How I Beat the Tyranny of Cataracts: By EARL SELBY with MIRIAM SELBY

Courtesy: Medical Miracles, from Readers Digest 1981. November.

From the frontiers of science and the far horizons of personal courage, these stories of medical triumphs and miracles will reaffirm your faith in the awesome powers of the human spirit. Dramatic victories and human triumphs.

Selected and edited by the editors of Readers Digest

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.”