Waiting for Cataracts, Or, Advice from Dr. Savage

 

2010-07-19_ProteusRicochet’s own Dr. George Savage happens to be the most completely competent person I know, and over the years I’ve come to rely on his advice for more or less every decision I make. In the last year alone, I’ve asked his advice on used cars (he told me I should go ahead and buy the car in question, because even with 100,000 miles on the odometer a BMW was just getting broken in), what to do with whatever remains of what I continue to flatter myself by calling “my career” (do what you can every day and just forget about the rest), and which Fitbit to buy (any model other than the one that incorporates a GPS, which is just too heavy and clunky).

With an eye exam coming up, I asked George just the other day for his advice on yet another matter:  Should I get Lasik surgery?

There is the risk of complications, which is low, but I prefer to avoid purely elective procedures as a surefire way of taking the probability down to a manageable zero percent. So you can tell that I’m not a fan.  If we were both thirty years old at this point I might have a different recommendation.

Good news: my ophthalmologist is positively ebullient when telling me that I can have perfect vision just after I develop my first cataract. She can’t wait to give me one of the great new adaptive intra-ocular lenses.   Something to look forward to!

Best regards,

George

Unafraid to look reality in the face (even if he does so through eyeglasses), George Savage remains one of the most cheerful men I know all the same.

The purpose of this post? Just a word on behalf of friendship…which becomes even more valuable, I find, during the, ahem, second half of one’s life.

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  1. user_358258 Member
    user_358258
    @RandyWebster

    My wife has had 3 surgeries.  Two were disasters, and one did nothing much.  No one’s cutting on me unless it’s a matter of life and death, and maybe not even then.

    • #1
  2. Percival Thatcher
    Percival
    @Percival

    Waiting for them? Boy, I’ll say. Those guys are always late. We should have left those jokers back in Constantinople…

    Oh… umm… I guess you wrote “cataracts,” not “cataphracts.” My bad.

    I gotta get my eyes checked.

    • #2
  3. user_358258 Member
    user_358258
    @RandyWebster

    Not nearly enough armor.

    • #3
  4. Basil Fawlty Member
    Basil Fawlty
    @BasilFawlty

    I think cataracts are a disease of the lens and lasik usually deals with the cornea. I’ve had cataract surgery in both eyes and would never go back to the blurred vision I had in the past. I have no interest in lasik because it is essentially cosmetic. Cataract surgery is not cosmetic. It restores sight.

    • #4
  5. Arahant Member
    Arahant
    @Arahant

    Percival:Waiting for them?Boy, I’ll say. Those guys are always late.We should have left those jokers back in Constantinople…

    Oh… umm… I guess you wrote “cataracts,” not “cataphracts.”My bad.

    I gotta get my eyes checked.

    Whatever I might have commented on Peter’s thoughts, it has been laughed right out of my head.

    • #5
  6. user_358258 Member
    user_358258
    @RandyWebster

    I need reading glasses when working at a desk or a computer screen, and I’ve never had any surgery.  I’m wearing them now.

    • #6
  7. TKC1101 Inactive
    TKC1101
    @TKC1101

    I got Lasik in my late 40s (63 now) and never regretted it. Nearsighted since I was 11, by the time I did the surgery I had one eye at 20/400 and one at 20/60. Lasik brought me to 20/25 in both eyes with minimal night vision loss. Got a lens replaced due to a cataract when I was 60.

    I think it all depends on how bad your vision is and if you have no problems with dependency on glasses with continuing deteriorating vision.

    • #7
  8. Blue State Blues Member
    Blue State Blues
    @BlueStateBlues

    I had Lasik done 12 years ago and it has been wonderful–one of the best decisions I ever made.  If you don’t mind wearing glasses or contact lenses, it’s probably not worth it for you.  But I absolutely hated glasses, and grew to hate contacts as well.  I was about 20/200 in the left eye and worse in the right.  I think I am still about 20/20 or close to it in both eyes now.  My night vision is excellent.  Also, I am 57 years old, and although my ophthalmologist assured me (in 2002 after the surgery) that I would need reading glasses soon, I still don’t.

    • #8
  9. Belt Inactive
    Belt
    @Belt

    Two comments:

    First, I underwent LASIK about 15 years ago, when I was 29.  I was quite nearsighted, so I can never go back for more; they did about as much as they could, and now I wear glasses again, though my vision isn’t that bad without them.  Still, I definitely need them for driving at night, and even in front of my computer I use a pair of low level glasses to bring the screen into focus.  I’ve never regretted it.  The convenience of not needing glasses for about a decade was well worth it.

    Second, though my eyes are deteriorating again, I can hold out hope that either advances in medical technology will catch up, and allow perfect vision in another decade; or the eschaton will be immanatized or I’ll die, either of which will give me a new body that will correct my eyes, as well as all those other pesky things that keep me from perfect physical health.  I can wait.

    • #9
  10. Ricochet Inactive
    Ricochet
    @Catalina65

    I am 46 years old, and had Lasik about 5 years ago to correct moderate nearsightedness.  Overall, I had a good result from the surgery.  After 5 years, my vision is about 20/25, and I can get along just fine without glasses or contacts.  I do feel like my night vision degraded slightly after the surgery, but it’s hard to tell, as age 40 is when that starts to happen naturally anyway.

    Many people require reading glasses after the surgery, but I can read just fine without correction.  I do notice that if I focus close up (e.g., to read) and then look up into the distance, it takes a few seconds for my eyes to focus clearly on distant objects.  It’s a nuisance, but not terrible.

    One thing to consider is the discomfort and recovery from the surgery.  While the laser was reshaping my cornea, I am confident I smelled the scent of burning hair.  After the surgery was over, they put an antibiotic ointment (like vaseline) in my eyes and I sat in a darkened room for a while for my eyes to rest.  During that time, I had no idea whether I had a good result or whether I had been blinded.  During this (mercifully short) period, the world appears as though you are peering through a fishbowl.

    Also, there is a suction cup that holds your eyeball in place so it doesn’t move while the laser is working.  The cup creates hematomas (bruises) on the whites of your eyes, and it’s pretty shocking for the first few days after the surgery – My eyes were so bloodshot, someone at work asked me if I had gotten into a bar fight.  It took two full weeks for the bruises to completely go away.  But they did go away completely.

    Finally, there are the halos or starburst patterns you will see around cars’ headlights while driving at night after the surgery.  This effect diminishes over time (about one month) – partially as the eye heals, and partially as your brain learns to ignore them.

    Despite all this, I would go through it again.  Before the surgery, I couldn’t function without glasses/contacts (and my eyes didn’t tolerate contacts well), but now I can wake up and see the alarm clock.

    • #10
  11. George Savage Contributor
    George Savage
    @GeorgeSavage

    My ophthalmologist’s enthusiasm for my someday cataract is explained by a relatively recent development: the presbyopia-correcting intraocular lens.  Both multifocal and accommodating-style premium IOLs have reached the market, and while none yet fully replicate the original equipment “user experience”, they are improving all the time.

    My lifelong -8.75 diopter myopia and more recent presbyopia will be only memories just as soon as my natural lens goes kaput.  Hopefully that is a long way in the future.  Glasses and contact lenses work just fine for me.

    • #11
  12. Arahant Member
    Arahant
    @Arahant

    Catalina65: My eyes were so bloodshot, someone at work asked me if I had gotten into a bar fight.

    I hope you responded with the de rigeur, “You should see the other fellah.”

    • #12
  13. Arahant Member
    Arahant
    @Arahant

    George Savage: Hopefully that is a long way in the future.

    May it be so, indeed.

    • #13
  14. user_358258 Member
    user_358258
    @RandyWebster

    anonymous:

    Randy Webster:I need reading glasses when working at a desk or a computer screen, and I’ve never had any surgery. I’m wearing them now.

    This is probably due to your having normal vision (in focus at infinity) and having lost accommodation as you age (many people begin to lose it around age 45). If you’re extremely nearsighted like me (my eyes focus about 5 cm from my face), you’ll still need glasses for reading and working on a computer screen, and another pair for driving or other activities which require seeing objects at a distance. There are bifocals and progressive lenses, but as somebody who spends much of his time in the near field, I prefer reading glasses which I wear 90%+ of the time and driving/hiking/watching movies glasses for the rest.

    You pretty much nailed it.  I’m 63, don’t need glasses for driving or general use, but can’t get along without readers.  And it happened in my mid-40’s.

    • #14
  15. Ball Diamond Ball Inactive
    Ball Diamond Ball
    @BallDiamondBall

    At 45, in the last two years I’ve gone from lifelong perfect, excellent, stupendous vision at all ranges and under all conditions, to reading glasses and a flashlight.  I don’t often need either, but that used to be never.

    • #15
  16. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    My vision was perfect till that magic age of 40. Since I was very cross-eyed as a kid I really only see out of one eye at a time. This led to me being far sighted in my left eye and near sighted in my right. I just naturally switch between them for whichever sight situation I’m in. Neither is that bad. I can still read reasonably well without readers (at least with my right eye), but sitting in the crane 80-100 feet away from the guy signalling I must have the glasses on.

    • #16
  17. Arahant Member
    Arahant
    @Arahant

    The King Prawn:…but sitting in the crane 80-100 feet away from the guy signalling I must have the glasses on.

    I’m sure everyone appreciates that.

    • #17
  18. Kozak Member
    Kozak
    @Kozak

    I’ve had Lasik, and a re-due in my 40’s and 50’s. I was very nearsighted and could not move without my glasses.  The ability to open and my eyes and see crystal clear is a near miracle.  I wouldn’t go back for anything.  Yeah, I need reading glasses ( one plus when I was nearsighted was I could see clearly VERY close, although that went away suddenly in my mid 30’s and I realized it at the worst possible moment, trying to put an endotracheal tube in a patient who had stopped breathing and I suddenly realized my arms were not long enough to get a good focus!).  One option is having Mono-Vision, where one eye is corrected for perfect distance, and the other is under corrected to allow near vision.  This results is a slightly less then perfect vision but still much better then your native vision.  Through the miracle of our enormously plastic brains, your eye learns to select the image which is clearer for the task you are preforming, near or distant.

    Of course you could wait for cataracts, although you may never develop them to the point you need to have them removed.  On the plus side if you wait long enough, you can get Medicare to pay for them.  On the down side is maybe decades of fumbling for glasses, fogging, not being able to find them immediately, and missing on the shear splendor of having GOOD vision.

    • #18
  19. Nick Stuart Inactive
    Nick Stuart
    @NickStuart

    Not to mention Dr. Savage seems a very dapper fellow.

    • #19
  20. user_216080 Thatcher
    user_216080
    @DougKimball

    Peter,

    You are two years my junior and I understand your frustration.  Can’t follow the ball after a drive, right?  My buddy had that problem, got the LASIK, and now he can see his drives perfectly.  The problem quickly evolved; once clubs are stowed and we’re  back in the cart, he can’t remember where his ball went.  You see those old guys zigzagging all over the course?  Us.

    I now golf with a guy in his early thirties.

    DK

    • #20
  21. user_358258 Member
    user_358258
    @RandyWebster

    My problem with seeing the ball after a drive has nothing to do with vision.  Sometimes they go as far sideways as down range.

    • #21
  22. DocJay Inactive
    DocJay
    @DocJay

    I had LASIK 15 years ago and don’t regret it. My eyes were lousy and high speed sports a challenge because I can’t do contact lenses.
    Waiting for cataracts is a good strategy given your situation though. At 49 I wouldn’t take the risk I did at 34.

    • #22
  23. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    I got it when I was 30, and never looked back. 15 years without glasses or contacts, which I had worn since the 8th grade. I could not even see the clock at night! It was great. My doctor that did it was at Emory, and had helped to pioneer the surgery. He had already done north of 5000.

    I do not yet have arms that are too short, but reading glasses are a fine price to pay for not dying.

    • #23
  24. doulalady Member
    doulalady
    @doulalady

    LASIK is wonderful. It has given me better sight than I have ever had. No glasses or contacts were able to correct for my astigmatisms. I can actually see pollen in the air. Needing readers intermittently is a minor inconvenience since I already needed them when I was wearing my contacts.
    My husband got his eyes done the following year. Bifocals had not been working for him. He had dizziness with them and hated not being able to see obstacles by his feet.
    But our son was first to get his eyesight corrected on returning from Iraq in 2003. The procedure was offered to any willing soldier after the Army had undertaken a large study which showed correction using LASEK was preferable to glasses or contacts for combat soldiers. Because LASEK involved no flap he is now a navy aviator. LASIK would have disqualified him.

    • #24
  25. Frank Soto Contributor
    Frank Soto
    @FrankSoto

    Contacts are just so easy to use that I can’t justify the risk of Lasik.

    • #25
  26. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    George Savage:My ophthalmologist’s enthusiasm for my someday cataract is explained by a relatively recent development: the presbyopia-correcting intraocular lens. Both multifocal and accommodating-style premium IOLs have reached the market, and while none yet fully replicate the original equipment “user experience”, they are improving all the time.

    My lifelong -8.75 diopter myopia and more recent presbyopia will be only memories just as soon as my natural lens goes kaput. Hopefully that is a long way in the future. Glasses and contact lenses work just fine for me.

    I hadn’t heard about these, although I was kind of hoping for the someday cataracts just for distance vision correction.  As a radiologist, my livelihood depends on visual acuity, so I have always been way too cautions to consider LASIK, although I do know radiologists who have done it.

    • #26
  27. PHCheese Inactive
    PHCheese
    @PHCheese

    I had LASIK about 15 years ago, but only on one eye. I now have mono vision. My lift eye is a telescope and my right eye is a microscope. My left eye was for years corrected to 20/05. It has slipped a little because of the beginning of a cataract.With my right eye ,I can see the smallest of detail. Apparently this arrangement does not work for everyone. I sort of backed into it. I was dickering with my LASIK surgeon for a better price when he threw up his hands and said I should just get one done since that was all I wanted to spend. He explained that can work for some people. It takes some getting use to and because I was so cheap,he was sure I would make it work. He was right. It is great. My cataract doc says I can do the same with the implant lenses when it is time.

    • #27
  28. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    I had cataract surgery this month with the corective lenses. The biggest decision I had to make was whether to correct both eyes to 20/20 distant vision or to correct one eye for optimal closeup vision where my brain would shift from one eye to the other depending on the situation. That would truly leave me with no need for glasses but I would be using monocular vision all the time. I took two weeks between the the surgery on each eye to decide and although I adapted well to monocular vision, I chose to go with 20/20 distant in both eyes. I am not sure that was the right decision because now I have to wear a pair of reading glasses around my neck but I was worried about reading mammograms with just one eye. Those microcalcifications are hard to see. Now I have to have the bags under my eyes repaired because they have been hidden by glasses for a long time.

    • #28
  29. PHCheese Inactive
    PHCheese
    @PHCheese

    SP, I didn’t know you were still practicing. You might be interested in checking out a web site Novascanllc.com. This is an invention that my cousin and his son are currently testing with the FDA. It could make a huge impact on the fight against breast cancer and some other types of cancer.

    • #29
  30. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    PH Cheese, An instrument that allows a surgeon to establish clean surgical margins in real time will be helpful but I am skeptical of the overall impact. The physiologic basis of the technology is unclear from their website. Having to reoperate on a patient because the margins were not clearly cancer free is suboptimal but not catastrophic.

    • #30
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