Cataracts
Hi,
You said, "Jim, chime in." so don't say that you didn't ask for this.
Cataracts through the ages.
I believe that cataract surgery is the oldest recorded surgery. There was a big improvement in the surgery when bronze was invented because it could hold a sharper edge.
The cataract surgery of WWII time and up until approximately 1978 was still a pretty brutal affair. The surgery was crude, the suturing was horrible. The patients had to lie on their backs with their head sandbagged into a non-moving position. Healing time was slow.
The glasses were horrible. They made the patient's eyes look like a couple golf balls. The glasses optically cut off the peripheral vision. The patient could be standing there and suddenly from the side, without warning, another person would appear nearly in front of them. The spectacles were extremely heavy; one lens would weigh more than several pairs of today's glasses.
With that said---The new surgery techniques are wonderful. The surgery is many times safer than a tonsilectomy and a whale of a lot less gory. With the newer techniques and implant lenses, sutures are not needed.
I was in an office where 16 to 20 cataract surgeries were done in a day. We kept a log of each thing done. Everything was done carefully and in order. For example: There were three stations that had instruments to measure the shape of the cornea. Two different techs using two different instruments routinely took the readings. If they did not agree, another tech, using yet another instrument took readings. This went on until agreement was reached.
The results of all of the surgeries were analyzed to see what could be done better.
The surgeon was superb. He could tie a knot in a suture that was so fine that you could only see it under the microscope. However, if this guy picked up a screwdriver or a hammer---Every one ran for cover because it wasn't safe to be near.
The surgical charge for each eye was almost six-thousand dollars. There was so much profit in cataract surgery that new implant lenses, new surgical equipment, etc. seemed to come out almost daily. Cataract surgery came out of the dark ages rapidly because there was a giant profit to be made. Today, we all benefit from that.
Patient "Down time" consisted of: Patient has surgery. Patient comes out of surgery. Patient given something to eat and drink because surgery was done on a fasting schedule. Patient was kept in the office for 30 minutes. Pressure readings to be sure glaucoma was not induced were taken. Patient was sent home with their eye meds and a semi-clear patch over the operated eye.
Patient was allowed to remove the patch some during the surgery day. After the one-day Post Op. the patch was to be worn at night so they would not damage themselves while sleeping. We had one patient that played golf the same day, after the surgery. Patients were not to pick up anything heavy for a few days.
Most patients had 20/20, uncorrected the day after the surgery. All patients, regardless of age, required reading glasses after the surgery. The implant lenses of that day could not change focus (they have lenses than can change focus today).
Surgery typically ran 15 1/2 to 18 minutes per eye. Only one eye was done at a time. The one-at-a-time thing is another story. We had an observation room where the family could watch the surgery. In that room was a large TV which had a view through the microscope that the surgeon was using for the surgery. There was someone in the room to explain what was going on to the family.
Most insurance companies in the USA will not pay for cataract surgery until the patient's vision has dropped to 20/60. If the patient cannot read print at 20 feet that a person with 20/20 vision could read at 60 feet they have 20/60 vision. If you happened to be an airline pilot the surgery might be done when your vision had only dropped to 20/25. That is because your livelyhood was at risk and the fact that you could become obsolete as a pilot in the time that it takes most people's vision to deteriorate to 20/60.
Off Subject For a Minute: Take a guess how often a navy pilot that lands on an aircraft carrier has to be recertified. Answer at the end of this lengthy post.
Cataract surgery is considered one of the safest surgeries to have done (at least in the USA). Yes, it is spooky because it is your eyes.
At the office we had seven (7) identical examination rooms. We would have a "Grand Rounds" type of thing for GPs, internists, etc. showing them cataract patients at different levels of cataract development. There would be a chart and a write-up about each patient so the visiting docs would know what they were looking at.
One time we had a twenty-something year old lady who had the faintest trace of a cataract beginning. Three weeks later this lady's information was obsolete. During that three-weeks her cataracts developed to something like 20/100. She was ready for surgery. She had not had any falls, blows, collisions, etc. to cause the sudden change.
People who are out in the sun a lot and who do not wear sunglasses, get their cataracts much sooner than other people. Other contributing factors are: high blood pressure, high cholesterol, dehydration, diabetes and I cannot remember what else.
If you are still with me---That navy pilot has to be recertified every seven days. That just plain blew my mind. I picked that info up at a lecture on research about refractive surgery done by the Navy. What they learned changed a lot of thinking about refractive surgery.
Enjoy,
Jim