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Through The Cataract Fog

Editor's Note: Our narrator for the audio version of the Canadian Blind Monitor, Garry Gaudet, has written an article for this edition on recent experiences with cataracts, which caused him temporary visual impairment. He now has lens implants in both eyes. Garry comes to us with a professional background of thirty years in broadcasting and print media in Saskatchewan, Alberta, and British Columbia. He spent the past decade with Okanagan University College in Kelowna, BC, in media relations and corporate communications. His duties included researching and writing the internal newsletter, editing the annual report and other publications, and co-ordinating special events. This year, Garry has taken early retirement to set up his own business, providing custom professional audio and video voicing and writing services. Garry hopes to narrate talking books in the near future, and would welcome your suggestions for titles and subjects.

Cataracts bring about a decline in the clarity of vision as the crystalline lens of the eye gradually becomes cloudy. They are generally thought of as a by-product of ageing. Nearly half of all North Americans over age sixty-five and more than seventy percent of people over seventy-five, develop cataracts. So I was very surprised in my mid-fifties to be cautioned that I was close to losing my driver's licence due to an advanced cataract in one eye, with the other likely to need surgical attention not long after.

This is a first hand, non-technical appreciation of the work being done by ophthalmologists, and recent advances in technology, which today make lens replacement quick, effective and relatively painless.

"Practically everyone will eventually develop cataracts over time," one surgeon commented as I settled into his space-age chair, composing myself for a twenty-minute procedure that would lift the cloud from my left eye. "They can appear in infancy and even rarely at birth, but normally don't cause problems until middle age. Today's procedures restore vision permanently, and will never cloud over."

The word cataract has its roots in both Greek and Latin words for "waterfall". According to the CARP News, a Canadian seniors' newsletter, the crystalline lens of the eye gradually turns milky for a variety of reasons. Causes may include cumulative ultraviolet damage from bright sunlight, diabetes, glaucoma, prolonged use of anti-inflammatory medications, and the common lifestyle "nasties" of smoking, dietary fats, and alcohol. The Grolier Encyclopaedia notes that recent links have been made with free radical pathology, a destructive chemical reaction also associated with arthritis, coronary heart disease, and ageing. Our genes may also predispose some of us to the condition.

The current technology of inserting intra-ocular plastic lenses-which are roughly a quarter the size of an adult's small fingernail-has its roots in World War II. An RAF surgeon noted that some pilots developed no permanent problems despite having plastic particles from shattered aircraft canopies embedded in their eyes. The new PMAA plastic compound (Plexiglas) did not react with body tissues. As microsurgical procedures improved in the 1960s, implants became increasingly successful.

Like a majority of adults, I enjoyed crisp, 20/20 vision through early adulthood. Sometime in my thirties, the moon seemed to develop a shadow on one side, and I began holding the newspaper and books at increasing distances. Reading for long stretches became tiring and irritating, for no apparent reason. Since I worked at times with graphics and printing, magnifying glasses were part of my professional equipment.

As I turned forty, my physician sent me off to an optometrist with a note that read, "Mr. Gaudet's arms are becoming too short." A mild prescription for reading glasses resulted, with a correction for a slight astigmatism. Vision in the middle and far distance seemed about the same as before, but, in retrospect, I was slowly losing the ability to distinguish fine features. And just like in the detergent ads, whites were becoming grey.

A follow-up exam years later revealed significant cataract formation in the right eye, and the beginnings of "opacity" in the left. My optometrist commented that eyesight tends to stabilize at around fifty, so the prescription did not need changing, but eventually the cataracts would need to be dealt with. She added that it would not be many years until I might lose my driver's licence without correction.

It is surprising how gradually vision changes, and how little impact the change has on day-to-day activity. My professional activities included photography, writing, editing, and proof-reading print materials, and working with graphics. Regular use of magnifying glasses probably delayed my noticing the decline. The purchase of an auto-focus camera for action photographs, made it less important to be able to focus manually. My recreations include tennis, cycling, cross country skiing, and canoeing, all of which can be enjoyed with less than perfect vision.

A drive to Vancouver two years ago illustrated that it was time for intervention. The weather was so mucky that I was barely able to make out the speed limits along the highway. Just south of the toll booth, it dawned on me that perhaps not all of the blurriness was caused by the fog and rain. Closing my right eye I was able to clearly make out the 90 kilometre limit sign with the left. Closer to the sign, I opened the right eye and closed the left. Good grief! All I could see was a grey blob with dark inside. Just weeks later, my first cataract was removed.

I was more than impressed by the thorough and friendly attention of Dr. Frank De Freitas of Kelowna, in dealing with my first cataract. He took time to discuss all aspects of the procedure, including risks, and arranged for measurements of the eye for the proper lens configuration. On the day of surgery, there was only momentary physical discomfort with the freezing. Otherwise, I did not feel a thing. Introducing me to the members of his team, the surgeon went to work. He was reassuringly gentle, making occasional comments throughout. Eventually my eye saw a field of red; then an overhead halogen light which seemed to rotate from vertical to horizontal as the new lens was put into place. Soon, I was out in the waiting room, munching a cookie and sipping on a cup of tea, waiting for my lift home.

A videotape of the procedure gave me the impression of the yolk of a sunny-side-up egg, being opened up by a small knife working its way in from the white. The ophthalmologist-surgeon gently cut into the lens-enclosing bag, then inserted an ultrasound needle to break the lens into bits and vacuum them out. Once the bag was thoroughly emptied and rinsed, a tiny plastic lens was slipped into place through the opening. Contrary to widely-held opinion, this is not a laser process, but one done with conventional small scalpels.

The following morning, for the first time in years, the stippled ceiling in my bedroom gleamed white in the morning sun, instead of grey, and I could see the wood grain in the blades of the ceiling fan. Amazingly, I hadn't even noticed its absence until that moment.

Last fall, events made it clear that the other eye was due for treatment.

The first situation was during a vacation trip to Saskatchewan. Despite spending an hour cleaning the lenses of my personal, manual camera, I could not seem to get a clear focus. My cousin Jack took a look and said, "It's fine, try it again." When I put the view finder to my right eye instead of the left, the focus was clear and sharp.

A couple of months later, a frayed strand of rope flicked up and scratched my right cornea. At the time, it seemed like nothing at all, but that night the pain grew excruciating. With the right eye useless and watering, I drove to the emergency ward. It seemed quite foggy out. When the nurse stood me in front of an eye chart, I told her, "Well, you're the blue blob on the left of the grey blob." So much for the left eye, and for driving, until the scratch on the right cornea healed.

As my original surgeon had a long waiting list, I was scheduled with Dr. Keith Yapp, who proved every bit as conscientious, thorough, and caring, as Dr. De Freitas had been. The second implant was a breeze, because of the ease of the first. I had only one problem in both cases. There was significant discomfort and pain for the evening and into the following day as the freezing wore off.

I characterize the declining vision to friends by telling them it's like looking at the world while sitting in a steam room. Everything is somewhat hazy. Colours become dull. It is basically impossible to identify a person-friend, relative or complete stranger-from ten feet away, if there's a light source or window behind them.

Since these adventures, I've learned that more than one million cataract procedures are performed annually in North America. In the Third World, cataracts remain a primary cause of blindness.

There are slight risks associated with the surgery. In occasional cases, retinal detachment can occur after surgery, and physicians insist on their patients taking great care with follow-up eye drops, protection, and hygiene around the eye.

In some cases, the removal of a cataract may produce relatively little improvement, because the dense cataract has concealed other problems. Some elderly patients whose lifestyle is relatively sedentary, choose not to have the procedure, preferring to go along with diminished vision against the discomfort and perceived risks of having implant surgery. But in at least ninety per cent of cases, patients experience a return to 20/40 vision or better, and frequently, patients achieve 20/20 vision as an outcome.

For me, the experiences have been overwhelmingly positive. I enjoy close to 20/20 vision and renewed colour and clarity of sight-probably better now than in the past fifteen years.

Reading is comfortable once again, allowing me to perform functions that I deeply enjoy, including narrating "The Monitor". Finally, I hope I can understand and appreciate better, some of the frustrations that declining vision can bring.