I can see clearly now

Cataract surgery gave me 20/20 vision for first time in my adult life, writes Valerie Hill

My surgeon says she can think of “no other surgery that provides such importance and fast improvement in quality of life.” — Photo by Peter Lee


By Valerie Hill

Sitting in my optometrist’s chair last fall, I was unprepared for his prognosis: cataracts and a referral to a surgeon.

Now this getting older stuff hasn’t really bothered me much, despite turning 65 in February. I still do the same activities, though likely with a little less vigour, and there is that wonky right knee that often curtails my enthusiasm for jumping in Zumba class.

Then last year I suffered from two bizarre minor ailments: geographic tongue and seborrheic keratosis, which has been dubbed “senile barnacles.” Yes, those are real things but not something I would put on my Tinder profile.

The tongue thing is when those bumpy bits on your tongue, the papillae, are all at different levels so it looks like a topographical map. The barnacles? Well, that was a skin condition on my scalp, though it sounds more like the name of an elderly group of East Coast musicians.

Those two issues were not difficult to deal with, but cataracts?

He assured me mine were genetic, not age-related. Is that a thing?

In our aging population, cataracts are common with more than 180,000 surgeries performed every year in Canada. That number is expected to increase to 250,000 by 2025.

In an interview, my ophthalmologist, Dr. Chryssa McAlister, said most cataracts are age-related, but other causes include diabetes, myopia, smoking, UV exposure, inflammation, medications such as steroids, and genetic factors.

“Although the vast majority are age-related, we see cataracts in newborn babies, congenital cataracts,” she says. “Also in young adults with uveitis or type 1 diabetes.”

I have worn glasses since I was 13, with my sight noticeably worsening in the past year. Even with strong glasses I couldn’t read street signs or recognize people standing just a few feet away. There were also issues of distortion. I remember sitting in a restaurant a few months ago looking at a man standing sideways, about three metres from me. His body looked like a rope, with a bright yellow triangle for a head. It made no sense.

On the road I would see two or three cyclists when in fact there was only one. Every street light and car headlight had multiple halos.

Cataracts also impacted my outdoorsy pursuits. One of my favourite activities in Algonquin Park is to swim to the island in Lake of Two Rivers, walk across the island, come out the other side and swim back. Last summer, I was Mrs. Magoo-ing my way across the island on what I thought was a path but instead I kept running into trees and stepping on sharp stones. I was not on any path and everything was a blur, like looking through a lens covered in grease. Good thing it was a small island which meant eventually I would simply fall back into the lake.

For less-active pursuits, such as watching Coronation Street, I could not read the channel guide on the television from my couch. And the high-tech gadget has this annoying distance alert feature, which I assume was designed for kids who sit inches from the screen. Get too close and a window opens, blocking the show, followed by an ear-splitting buzzer. Honestly, you would think it was warning the viewer of an air raid. So how was I supposed to get close enough to read the screen?

To circumvent the alert, I had to sneak up on the screen in stealth mode, sidling in from the side like a cat. I couldn’t let the television detect my presence, so I even tiptoed — which was ridiculous, but you just never know about technology. It’s watching me so maybe it’s listening too.

I knew my vision was getting worse, but I hadn’t really thought about cataracts, despite my family history. My two siblings had cataract surgery within the past year. Our great grandparents, Ukrainian peasants, had been blind in their older adult years, likely from cataracts.

Developing cataracts myself, however, turned out to be a gift.

Because my cataracts were aggressive, Dr. McAlister accelerated the surgery date to April 4 for the right eye, April 23 for the left.

Cataract surgeries are performed at St. Mary’s General Hospital where McAlister averages 18 patients a day, one day a week.

In an interview, she explains the surgery is now so streamlined and safe, there really is no upper age limit.

“I have had several patients in their late 90s.”

The procedure takes about 20 minutes, with either mild sedation or none at all.

“The incisions have reduced over the past several decades to now be two millimetres in size,” she says. “Small enough that we don’t require sutures and there is minimal post-operative risk.

“I can think of no other surgery that provides such importance and fast improvement in quality of life.”

The doctor was not underplaying the results.

When I arrived at the hospital, the cataract ward nurses settled me in, installed an intravenous port then started putting a series of drops into my eye. Not pleasant — a bit of a sting — but tolerable and all that squirting and dabbing was over in no time.

I had to sit for a while, perhaps an hour, so the drops could dilate the pupils and freeze the eye. Then it was off to the operating room where more drops were applied, plus some goop that sealed my eye shut for a while.

In the operating room, they applied a sticky pad to isolate the eye and pull the eyelid out of the way to prevent any “skin bugs” from filtering into the surgical site. The bugs are microbes and everyone has the little critters.

Once ready, a powerful microscope is brought into position over the eye. The light from the instrument is intense, but I was immobilized and couldn’t squint, so instead I concentrated on what looked like two marshmallows in the lens reflection. I don’t even like marshmallows, but it was a distraction.

Luckily, you can’t actually see the surgeon coming at you with the scalpel, you just hear some movement while she makes the surgical incision then uses phacoemulsification, an ultrasonic oscillating probe that is inserted into the eye through the surgical opening. The probe breaks up the existing lens and its cataracts.

I heard a little noise, but McAlister warned me ahead of time, and it was nothing like the dreaded dentist’s drill. She next suctioned up the broken bits of lens and cataract and inserted a new, permanent artificial lens. I was done.

McAlister placed a clear plastic cup over my eye — I wore it nightly for a week — held in place with medical tape. Back in the cataract recovery room, there we were, all us old folks with our eye cups on, looking like we’d just come from some kind of geriatric fist fight at the seniors centre.

Within five minutes, my sight started to clear. My right eye, with its brand spanking new fake lens from Bausch & Lomb, was focusing. I started reading the posters on the wall, the nurses’ instructions, the department phone numbers, the warning labels. For the first time since I was a preteen, my right eye was working perfectly.

McAlister wanted all patients to wait around for an hour or so following surgery, so she could check our eye pressure before releasing us to a world that was suddenly visible. And very bright, albeit only in one eye.

My friend, Jenny Keeler, had driven me to the hospital and had to come fetch me as well. The nurses won’t let a patient leave the recovery room unattended. Keeler became a bit of a seeing-eye guide because I couldn’t see anything on my left side.

As excited as I was to be able to see out of one eye, the next three weeks were difficult. The new lens gave me 20/20 vision, but the left eye was still weak and blurry. My brain was going into overdrive, trying to co-ordinate my body so I wouldn’t run into walls. It was physically and emotionally exhausting.

I tried taking out the right lens in my glasses so I could still use the left lens and hopefully equalize my sight. But it made me feel very woozy. I tried an eye patch on the left eye, but that was really irritating. So was being called “pirate” by all the mean kids in the Waterloo Region Record newsroom.

I took three days off work. On my return, we had to adjust the computer screen, making the font as large as possible. My left eye, the bad eye, was still near-sighted so I could read without glasses. The right eye was perfect, so I could read the computer screen. This meant I had to hold my notebook to my left eye to read my interview notes, then use my right eye to see the computer screen and write my story.

At a family Seder dinner, we were taking turns reading from a script prepared by my daughter-in-law’s uncle. It was the story of Passover and when he looked at me, holding the script within inches of my left eye, he suggested I let someone else read my part. He next asked my ex-husband. He can’t read without glasses.

“Between the two of us, we only have one good eyeball,” I pointed out.

On April 23, the process was repeated: eyedrops, rolling into surgery, intense light from the microscope, a bit of discomfort and it was all over.

Back in the recovery room, the left eye began to focus and, suddenly, everything in both eyes was crisp and clear. I could read the labels on the running shoes of hospital staff walking down the hallway. I could see all the trees outside, make out each leaf, each branch.

My friend, Mary Voisin, had driven me this time and she witnessed this person who was like a newborn, experiencing life for the first time. It was heady.

Later that day, sending out messages to all my friends that I now had 20/20 vision in both eyes, I also noted that I’d be able to see all the dust bunnies in their homes.

Oddly, dinner invitations dried up. OK, so that’s not true. My friends have always been supportive and several brought me food while I recovered though, frankly, I felt great. Some patients experience a feeling of grittiness in the eye and I still had to wear the patch at night for a week.

Over the next several days, my vision became clearer and clearer. I had to continue with drops for three weeks, then it was all over, and my eyeballs are like they were when I was a kid, working perfectly.

As McAlister concludes, being able to restore sight to patients like me every day, supported by what she says is an exceptional team of skilled nurses at St. Mary’s, is very satisfying.

“I have the best job in the world,” she says.

Aside from my perfect vision, one of my biggest thrills is being able to buy a pair of regular sunglasses. Not prescription, not clip-ons, just sunglasses.

Sometimes it’s the little things in life that are often the most pleasurable.