Tuesday, February 8, 2011

Cataract Surgery

When I was a major at Scott AFB in downstate Illinois, I was also a weekly science columnist with the Belleville News-Democrat.  I wrote several columns about medicine and especially about ophthalmology. In posting this column that was written over a decade ago, I was surprised to see that while the surgery has improved by leaps and bounds, the essential magic of cataract surgery was still present.

With the continual debate over national health policy, something seems to have been forgotten.  Miracles are taking place.  Every day, in every city, modern medicine is performing miracles.  Surgeries that would have been impossible a few years ago are performed in community hospitals.  These “miracles” have become so commonplace that we forget what has been accomplished.
Cataract surgery is the most commonly performed operation in the United States.    The days of the Coke bottle lenses are gone.  Fear of blindness from this condition is virtually eliminated.  These days, everybody has a relative or friend who has had this operation.  Yet, most people are not exactly sure what is done.
The eye is truly like a camera.  A cataract is a dirty lens.  It can distort the vision, cause glare, blur words, and turn white into dull gray.  The surgery removes the dirty lens and replaces it with a man made implant (a bionic eye as one of my patients puts it).
How does the lens come out?  There is no such thing as laser cataract surgery.  In some patients, a laser has to be used AFTER the surgery.  Instead of a laser, current techniques use the same energy that the obstetrician uses to find out the sex of unborn children--ultrasound power.
I like to use a grape model to explain how we operate on the lens.  First we take a tiny needle and tiny tweezers and tear a small circle of grape skin off.  Then we take a tiny ultrasound hose which shakes and sucks out the grape part.  A little bag of grape skin is left.  A small piece of plastic or silicon is then put inside this bag as a replacement lens.  The bag holds this lens in place just like the original lens.  Vision is restored.  I hope this explanation doesn’t spoil your taste of grapes.
The technical aspects are interesting but they don’t tell the whole story.  My excitement occurs in the following days when people begin to see again.  As one of my patients said, “You know, as I get older, everything gets worse.  From my arthritis to my hearing, I seem to be breaking down.  That’s why it’s so special to have something get better.  I see like I used to years ago.”
That sums it up better than I could have done it.  The miracle is the magical rejuvenation of sight.  Sadly, millions of healthy people in the rest of the world are totally blind from cataracts.  Many are forty to fifty years old, in the prime of their lives, and yet they cannot work, cannot see their children, or cannot even see a doorway.   The newspapers report on the aging of America, but in reality, the world is aging.  Let us hope that miracles will take place there as well.

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