How I
Beat the Tyranny of Cataracts
By
EARL SELBY with MIRIAM SELBY
Two summers ago, I noticed deterioration in the vision of my right
eye. A tennis ball, when seen through
this eye for backhand shots, was a blurry blob until it was almost on top of
me. At night, the lights of oncoming
cars splattered into distracting shears of glitter. I could read a newspaper only I held it close to my nose.
Although I felt no pain, I went to see an ophthalmologist. Placing a corrective lens in front of my
right eye, he asked me to read the wall chart.
What chart? Not one letter was
visible. After a through examination,
he said, “You have a cataract.” I
didn’t exactly know what a cataract was, but the diagnosis quickly sharpened my
interest.
A cataract, I learned, is a cloudiness of the eye’s
lens that occurs when the lens’s clear protein becomes opaque. Normally, light rays pass through the cornea
to lens, which focuses the rays on the retina, triggering the impulses we
translate into sight. A cataract
impedes vision by preventing rays from reaching the retina.
Cataracts are among the worlds leading causes of
blindness. They can appear in one of
both eyes, at any age and may be congenital, trauma0induced or, most commonly,
associated with aging. The National
Society to Prevent Blindness estimates that 44 million Americans age 40 and
over has cataracts. Fortunately, only a
small percentage has vision sufficiently impaired that they must have the lens
surgically removed—the single cure. In
the United States, there are about 400,000 cataract operations a year.
Medical wisdom used to caution against surgery until
cataracts were ‘ripe,’ or matured into grayish, hard kernels. But this was not necessarily the best time
for patients, struggling with failing sight for years while awaiting the
operation. Today, however, cataract
victims almost always have the option of scheduling the operation at their
convenience, when impaired vision forces significant changes in life-style.
I saw the shadow of my cataract everywhere—on my
reading, driving, recreation and job.
Once the cataract was diagnosed, I had to stop flying an airplane, which
is essential in my work; I could no longer pass the pilot’s medical examination. I needed surgery; the only available
treatment for cataracts.
Vaguely, I recalled horror stories of cataract
operations in which patients were hospitalized for weeks, eyes bandaged, heads
locked in sandbags. A neighbor of mien
who had twice undergone cataract surgery eased my fears. He said modern techniques could reduce
hospitalization to a day or two.
Somewhat relieved, I considered the options I’d have
after surgery. Once a clouded lens is
removed, something must be substituted to focus light rays on the retina. Cataract eyeglasses or contact lenses are
the traditional alternatives. But each
has definite limitations for certain people.
On being introduced to thick cataract eyeglasses,
most patients feel they have moved into the fun house’s crazy-mirror room. Parallel lines bend. Door frames bow inward. Floors are wavy. Peripheral vision is severely restricted. The eyeglasses magnify about 30 percent,
meaning they can’t be worn when one eye is normal.
Contact lenses, which cause a 6 to 10 percent
enlargement, are compactable with a normal eye, but can be difficult to manage,
especially for anyone with shaky hands, arthritis or poor coordination. Patients with dry eyes or allergies also
have difficulties with them. Most
contacts must be taken out daily for cleaning, and to rest the eye.
To escape either of these choices, a growing number
of cataract victims—approximately 100,000 in the United States last year—are
turning to intraocular lenses [IOLs].
Pioneered in Europe, IOLs duplicate nature’s way of creating sight: a
plastic lens surgically implanted in the eye gives vision [essentially no
magnification] 24 hours a day and never has to be touched, adjusted or cleaned
by the patient. Still, because implants
require additional surgical steps, they do involve greater risk of
complications than simple cataract extractions coupled with spectacles of
contacts.
IOLs are not for every eye. It takes a skilled ophthalmologist to
ascertain when IOLs are advisable, and a well-trained surgeon to implant
them. In general, IOLs are not
recommended for relatively young patients.
In September 1979 the National Eye Institute
sponsored a Consensus Conference to determine guidelines for the use of the
intraocular lens. Participating
ophthalmologists, research scientists, consumers and others recommended that,
in general IOLs be used in elderly patients.
They also suggested that use be restricted to one eye unless special
needs of the patient indicated otherwise.
Before deciding on an IOL implant, I sought information
everywhere, especially since the ophthalmologist I consulted had shown no
enthusiasm for the technique. I again
talked with my neighbor, who had implants in both eyes and could read without
glasses. He mentioned friends who also
had good vision with IOLs. I talked
with his ophthalmologist, Dr. Steven G. Cooperman of Beverly Hills, California.
Also, I asked a neurosurgeon friend to refer me to
other ophthalmologists. One said that
implant techniques were steadily being improved and lens designs refined; he
considered implants safe. Another said
that he did not perform implants. That
was not surprising. Until the 1970s,
implants weren’t used much by U.S. doctors, and not all ophthalmologists are
trained to do implants. [Others feel they cannot conscientiously recommend them
because of the greater risks.]
I read everything I could from the Food and drug
Administration, including what was to me a rather scary statement explaining
why the agency is investigating the safety of IOLs. May be implants are too dangerous, I thought, and began to
waver. Then I came across an article in
the FDAs “Drug Bulletin.” It said there
was “widespread acceptance” of IOLs by doctors, adding that 3000
ophthalmologists in 2500 U.S. hospitals were doing implants. That certainly did not indicate gloom and
doom. I could not believe that one in
four ophthalmologists would be inserting IOLs if there were an intolerably high
risk.
So, in august 1978, I elected to have an implant and
went to Dr. Cooperman. Within three weeks
of my original cataract diagnosis, I was in a hospital, prepared for the
operation.
There are several methods for removing cataracts;
the surgeon chooses the procedure best suited to the patient. In one method, the ‘intracapuslar”
extraction, the entire lens and its surrounding capsule are taken out. Although this means a relatively large
incision [half an inch or so], the procedure is quick and is used by most
ophthalmologists.
In my case, Dr. Cooperman went to and
“extracapsular” extraction. Looking
through a microscope, he cut an eighth-of-an-inch incision at the outer edge of
the cornea and lifted the corneal flap out of the way. He then separated the lens nucleus from its
capsule and cased the nucleus through the pupillary hole into the eye’s front
chamber. Then he inserted a hollow
titanium needle, and with high-frequency sound vibrations softened and
liquefied the cataract. ] NewYork’s Dr.
Charles Kelman developed this process, called phacoemulsification,] the
fragments were removed by suction through the hollow needle, along whti the
front portion of the lens capsule, leaving its back in place.
From among the many styles of implant lenses, my
surgeon had selected a two-looped Binkhorst type [named after Cornelius
Binkhorst, a Dutch doctor famous for his implant surgery. To insert a quarter-inch plastic disc into
my eye, Cooperman first widened the corneal incision to accommodate the
lens. Them be maneuvered it into place
and anchored it by slipping under iris the two plastic loops extending from its
sides. The wound was stitched shut, the
eye medicated and patched. The surgery
had taken 21 minutes.
The patch came off the next morning, and after 20
hours in the hospital I was discharged.
Three rules were lay down: prescribed drops three times a day for a
month; don’t strain in heavy lifting; sleep for several nights with the eye
covered by a protective shield.
How was my sight?
Blurry. Although I could work
and read with my good eye, I was worried.
I would stare at digital clock, wanting to strangle the numbers into
recognizable shapes. I tested the
implanted eye continually. One night a
star I had not previously been able to make out suddenly popped into view. It was my own personal miracle.
The blurriness gradually tapered off until the eye
just had double vision. Tennis court
No. 2 was 22. On the second post-surgery visit to my doctor he found minuscule
swelling around the sutures, which was pulling the cornea slightly out of shape
and causing the dual images. This is
not unusual. Once he had snipped three
stitches to relieve the pressure, my vision cleared. With a corrective lens, my eye tested 20/20. Absolutely normal!
At the 1979 international symptom of the American
Interlobular Implant Society, I heard Miami’s Dr. Norman S. Jaffe, a veteran of
more than 4000 implants, report that 90 percent of his IOL patients got
essentially normal vision, good enough at least for a driver’s license. ‘Most of the remaining 10 percent had other
conditions that prevented a similar degree of improvement]. He contended that good surgeons, using
high-quality IOLs, have the same success rate.
The society’s president, Dr. Robert C. Drews of St.
Louis, declared, “IOLs have come of age.”
Referring to the continuing FDA investigation, which after one year of
monitoring all implants found no reason to suspend the procedure as unsafe,
Drews called IOLs an “overwhelming success.”
Since I am in the FDA study, let me add some
details. One year after the surgery, my
implanted eye tested 20/15 with ordinary glasses—better vision than I’d had in
years. For distance vision, I am 20/20
without glasses. My new driver’s
license says I do not need corrective lenses.
And the Federal Aviation Administration has approved me once again to be
a plot. One surgeon has an apt
expression for all this. He calls it
IOL. “Happiness factor.”
