Monday, September 2, 2013

My Cataract Surgery Experience

 Many people with RP would develop cataract earlier in their life, that's what happen to me.  Removing the cataract might improve vision to some people.  Everyone is different, people with normal vision seem to be more please with the result than those people with other vision issue, so set your expectation accordingly.

I had a cataract surgery in my left eye in 2009.  Even with the YAG laser treatment, the result was disappointing, that's why I didn't do the right eye back then. At that time, the vision in the left eye before the surgery was much worst than the right eye.  The Dr.  told me the reason that I didn't see that much improvement was probably due to the fact that too much damage on the retina already.  In 2013, the vision on the left eye has gone even worst, it is pretty much useless.  I can only see outline of large objects, no deapth preception, very narrow visual field.  The image in the left eye is somewhat distorted with no details, I can't really use the left eye to read anything.

  I think around 2011,  the vision in my right eye took a nosedive.  Everything seem like looking through a sheet of wax paper, everything were fuzzy..  Sun glares was a major issue when walking outside.  In 2013, I could still see the near by objects indoor OK, but I couldn't see anything clearly outdoor beyond 20 feet or so.  I couldn't even see the traffic signal across the street, that made crossing the street very unsafe for me.  i had many self debates and second thoughts on having the cataract surgery in the right eye.   I read about the potential risks and complications.   I was really afraid to loss what little remaining vision I had due to surgery complication.   After more sleepless nights, I finally decided to take the gamble to have the surgery and hoped for the best.

In July, I checked with my eye doctor to see if removing the cataract would help my remaining vision.   He said I had a small but very dense cataract.  Removing it should take care the glare issue, but he couldn't promise any other vision improvement.  He also mentioned that dense cataract is a risk factor for glaucoma in the future.  With great trepidation, I scheduled the surgery in August.   

One week before the surgery, I had a Pre-Op appointment with the Dr.  Three things were done in this appointment.
  1. Watched a video about all the potential risks and complications with cataract surgery.  It also stated that cataract surgery does not guarantee vision improvement.  I had to sign a consent form to accept all risks.  I was also given Pre-Op and Post-Op eye drop instruction.
  2. Measurements were taken on both eyes to figure out what power of lens to be used.  I told the Dr. I want to be nearsighted after the surgery.  I told him I want to see the computer screen without  eyeglasses. BTW, my left eye is farsighted. 
  3. A very brief physical checkup.  The Dr listened to the heart and lungs.  Blood pressure and eye pressure were taken.  Three eye drops were prescribed.

Side note about the eye drops.  In 2009, I was given eye drop samples so I didn't realize the price for those eye drops.  In 2013, I was told due to some sort of regulation, they can't give out sample anymore, so I have to buy them.  What a shocker, those eye drops were very expensive.  Each tiny bottle costs more then $100 retail price.  Who can afford these without insurance?  The following drops were prescribed.  1ml is just a bit under .034 fl oz.
  •  Vigamox Anti-bacterial eye drop, 3ml bottle.  Retail price $110.
  • ILEVRO. Nonsteroidal anti-inflammatory eye drop, 1.7ml bottle.  Retail price $144.
  • DUREZOL. Steroid anti-inflammatory eye drop, 5ml bottle.  Retail price $125.

Three days before the surgery.  I started the pre-op eye drop regimen.  VIGAMOX 3x per day and ILEVEO 1x per day.  I found it was not easy to put eye drops in my own eye.  I wasted few of those very expensive eye drops on the first morning I tried it.  I had to fast for 8 hours prior to the surgery.

The surgery day.  My surgery was scheduled for 8:30 AM at the local out patient surgery center, but I have to be there by 7AM.  Once I paid my portion of co-insurance, I was led into the prep room.  After putting on the  gown, I was told to lay on a gurney.  A prep roomnurse took my blood pressure, EKG, and other vitals.  After she vertified the surgery to be on the right eye, she put dilating and anti-bacterial eye drops in the eye, an IV on my left hand and an oxygen nozzle under my nose.

Soon after, an anesthesiologist came by to listen to my heart and asked few routine medical questions.  He also vertified the surgery to be done on the right eye.   Then an operating room nurse came out to to let me know i would be next.   She asked me to point to my right eye and she put a marker right next to it.  I guess they really want to double and triple check that the surgery would be done on the correct eye.  About 10 minutes prior to my turn, the eye doctor put plenty of numbing gel all around my right eyeball and told me to keep my eye closed.  At that point I had a strong urge to pee, probably due to nervousness,but I was told I need to hold because everthing already hookup.  I was told  the procedure shouldn't take more than 10 minutes.

At around 8AM, my gurney was wheeled down the hall into an operating room.  A nurse rinsed out the numbing gels from my eye and cleaned the skin around the eye with some cold solution.  I felt something on the IV line and oxygen start flowing into my nose.  The doctor used a device to keep my eye lids open and told me to stare at the bright over head lamp.  The next thing I knew I was back at the recovery room.  My right eye was covered.  I did not feel or remember the actual surgery.  I didn't feel any pain and the doctor said the surgery went well.  A nurse offered me a can of apple juice and went over the discharge paper and we went home around 9AM.    

I went back to the doctor's office that afternoon for post-op check up.  After couple of eye drops in the eye, the eye pressure was taken.  The doctor looked into my eye and said I had slight corneal edema and slightly elevated eye pressure.  He told me both these conditions are fairly common after cataract surgery, and the post-op eye drop  regiment should take care of them.  I was able to see the really big letters on the eye chart, that was a huge relief knowing that I didn't go blind after the surgery.   I was told to wear an eye protector during sleep for the first week and avoid getting water into my eye.

Post-Op eye drop regimen.  This regiment would last for next 4 weeks.
  • Week 1.  Vigamox 3x per day, Ilevro 1x per day, Durezol 3x per day.
  • Week 2.  Ilevro 1x per day, Durezol 2x per day.
  • Week 3 and 4.  Ilevro 1x per day, Durezol 1x per day.

The first few days after the surgery, I was a bit paranoid on protecting my right eye.  I wore a safety goggle when I move around in the house, I even wore the goggle when taking showers to prevent water get into my eye.  I wore the eye protector to sleep but I couldn't sleep with that thing taped on my face.  Don't laugh, I even believed in the myth of avoiding constipation and avoid bending down to tie my shoelace.  I kept comparing my vision between my left and right eye, and then realized my foolishness of doing so.  I guess I was too anxious to see the result.   

Preliminary result after 5 days.  I was able to see the monitor without eyeglasses.  The text and image on the monitor were a bit fuzzy, I hope this would improve in the next couple weeks.  I also noticed the image in the right eye is dimmer than the left eye, I would definitely mention this on my next checkup.   Sun glares problem has improved.  Everything outdoor is out of focus due to incorrect eyeglasses prescription, I hope this would be resolved when I get my new prescription in few weeks.   

 Post-Op 1 week follow up.   Dr. said my eye has completely healed.  No more corneal edema.  The eye pressure was still a bit elevated.  Acuity was 20/150, it was 20/250 before the surgery.  He told me this may get better in few weeks.  The image brightness in both eyes were about the same.

Post-Op 1 month fellow up.   Acuity was 20/100 in the right eye, it was 20/250 before the surgery.  I was hoping for better acuity, but that's the best can be done.  I told Dr that my right eye seem to see through a slightly tinned glass and everything are a bit fussy, he told me the new prescription might resolve these problems. The Dr told me the right eys has completely healed.  He also recommended amber color lens to improve visual contrast.  Hopefully I would see better with a new pair of eyeglasses.    

Well, I finally got my new eyeglasses almost 7 weeks after the surgery.  I was very disappointed that it didn't help that much.  Although the acuity test taken in the doctor's office shown some improvement but it was done with an eye chart with good contrast and with ideal lighting condition.   In the real world, I still can't read the street sign or the caption shown on the TV.  The only improvement after the surgery is the stuff I can see is clearer and less glares, so it is not a total lost.

Did the gamble pay off?  I think it was only a small pay off with that much expenses and efforts.  But I guess it was worth it in that any improvement is best than no improvement.  Would I do it again?  Yes, I owe it to myself to do every reasonable things to improve my eyesight.   

Update April 2015.
Had YAG laser procedure done on the right eye, it didn't help much.
Bought a pair of amber color fit-over sunglasses, it really help with contrast.

Final thought: Unless there are medical breakthrough in the near future, I would just let RP take its nature course. 

"God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And wisdom to know the difference"

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