Cataract surgery choices and unexpected results
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    My mother was depressed; she felt she was getting old and she could no longer read her precious bible even with her glasses on. When I visited my mother after her cataract surgery, she was a different woman. She was lively, her face beaming with happiness. Good vision can change your life, although not everyone may experience as dramatic a change as my mother. When I started having trouble reading fine print, I thought I needed a new eyeglass prescription. I didn't need a new prescription, I needed cataract surgery.

    Cataract surgery

    About 22 million Americans have cataracts at age 40 or older, according to the American Academy of Ophthalmology. In the 40s and 50s, cataracts may be small and may not significantly interfere with vision, but after age 60, cataracts can cause glare, blurry vision, washed out colors and sensitivity to light. A cataract is the clouding of the lens of the eye. Cataract surgery is usually an outpatient procedure to replace the clouded lens (cataract lens) with a clear artificial lens. After pupils have been dilated, the eye surgeon uses blades or lasers together with ultrasound to break up and remove the cloudy lens. I chose laser surgery, hoping for greater precision. Unfortunately, many insurance policies don't cover laser cataract surgery.

    Lenses

    Once the cataract or clouded lens is removed, the surgeon places the clear artificial lens into the capsule that held the old lens in place. The main choices in new artificial lenses, also called intraocular lenses (IOLs), are the standard IOL, which is a lens with a fixed distance focal length and may still require reading glasses, the multifocal IOL, which is similar to multifocal glasses, and the accommodating IOL, which is a flexible, hinged lens that is supposed to provide distance, mid-range and near vision. Because multifocal IOLs sometimes produce glare and halos at night, I chose the accommodating IOLs. The most widely used replacement IOL is the fixed distance lens - insurance policies and Medicare may not pay for multifocal or accommodating IOLs.

    Complications

    Cataract surgery is one of the safest medical procedures. Most cataract surgeries are complication-free, but when I woke up the next day, my vision was terrible with or without glasses. Finally, blocking out the part of my glasses covering my operated eye gave me reasonable vision with my unoperated eye. Taking out the lens of my glasses covering my operated eye made seeing easier. The pupil on my operated eye was fully dilated and vision was blurry. As the dilation of the pupil receded over the course of a week, my vision in the operated eye improved to the point that it was better than it had ever been before, even with glasses. I knew my eyes were changing when I noticed that the flower colors on the cover of my gardening magazine were crisper and brighter than they had been previously.

    Eyes and the brain

    Although the cataract in my other eye was small, I had cataract surgery to be free of glasses and allow my brain to better adjust to the accommodating IOLs. My second cataract operation was uneventful; my pupil was dilated for only 48 hours. However, the vision achieved in my second eye was not as good as in the first. After IOLs are implanted, the vision center in the brain has to adjust and coordinate images in a process called neuroadaptation. Neuroadaptation may take two months to a year and in a small number of patients may not work very well. My distance vision has improved since the surgery and I am very pleased with my near and mid-range vision.

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