I spend a lot of time on my eyes — their vision, not their wrinkles. Blind as a bat since age 5, I’ve worn glasses and contact lenses; I’ve had eye surgery. Now, dealing with cataracts and glaucoma, I’m naturally drawn to headlines like “New Hope for Aging Eyes,” a chirpy article in AARP’s magazine. I was disappointed.
Many new advances are in the pipeline when it comes to eye care for seniors. But all new treatments involve risk. Some sections of the AARP piece read more like a press release than journalism. For example, an ophthalmologist who is a “consultant” for an optical manufacturer says of its newly-approved intraocular lens (IOP). “It’s such a leap forward that the Food and Drug Administration has recognized this as a completely new category of lens used in cataract surgery.”
My eye story: In 1998, I heard similar “testimonials” when I contemplated having LASIK, then the latest laser-assisted procedure to correct nearsightedness. A “high myope,” I couldn’t navigate my bedroom without reaching for my glasses. The lure of life without contacts trumped my fear of eye surgery. I had an excellent surgeon, and I was thrilled with the results. I wrote about it in New York magazine. I wasn’t thinking about cataracts twenty years ago. Nor did I know then how many post-laser-surgery patients would develop serious vision problems.
When it comes to any health care decision, buyers better beware. Below are a few things NOT stressed in the AARP article that all consumers of “cutting-edge” cataract treatments should know and ask:
Cataracts are common but the surgery is NOT a slam-dunk. According to a Michigan eye center, “over 90 percent of people have a cataract by age 65 and half of the people between the ages of 75 and 85 have lost some vision due to a cataract.” In most cases, the surgery is successful and without complications. “It was nothing,” patients say afterward. But the “nothing” involves a surgeon making a slit in the envelop (capsule) that houses your eye’s natural lens. The lens, along with the cornea, determines how well you see. With age, it crystallizes and obscures vision. If you feel like you’re constantly looking through a cracked, filthy window, it’s time to seek help. Understand what’s at stake. If you’ve already had eye surgery, such as LASIK, or you have other eye conditions, like glaucoma, it’s even more important to go to a doctor who has handled such cases before.
My eye story: When it’s clear that my cataracts are “ripe” enough to warrant surgery, I consult five highly-reputed surgeons in New York City, including one who performed LASIK on my eyes 20 years ago and a retired cataract surgeon who had no skin in the game but years of experience. When friends wonder whether I am “overdoing it” or “confusing myself,” I answer, “It’s my eyes!” If I am going under the knife again, it will be (pardon me) with my eyes wide open.
Cataract surgery isn’t always done with a laser. Ask your surgeon what the procedure involves? Some surgeons use the “traditional” phacoemulsification method and others use a “bladeless” technique in which the incision is made with a laser. You’re likely to find more doctors using laser in big cities than if you went to smaller cities or towns or to a locale with less-affluent patients. Medicare doesn’t pay the extra cost of using a laser (around $1000-1500), and the jury is still out on which method is “better.” According to the American Academy of Ophthalmology website: “…studies have not shown that laser-assisted cataract surgery results in fewer complications or better visual outcomes than traditional cataract surgery. With any type of cataract surgery, your outcome depends in large part on the skill and experience of your eye surgeon.”
My eye story: I spend hours Googling “cataract surgery” to learn more the procedure and “glaucoma” and “myopia” to understand the possible complications. And because I’m not squeamish about such things. I also watch both methods on YouTube. I’m in New York City, Only one of the five surgeons I consult still uses the traditional method. I say to him, “I hear from other surgeons that the healing is faster after laser,” and he responds, “That’s what the manufacturers of the laser machines tell them to say.” I choose him.
Not everyone is necessarily a good candidates for the “new category” of lenses. After the crystallized lens is removed, it is replaced with a hair-thin plastic intraocular lens. Ask which IOL your doctor plans to use — and why. The IOL described in the AARP article is the newest of several “premium” IOLs on the market, including bifocal lenses and lenses designed to correct astigmatism or to help the eye shift focus. Premium lenses are marketed heavily to Baby Boomers and not covered by Medicare. Some patients don’t want to pay the extra cost and some are not good candidates.
My eye story: My surgeon and my optometrist (whom I’ve known for 40 years) recommend a premium IOL because I have high astigmatism. I have mixed feelings. Four of the five surgeons said a “conventional” lens was called for in my case, because I had LASIK, which thins and reshapes the cornea. I choose the one who disagreed. As it turns out, the premium IOL is worth the risk — and the extra $1500. I see more clearly through my newly-corrected right eye than I did after LASIK which didn’t correct my astigmatism.
Schedule recurring eye check-ups. Eyes can change unexpectedly. Just ask New York Times writer Frank Bruni, who one morning woke up unable to see and later wrote about it in “Am I Going Blind? My 80-year-old sister-in-law was told on a routine visit that her eye pressure — the barometer of glaucoma — was so high she needed immediate surgery. Six months earlier, her pressure was normal. Such crisis aside, if serious eye conditions are caught early enough and if they’re closely monitored, they can at least be slowed down. Drops or medications can be adjusted. And other aspects of your health can be shared with the practitioner so he or she gets to know the whole you, not just your eyeball.
My eye story: I see my optometrist (OD) every three months instead of six, mostly to monitor my pressure. This man has cared for my eyes for more than 40 years. Talk about an important consequential stranger! He is a sounding board and a guide. Recently, I made the rounds, and, in some cases, had multiple consultations with the aforementioned five surgeons, a retinologist, and a glaucoma specialist. (Who knew that such a small body part could support so many sub-specialties?) Lucikly, my go-to guy was there for me, coordinating my care.
Eye disease is scary but as the AARP headline promises, there is “new hope.” Diseases that once blinded us no longer necessarily win. I believe — perhaps, given my eye story, I have to believe — that you can stack the deck somewhat in your favor by educating yourself, picking the right doctors, and being vigilant. But it also boils down to what my centenarian friend Zelda answered, whenever anyone asked her “secret”: LUCK
I had some problems (luckily not too serious ) after my first cataract surgery done in NJ. Several years later (it tooK me that long to do it again) I had a much better experience with a wonderful Opthamologist in of all places Plantation FL
Good surgeon is key! Glad you found one.
Vision “slipping” (my term, not docs’) is common after LASIK, too. I eventually had to get glasses for driving, especially at night. I asked my cataract surgeon about slipping and was told, “It shouldn’t,” which was not exactly a NO! That said, even if I someday have to get glasses, they won’t be like the coke-bottle lenses I once had to wear! (Oh! the horror of those days when I had to wear them because I’d lost a lens or for some other reason couldn’t wear them!) And when I was growing up, “fashionable” eyeglasses didn’t exist! As for night driving, I think many, if not most, “seniors” have issues, even those who were 20/20 most of their lives!