At first, I began noticing halos around street lights at night and glare from bright lights during the day. Before, I always had 20/20+ visual acuity without glasses. But cataracts were developing in both of my eyes, with my right eye much worse than my left. In my exam chair, I still could see the 20/20 to 20/25 line on the eye chart without much problem. In other words — and as I would always tell my patients in the past — I supposedly could see "just fine."
But about a year before deciding to have cataract surgery, I performed very poorly on a contrast sensitivity test when a glare source (bright light) was directed toward my eyes during the test. This means that scattered light and other interference from cataracts clouding my eye's lens were making it much harder for me to distinguish objects from their background when the contrast between the two wasn't starkly black and white (like letters on a standard eye chart).And closing my left eye made me feel as if I had a piece of wax paper in front of everything I saw. This view became even more opaque as time went by.
During night driving, I had the classic symptoms of cataracts: seeing halos around lights and headlights, and a little glow around street lights. The contrast between dark-colored cars and the dark night background made it difficult to delineate the true outline of the cars in front of me. Notwithstanding these symptoms, the eye charts still said I could see "just fine."
The central blurriness and haziness in my right eye had rendered me almost monocular or "one-eyed." I became left-eye dominant, because I still could see through this eye, where the cataract was not nearly as bad.
My altered vision did not hinder normal daily activities. But when I performed surgical procedures, I noticed that I definitely was slowing down due to loss of contrast sensitivity. Because I no longer could see well with both eyes, I also experienced decreased depth perception.
Even overhead lights failed to illuminate the surgical site as well as they once did. My portable surgical headlight also seemed to have lost some of its luminance.
These complaints I voiced in the operating room were similar to those I had once heard from patients with "early" cataracts who protested that they required a lot more light to read comfortably.Outside the operating room, I found myself reaching for an old magnifying glass at my desk when looking at black print on a colored-background paper.
If a friend or family member stood in front of a glass sliding door or bay window, I would see only their silhouette with my right eye without being able to differentiate facial features.
But the eye chart still said I had 20/20 to 20/25 vision, and that I could see "just fine." So I hesitated, and followed the advice I almost always gave my cataract patients. Like any other ophthalmologic professional, I knew too much about cataract surgery, especially those "few and far between" complications. Why take any kind of risk unless I absolutely had to?
And besides, I could see "just fine" — with occasional visual frustrations.
One late afternoon, however, my sentiments changed drastically during a drive home from my office. I was headed west into a typical Florida sunset. Somehow, while I was switching lanes, the sun peeked between the edge of my sun visor and my rearview mirror just inside the frame of my windshield, creating a severe glare that momentarily blurred out my view of the road in front of me.
Luckily, no cars were nearby, and the incident did not affect my driving. But that was the final straw. Next time, I realized, I might not be so lucky. And the risk of a driving accident of this sort far outweighed the now much slighter risk of undergoing cataract surgery.
I am surrounded by excellent cataract surgeons, so selecting someone for my own procedure was not at all difficult. I chose Steve Updegraff, MD, who I had seen perform many cataract surgeries.
But forcing myself to schedule the surgery was almost as difficult as making the decision to have the procedure in the first place.
I received my preoperative eye drops, antibiotics to prevent possible eye infection and a nonsteroidal anti-inflammatory drug (NSAID) to control inflammation and swelling. On the day of surgery, while in the holding area, I asked for medication to calm my anxiety. However, I didn't want too much, because I wanted to remember the surgery and recall as many details as possible. I remember the trip into the operating room and my surgeon saying "hello" to me. I received topical anesthetic drops, and then I was prepped and draped. Someone asked me to look straight up at the light, where I saw two thick, gray three-dimensional half circles slightly offset and separated by a space.During the procedure, my entire view was a light-colored gray, as if I were underwater looking through the water. This view never changed. I listened to the sounds of the phacoemulsification machine and tried to see the changes in my vision as my lens was broken up (emulsified) and then suctioned out (aspirated).
Because of the brightness of the operating microscope light, my view remained virtually unchanged. My surgeon commented that my cortex (the soft, peripheral part of my cataract) was a little more tenacious than he had expected from what he saw on the microscopic (slit lamp) eye exam. But everything was going fine.
My surgeon then announced that my cataract was removed. I looked up at that moment, and tried to see what vision was like without a lens (aphakic). But I still couldn't make out any details. Everything looked the same. When my surgeon announced that the aspheric IOL was inserted into place, my view still was not much better. This was definitely disappointing, considering my anticipation. Instead, the three-dimensional gray half-circles remained exactly as I had seen them throughout the entire procedure. Then the drapes covering my face were removed. When my surgeon said everything had gone perfectly, I was totally relieved. I looked around the room and noticed that my photoreceptors (light-sensitive cells in the retina) were still bleached out.
This condition results when a constant light aimed into the eye causes the photoreceptors to work overtime, without a chance to recover and replenish light-sensitive photopigments (chromophores). This creates a temporary situation where the photoreceptors are "bleached" or left without pigment needed for good vision. At least, I could see images and shadows in the room. That was definitely satisfying.