For a man of a certain age, life would seem to hold few surprises. If he’s been careful and lucky, he will have arrived in his sixties with his health intact, his family and friends within easy and loving reach, his libido alert, his love of life in full bloom, and little to regret. But he will also have become a bit worldly and jaded, and will rarely be truly surprised by anything, good or bad.
I was recently profoundly surprised, in a wonderful way: I was given back the ability to see clearly. I mean this quite literally. Overnight, I went from having mediocre vision in daylight and truly lousy vision at night, to 20/20 vision all the time. It was revelatory.
Like millions of people, I am (or was) nearsighted, and have been since a rather young age. Problems with eyesight were nothing new to me. My mother never wore glasses, but my father had truly bad eyes. He’d had double detached retinas as a child, and would try to frighten me into using better reading light (I loved to read, but for some reason preferred dark corners to do so) by repeating the story of how he’d had to lie in bed with his head sandwiched between sandbags for a week after the surgery needed to save his sight. (One can indeed only shudder to imagine what eye surgery was like in the 1920s.)
Sometime in high school I realized I couldn’t read what teachers were putting on the blackboard. I was given some geeky glasses and was temporarily cured. When I grew older and vainer, I started wearing contact lenses, which provided better acuity than glasses, but which involved a lot of fuss with chemicals and heat to sterilize them. Finally I graduated to disposable contacts, which were thrown away each evening and replaced by new ones each morning.
I lived with this happy visual solution for the next couple of decades while my eyesight grew weaker, requiring stronger and stronger correction for distance, and reading glasses (over the contacts) for close work (as a lawyer, there was a lot of close work).
In the last year or so, I had begun to notice a haziness surrounding everything in bright daylight, like the soft-focus used in romantic movies in the 70s, and a real difficulty in reading distant street signs when driving at night. High-def TV didn’t seem all that high-def. Computer screens, situated in that no-man’s-land between near and far, became annoyingly low on “resolution,” no matter how I upgraded the hardware or shifted my seating position. When playing golf, I often couldn’t follow the flight of the ball, and there were times, on a beautiful night on a beach or in the high desert where the air is most crystalline, when my wife would point out a star or ask the name of a constellation that I just couldn’t see. The realization that she and I were literally perceiving different realities was perhaps the final straw.
I complained to my ophthalmologist and he agreed to crank up the strength of my contact prescription yet again, but then he said something else: the real problem was that I had incipient cataracts, and this would only get worse.
Now the word “cataracts” is one that I associate with people who are truly old, a category I do not yet willingly inhabit. My father, vision victim par excellence, had of course had cataracts in addition to all his other eye maladies, so it was no real surprise that I had inherited this tendency of the natural lenses of the eyes to become cloudy over time, flecked with little granules of opacity that no amount of optician’s light-bending could overcome.
During my eye exams, the problem was brought home to me by having me hold a paddle full of tiny pinholes in front of my eye, so that only slivers of light from the chart at the other end of the room could penetrate the eye. Thus channeled (like the photons in the famous double-slit experiment that showed that light is somehow both particle and wave), the murky blobs on the chart suddenly congealed into actual, readable letters: light shot through a pinhole could avoid the cataracts and make it to the retina without interference, whereas normally the swarm of photons entering my eye caromed off the cataracts in all directions, resulting in the haze I was all too frequently experiencing.
In my father’s day, cataracts were dealt with by surgically removing the defective natural lenses of the eye and then compensating for that absence with really thick glasses. It was a very big deal with a less than satisfactory outcome, and I wanted no part of the problem or what I knew of the solution.
It was explained to me that things are different now. In the last decade, no area of medicine has seen greater technical advances than ophthalmology, where formerly risky and scarily invasive procedures are now performed with low trauma and extraordinarily high success rates. Across an array of eye ailments, highly effective and relatively cheap solutions that were only recently ophthalmologist’s dreams are now routine, and the current cure for cataracts – intraocular lens replacement – is ordinarily accomplished in a 15-minute procedure on an outpatient basis.
Still, I waffled. Eye surgery is eye surgery, I thought, and those two words should not appear in the same sentence, as anyone who has seen Roman Polanski’s “Repulsion” will attest. So I muddled along for another few months, increasingly avoiding driving at night, fruitlessly searching the sky for errant golf balls or elusive stars, and squinting at my computer screen. Finally, with my COBRA coverage about to expire and my tolerance for blurry movies waning, I scheduled the procedure.
My ophthalmologist is the major domo of a local “Center for Sight,” which is code for “Medicare money machine.” The waiting room is usually crammed with geriatric clients, probably none of whom is personally paying for more than a fraction of the charge for his expensive attentions. I’m usually the youngest guy there (really), and the good doctor has developed a tendency to speak more loudly than necessary in order to be heard by his average octogenarian patient.
A week before my surgery, I’m given a full eye exam. I’ve stopped wearing my contacts a week earlier in order to allow my eyes to resume their natural shape (even soft contacts distend the eye slightly). This means I have had to wear glasses, and wearing glasses makes me very grumpy. For one thing, I see even more poorly out of them than with my contacts.
Today I am peering into the front of an expensive-looking device while a nurse takes measurements of the focal lengths of my eyes. This will determine the precisely right new lenses for me. You can choose lenses that provide near, middle, or distance vision, and some new lenses are claimed to do all three, but I’m a purist: give me good vision at a distance and I’ll wear glasses to read if I have to.
My ophthalmologist, Dr. Davidoff, has explained the procedure before, but he goes over it again (this is only my impression of it, so don’t do this at home — get your own doctor’s account): the eye is thoroughly numbed with a topical anesthetic (you’re awake and aware throughout), and a tiny, beveled incision is made where the cornea meets the pupil. Through this hole, a tiny, magic ultrasound device is inserted that emulsifies the old lens to a fine paste, which is then gently sucked out of the eye. Your new lens, the new window on your soul, folded up like a tiny, high-tech origami, is inserted into the little sack of tissue, still in the eye, that held the old lens. Then the surgeon trips a microscopic switch on the new lens, and little armatures spring out of it to hold it in place within the sack. The original incision was beveled so that the internal pressure of the eye holds it shut from within, making sutures or lasers unnecessary.
And that quickly, in a span of 10 minutes or so, it’s done. It’s done only one eye at a time with at least a couple of weeks’ interval in order to check for complications (and, though they never say this, to leave you with at least one eye intact if they totally screw up on the first one).
It all sounds wonderful, but I’m more than a little nervous as the day approaches. It’s still eye surgery, and there can be complications (though the incidence of problems is about one in a hundred). Do I really need to do it now? Should I wait? Maybe the technology will get still better. Maybe my sight isn’t that bad yet. (No, it’s bad.)
The day (or rather, the very early morning) arrives and my dear wife Courtney accompanies me to the local hospital where the procedure will be done. She’ll need to drive me home afterwards, as I’ll be slightly high on a tranquilizer (I hope) and my eye will be dilated to the size of a saucer.
I’m ushered into a nice little hospital room where I lie on a nice little hospital bed while I’m fed that little happy pill (not sure what it is) and my blood pressure is taken (Courtney later tells me it was so high she was afraid they’d call off the procedure). I’m asked for the first of what will be at least a dozen times which eye we’re doing today (the left). The repetition of this question has two purposes: to make sure we’re all in agreement, and to see if I’m coherent, as my conscious cooperation will be needed during the procedure.
A burly orderly squirts anesthetic into my eye, and in minutes it feels like I have a billiard ball in the socket where that eye used to be (though I can miraculously still see out of it). A nice young trainee nurse inserts an intravenous drip into my hand near the thumb (this turns out to be by far the most painful part of the entire process). Another nurse puts dilating drops in the eye. Everyone is extremely nice; I’m probably the youngest person they’ve seen in here in months.
Finally they’re ready for me. I later learn that Dr. Davidoff does about a dozen of these procedures a day, once or twice a week. Today he’s scheduled for 14 of them. There’s a sort of slow tango involved: two operating rooms are in use, and when he’s done in one he slips through a door to the other one, re-suits in new sterile garb and does an eye while the first O.R. is readied with another patient. This goes on, back and forth, for several hours. He probably does these things in his sleep.
It’s near freezing in my O.R. (the better to suppress germs, I’m told), so I’m bundled up in a blanket fresh out of a warmer somewhere. I’m asked yet again which eye we’re doing today (still the left). I’m not nearly as tranquilized as I would like to be, and practice slow, meditative breathing while someone tapes a blue sterile drape over my face so that only my left eye is exposed. It’s a little hard to breathe under there, and it smells of antiseptic. In what I hope will be taken by the O.R. crew as rakish insouciance, I ask whether they couldn’t make the sterile drapes so they smelled like something nicer, like Cinnabons. No one laughs much.
Finally I hear Davidoff come in and suit up. I can tell it’s him because he’s from New York and sounds it. He’s about the size of my wife and has a huge shock of unruly white hair (though if I roll my billiard ball eye in the right direction, I can see that today it’s covered in a sterile cap). I call him the Jewish Leprechaun (though certainly not at this moment).
He sits out of sight behind my head and maneuvers a very bright light into my eye. He puts something over the eye and all I can see is an intense spot of light that seems to be subdivided into distinct segments. There follows a period of time when I hear high-pitched sounds and watch the light and feel essentially nothing but a very slight pressure on the eye.
At one point he asks me to look to the left. He tells me things are going extremely well, and I mutter “that’s good” inanely from under my blue tent. At another point I think I hear him asking for “a Davidoff,” and as things seem to be going well I hazard to ask (moving my face as little as possible) whether he has named an instrument after himself. He tells me that indeed he has, but no one uses it but him because the manufacturer wouldn’t share royalties with him so he wouldn’t turn over the design (or something like that). I decide not to pursue this and fall silent again.
Now something has changed. Something spreads across my vision, and the segments of the light seem clearer. A few more minutes and we’re suddenly finished, the drape is peeled off my face, Davidoff has spun through the door to his next procedure and I’m being wheeled down the hallway, staring at everything.
I’m shocked at how much I can see. Signs that were blurs now convey detailed information. My wife’s pretty, anxious face is startlingly clear. I’m staring at people’s nametags and reading them easily – something I could never have done 15 minutes earlier. And this with just one eye working!
We thank everyone and Courtney goes to get the car while I’m put in a wheelchair and wheeled down to the entrance by a little gray-haired lady a third older than me. This seems backwards, I think, but keep it to myself.
Later, at home, I take a nap. There’s a little sensitivity around the eye, but nothing you’d call pain. I have to avoid showers for a couple of days. I was told I could exercise normally, but I think I’ll put off running for a day or two. I have antiseptic drops to put in my eye for the next three weeks.
Even with just the one eye restored, I can see things I haven’t seen in decades: individual blades of grass and leaves on trees, the lettering on distant street signs, a friend’s face while he’s still down the block, the oceans of the moon. Night driving is fun again. Even close-up sight has improved; reading glasses now reveal every detail on my iPhone (who knew those app icons were so pretty?) or that high-resolution computer screen or on a menu in a dimly lit restaurant.
I’m living between sight and non-sight now, waiting to have the other eye done. The contrast between the clarity with which I see out of the one eye and the murk in the other is startling (I still can’t wear contacts in the bad one). I can close the right eye and see the future, close the left and see my blurry past. With both eyes open my brain compensates for the bad one with heavier reliance on the 20/20 information from the new lens, somehow filtering out the drek it’s still receiving from the old one. I can hardly imagine what near-perfect, binocular vision will be like.
But I’m ready to be surprised again.