spherical lens (think of a soft M&M candy). Then I vibrate each quarter into small
fragments and use the vacuum part of the probe to suck out the fragments. The lens is inside a lining so I carefully
clean it out right up to the capsule that holds it and suck it all out.” He was doing this with highly magnified eye and screen images to see the details and in extreme white light. I could see only the white light, but when he said the lens was quartered, I think I could see the division lines coming through the intense brightness.
The ultrasound probe and vacuum made different musical tones
based on speed or vacuum level (not sure which or maybe both). “The sound helps me gauge the speed/vacuum levels
so I can tell how the probe is working and leaves my hands free.”
I was able to ask questions and seemed like I was rational,
and I asked “How do you get the big lens into the tiny opening, or do you have
to make it bigger and sew it up?”
"The lens is sort of folded up and I can slip it into the empty capsule and unfold it inside. It is a flexible plastic, so it bends easily. The opening is so small I don’t have to sew it up after I get the lens in.”
“Now I have the lens inside, and I have to get it oriented the correct way so your astigmatism axis is right. There are several adjustments I do sliding it around until it is just where it is supposed to be. After surgery it takes a while for it to get fixed into place and so you have to be gentle with your head movements and keep your fingers out of your eye so it remains lined up perfectly.”
"The lens is sort of folded up and I can slip it into the empty capsule and unfold it inside. It is a flexible plastic, so it bends easily. The opening is so small I don’t have to sew it up after I get the lens in.”
“Now I have the lens inside, and I have to get it oriented the correct way so your astigmatism axis is right. There are several adjustments I do sliding it around until it is just where it is supposed to be. After surgery it takes a while for it to get fixed into place and so you have to be gentle with your head movements and keep your fingers out of your eye so it remains lined up perfectly.”
“All done. Everything
went the way it is supposed to. Looks
good. Now you can get unhooked and I’ll
see you at 3:30 pm this afternoon.
Remember, it will look strange at first, and gradually get better and
better over several months, although in a day or too should be usable. See you this afternoon. Don’t drive today, and let me know if
anything seems abnormal.” Abnormal was
changes like flashes of light, worsening vision instead of improving, pain,
etc.
Most folks come in the next morning for their followup, but as I was done early in the morning and from a distance, he said he would do it the same day so I could leave Rochester that afternoon.
Most folks come in the next morning for their followup, but as I was done early in the morning and from a distance, he said he would do it the same day so I could leave Rochester that afternoon.
And I got unhooked, some more instructions on being gentle
on the head and eye for a month or so, and walked out with Scott, my left eye
patched with some gauze and a metal shield, not really feeling dizzy or confused or anything odd.
Getting around with one eye, as I had already learned with
Myasthenia Gravis in 2012 (I had to patch one eye for a few months to get rid
of double vision), is sort of like dropping your vision level to 1/3 of what it
was with two eyes. Everything seems
unreal and incompletely there. And
sitting in the passenger seat with Scott driving was clearly necessary as I
didn’t think I would have felt safe to drive myself yet.
At home, I took off the shield to put in the two different
kind of post surgery drops (5 minutes apart) and got really worried. I could see through that eye, but everything
was sort of like looking through a snowstorm and whatever came through the left
eye was slanted about 30 degrees – like the TV screen was tilted that much—the whole
world was. Gee whiz, did the doctor get
the lens put in rotated by 30 degrees?
Remembering the doctor and nurses said “your vision won’t be
normal for a day or two, and then will keep improving for months” I refused to
panic and turned to Dr. Google who assured me that as the numbing agent wears
off, the slant should go away too. At
1:45 pm, I tipped up the patch to look out and the world is level with both
eyes, but the left eye sees a white fog over everything. So I won’t panic yet, but keep waiting to see
what happens.
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| Post surgery with temporary eye shield and still a little sleepy from the mellowing agents |
Update: 4 pm day of surgery
The good news: went in for my post surgery checkup and took the eye patch off and I can see pretty good already with that eye. The doctor says it will take a few more days to get to normal, but everything looks pretty good.
The bad news: My glasses are no longer any use for the left eye as it has been corrected. I can't really get new glasses until about 1 month when the vision is completely stable from the surgery. "All I have to do is remove the left lens from my old glasses and the distance vision will be good" I told the doctor.
"Don't you remember me telling you that doesn't work right with severe nearsightedness like yours?" he replied.
"Sort of, but remind me why again"
"Your right eye still has to use the glasses -- and for nearsightedness, the lens makes everything you see smaller. And your new left eye leaves them larger, like they should be. So you will see one big image on top of a small one. It will be enough difference it will confuse your brain"
"So can't I get glasses that will fix that?"
"No, you either have to shut one eye or patch one, or get your other eye done too. I knew you would need that, so if you want to go ahead, I scheduled it in 30 days on December 9th. That is as close to each other as we do the second eye."
So I am in that sort of between stage where my new eye sees much better, but won't work together with the old one. I already learned to read with one eye shut, and drive with one eye shut when I had myasthenia gravis double vision, so its back to that for a month.
The new eye lens gives me whiter whites, more colorful colors, but is still a little foggy -- sort of like a bar in the smoking days. That is supposed to clear away soon. Overall, I think it was quick, easy, painless, and likely to improve my life. However seeing folks more clearly may change some of my friendships.
In college, a girl friend always took off her glasses when I came to join her at the library or lunch table. "You are just vain and want to look better," I told her. "No I take them off so you will look better!"
Update 2 years later.
I had both eyes done. They both were without problems. I still have a few vision difficulties that are from a cornea that is somewhat irregular. It could be improved with laser surgery that shapes the cornea (Lasik). However, I don't consider it enough of a problem to bother with.
I also learned I did something wrong with my first eye that I fixed for eye two. When I had the pre-eye exam to get the replacement lens prescription, I attempted to squint a little to see the chart better, something I had been doing as a matter of course in daily life. That meant that the lens was made for my squinting eye rather than my eye at rest. So for the exam for eye two, I didn't wear glasses for whole day before, did not squint and attempt to see better. That lens gave me better focus than the first one.
Both are good enough so I mostly get by with glasses for reading only. However, I did get prescription glasses that improved the vision the squinted eye and add a little better vision to both. But mostly I just have a dozen cheap pairs of reading glasses here and there (cars, computer, workshop etc). I use 1.25 for the computer, 1.5 for reading, 2.0 or 2.5 for close work and buy them by the bundle of 4 at the chain store.
I paid an extra $1000 per eye above Medicare reimbursement to get the astigmatism (a great deal in my eyes) included in the replacement lens so that is now gone mostly from my eye glass prescription and lets me wear the reading glasses and have no astigmatism problems.
Here in NW Wisconsin, going in and outdoors in the winter was a pain with glasses fogging up. That is gone!!!! I have gotten in the habit of wearing my prescription glasses with bifocals and mostly window glass above because it does give me some eye protection here on the farm, it does help a little to have the closeup always available, and it makes me look very intelligent.
The good news: went in for my post surgery checkup and took the eye patch off and I can see pretty good already with that eye. The doctor says it will take a few more days to get to normal, but everything looks pretty good.
The bad news: My glasses are no longer any use for the left eye as it has been corrected. I can't really get new glasses until about 1 month when the vision is completely stable from the surgery. "All I have to do is remove the left lens from my old glasses and the distance vision will be good" I told the doctor.
"Don't you remember me telling you that doesn't work right with severe nearsightedness like yours?" he replied.
"Sort of, but remind me why again"
"Your right eye still has to use the glasses -- and for nearsightedness, the lens makes everything you see smaller. And your new left eye leaves them larger, like they should be. So you will see one big image on top of a small one. It will be enough difference it will confuse your brain"
"So can't I get glasses that will fix that?"
"No, you either have to shut one eye or patch one, or get your other eye done too. I knew you would need that, so if you want to go ahead, I scheduled it in 30 days on December 9th. That is as close to each other as we do the second eye."
So I am in that sort of between stage where my new eye sees much better, but won't work together with the old one. I already learned to read with one eye shut, and drive with one eye shut when I had myasthenia gravis double vision, so its back to that for a month.
The new eye lens gives me whiter whites, more colorful colors, but is still a little foggy -- sort of like a bar in the smoking days. That is supposed to clear away soon. Overall, I think it was quick, easy, painless, and likely to improve my life. However seeing folks more clearly may change some of my friendships.
In college, a girl friend always took off her glasses when I came to join her at the library or lunch table. "You are just vain and want to look better," I told her. "No I take them off so you will look better!"
Update 2 years later.
I had both eyes done. They both were without problems. I still have a few vision difficulties that are from a cornea that is somewhat irregular. It could be improved with laser surgery that shapes the cornea (Lasik). However, I don't consider it enough of a problem to bother with.
I also learned I did something wrong with my first eye that I fixed for eye two. When I had the pre-eye exam to get the replacement lens prescription, I attempted to squint a little to see the chart better, something I had been doing as a matter of course in daily life. That meant that the lens was made for my squinting eye rather than my eye at rest. So for the exam for eye two, I didn't wear glasses for whole day before, did not squint and attempt to see better. That lens gave me better focus than the first one.
Both are good enough so I mostly get by with glasses for reading only. However, I did get prescription glasses that improved the vision the squinted eye and add a little better vision to both. But mostly I just have a dozen cheap pairs of reading glasses here and there (cars, computer, workshop etc). I use 1.25 for the computer, 1.5 for reading, 2.0 or 2.5 for close work and buy them by the bundle of 4 at the chain store.
I paid an extra $1000 per eye above Medicare reimbursement to get the astigmatism (a great deal in my eyes) included in the replacement lens so that is now gone mostly from my eye glass prescription and lets me wear the reading glasses and have no astigmatism problems.
Here in NW Wisconsin, going in and outdoors in the winter was a pain with glasses fogging up. That is gone!!!! I have gotten in the habit of wearing my prescription glasses with bifocals and mostly window glass above because it does give me some eye protection here on the farm, it does help a little to have the closeup always available, and it makes me look very intelligent.
