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.

Innovative Eye Surgery For Cataracts

Those who have read some of my previous posts here at Eureka Ideas Unlimited and on Skin Cell Forum are already aware that I have an advanced nuclear cataract in my right eye and a developing one perhaps two years behind in my left eye.

Although I hadn’t been to a doctor for a few decades, this year I went first to an optometrist and then to an ophthalmologist and scheduled the removal of the right lens and surgical implantation of an intraocular lens.
I ultimately cancelled the surgery for a variety of reasons which I have already written about. Central among these reasons was the fact that I saw several of the procedures involving phaco emulsification of the opaque lens, the chopping of the lens into small pieces, and the removal of the pieces by suction, and the insertion and placement of the intraocular lens in the cavity left vacant.

I saw a variety of things in these procedures which gave me food for thought. To put it more succinctly, I thought better of the procedure. But one has a responsibility, if being critical of the way things are done, to give some notion how they should be done instead. So, for each part of the procedure that I thought could be improved on, I worked out some possible ways in which it could be done better.

For several months I talked about these possibilities on Skin Cell Forum. (some of the people on the forum are effectively blind, a few with exceedingly rare eye conditions requiring experimental surgery.) I am pretty confident that some of these experimental surgeons of these patients have heard about me. None, to date, has shown the slightest curiosity as to whether any of my ideas have merit. This points up, with great clarity, the ivory tower nature of the medical "community."

The surgeon who I went to, was not a “breaking edge” sort of girl. She wanted only “routine” cataract surgeries on her agenda. If any unusual incident arose, she would call in someone who could handle it. The last thing in her mind is to try anything new. And it became the last thing in mine to use her.

So, I haven’t been able to attract the attention of the pioneers, and I don’t want the journeymen surgeons. Quite a quandary. I have only personally performed one serious eye operation. The eye had been seriously damaged and was in front of the orbit, and therefore unblinkable. The patient was nearly dead, so the other traumatic injuries needed to be stabilized.

It was about a week before I was able to remove the eye safely. The only complication was some secondary infection, which I got under control in another few days. The patient made a full and uneventful recovery. I have had no training as a surgeon. Just emergencies in the field.

I really did have some hopes of finding an experienced surgeon with whom to discuss my ideas about changing the nature of cataract surgery. But the group is such an insular bunch that it is not really even a remotely likely prospect. and I won’t be engaging in the usual bureaucratic gauntlet of the hospitals and government agencies either. I’m also treating my blood pressure. Going through “channels” would not be productive in that regard. Currently my blood pressure is in better shape than my eye.

The good side is, I am learning a great deal more about eyes and vision and blood pressure as well. These are not inconsequential benefits from being more self-reliant. And if I can’t find a surgeon with whom to work out the new procedure, I’ll eventually sort out another means to restore my sight.