None So Blind As Those Who Will Not See

Alright, since I am entirely alone, and this is in effect a diary, I might as well knuckle down and try to sort out the mumbo jumbo of current ophthalmologic theory.

My focus is on cataracts. The reason for this is simple. A presumably “nuclear” cataract has seriously affected the vision of my right eye, and threatens to eventually do the same sort of thing with the left eye as well.
Having first gone to see an optometrist and shortly thereafter an ophthalmologic surgeon, I was left with considerably more questions than I was comfortable with, and the answers I did receive had to be extracted almost by force, and were simplistic and routinely condescending.

Throughout this whole time, I have sought real dialogue and counsel from people in the field. I have had no success in this regard at all. The closest I came was to finally have a ten minute follow-up conversation with the surgeon with whom I had scheduled the surgery. I achieved this small victory only by canceling the operation.

During that telephone conversation, the answers I got were vague, statistical, and dumbed-down to be suitably understood by someone of plebeian patient mentality. The doctor was clearly surprised that I did not just leave her to do what she does. There are protocols in place, presumably to assure that patients are given enough facts to be able to give “informed consent.”

You are told that more than 9 out of 10 cataract operations have a good result, meaning that there is some improvement or great improvement in the sight of the eye. In the remaining ten percent, there is a range of unfortunate outcomes from no appreciable improvement to various complications secondary to the surgery, to blindness.

What is glossed over with these simplistic statistics, and what you will not hear at all if you do not dig in and ask the doctor for some specifics about some of the complications by type, is that certain complications happen to the majority of those having cataract surgeries. There is a secondary cataract which develops, much more often than not in the capsular membrane, and which is corrected by subsequently burning a laser hole in the membrane. (This is an additional procedure, done at a later time and billed separately). There are also some post surgical problems of other sorts that relate to the kind of surgical procedure performed.

What I am saying is that much of what the doctor tells you to elicit your informed consent, amounts more to salesmanship in the guise of information. And the worst of it is, I do not believe the doctor even realizes it. It is simply an artifact of how the system has evolved. It is the “routine” way they have developed as an industry to sell to their customers.

Now I want to turn to another element of cataract treatment. From the perspective of the industry, the treatment of choice for the entire range of cataracts which interfere with vision is surgical. An extremely tiny segment of the medical community thinks that any other method of reversal or stabilization of a developing cataract is worth consideration.
Surgery is the gold standard, and it is worth many billions of dollars every year.

The consensus is, if you get old enough, you will get cataracts, and will require surgical intervention. The surgery is often less than an hour and can range in price from three to five thousand dollars.

Soon I will be talking about some of the elements of the evolution of cataract surgery over the past three or four decades, some things which may be serious blunder in the field, and some possibilities which have not yet been explored. I realize that my remarks are less and less diplomatic, and will find physicians even less receptive to a conversation on this subject.

But what about the rest of you? Are you really receptive to the notion that eventually you will have to make the same sorts of decisions with which I am faced now? One would think that some of you would be moved to comment or ask some hard questions.