Sunday, December 29, 2013

Cataracts, Contacts & Rainbows by Big Toe Buddha

How to prepare for cataract surgery if you wear contact lenses.

The image above is how my world looked without contacts and prior to cataract surgery.

Cataract Surgery Spring, 2013.

And this is what I see today when I go to my local Rite Aid in Aptos. The packages burst with color, there really are three dimensions and the detail is striking.

Cataract Problem

For background, I recommend reading the overview available at Wikipedia.

Cataracts affect millions of people and as the population increases in longevity, the number of surgeries will likely continue to increase.
Cataract Statistics
  • Number of Americans age 40 and older who are affected by Cataracts 20.5 million
  • Percent of Americans age 80 and older who have Cataracts 50 %
  • Annual amount spent by the federal government to treat cataracts through Medicare $3.4 billion
Cataract Surgery Statistics
  • Average cost of cataract surgery per eye  $3,279
  • Number of Americans who have cataract surgery each year 3,000,000
  • Success rate of cataract surgery 98 %
  • Percent of patients had no severe postoperative complications 99.5 %
Source: Statistic Brain

The following overview of the cataract problem iis from the National Eye Institute.
What is a cataract?
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.
How can cataracts affect my vision? 
Age-related cataracts can affect your vision in two ways:Clumps of protein reduce the sharpness of the image reaching the retina.The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.  
When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier. 
The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.  As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.  
If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.
What can I do to protect my vision. 
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants. 
If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.
What to Expect if You Must Wear Contacts Full Time

 Dr. Jason Ludsich Bringing Life to Light

If  you must wear contacts full time, due to acute astigmatism that is non correctable by glasses (as did I), it makes the fairly involved series of pre and post cataract surgery even more time and effort consuming. 

Pre-Surgical Assessment

For example, since contacts may cause a certain degree of corneal distortion, the pre-surgery mapping requires removing contacts for two weeks prior to the exam. This poses a problem for someone that cannot function without contacts. The solution for me was to extend the assessment stage into two sessions, one for each eye doubling the surgery time span. 

You will be given a prescription for several eye drops that have a variety of application schedules. Be sure to check with your eye doctor to see if your are required to remove your contact lenses prior to applying the drops. Each eye requires a unique surgical procedure. I chose to have my left eye operated upon first because my right eye was originally my "weak" eye and I wanted the best vision possible as soon as possible.

Post Cataract Surgery

The drop schedule for each eye requires planning and discipline which is more complicated if you are contact lens dependent. This is because of the change in focal length for the new lens that is selected by you and the opthamologist. For example, if you select optimal viewing distance acuity, then post surgery the eye with the synthetic lens will experience great distance viewing, but for close up it will require glasses. 

The problem is that your right eye (which is yet to be worked on and still requires a contact lens for distance viewing  and still offers good near vision) will be out of focus when wearing the reading glasses. The solution is to purchase inexpensive, off-the-shelf close up glasses and remove the right lens from the frame. Your optometrist can do this very quickly. Be sure to save the glasses' lens because you will need to replace it after the right eye gets a new synthetic lens until you receive a new set of high quality, prescription "reading" or "computer" glasses.

Note: This strategy may not apply if you elect to have a new set of lens optimized for different distances in either or both eyes.

The Good News and the...Great News

Now that I am an enhanced cyborg, I have the best vision ever, even better than when I was a child. Even though my left eye is now my "weak" eye astigmatism correction-wise, when I use both eyes somehow my brain is Reprogramming the Human Operating System to give me incredibly sharp, vibrant color, clear cut three dimensional layering, and distance vision. When driving  at night I do use my original half-pair reading glasses with a single lens which gives me the same razor sharp vision as in daylight. For some reason, a reading glass lens now sharpens my distance vision.

No more contacts. My whole life routine is changed. For example, waking up at night and being able to see well is just part of being liberated from the cost, care and feeding of contact lenses. However, I would not have visually managed so well for so long without special attention, patience and guidance of Dr. Farberow at Plaza Lane Optometry.

Unexpected Color Feast 

Places and scenes which I had walked by for years, have suddenly come to life. Do these images burst with color for you too? Comments are welcome. Now that I am color sensitized, I recognize for the first time how top flight graphic designers use blazing colors to lure us into a product purchase -- just like a flowers attract bees.

or the security of blue skies

Possible Explanations for Enhanced Color Vision

Faulty Recollections

This explanation assumes that my cataract clouding process has gone on so long that I have lost an accurate appraisal of color intensity from my childhood. 

I regard this as unlikely in that over time, the high-intensity color effect should weaken or "normalize." But nine months after surgery, this is not the case. Everyday is an astonishing parade of color from the Blue Buddha figurine in front of my monitor, to car brake lights at night, and deeply saturated American Flags flying from RVs on the beach during the day. 

Sensations Vs. Reality

However, I do recognize that the perception of color may be more than first meets the eye,

Do you see the same color red that I see?

Even if we quantitatively agree upon a shade of red matching a specific wave length, qualitatively we may see and interpret the input differently. In other words, we both see the top traffic light signal radiate light that we both know as "red." but there is no way to confirm that we interpret the light in the same way.

The nuances of senses and sensing was explored in detail by famed philosopher, Bertrand Russell in The Problems of Philosophy (1912). The document is publicly available at Project Gutenberg
To make our difficulties plain, let us concentrate attention on the table. To the eye it is oblong, brown and shiny, to the touch it is smooth and cool and hard; when I tap it, it gives out a wooden sound. Any one else who sees and feels and hears the table will agree with this description, so that it might seem as if no difficulty would arise; but as soon as we try to be more precise our troubles begin. Although I believe that the table is 'really' of the same colour all over, the parts that reflect the light look much brighter than the other parts, and some parts look white because of reflected light. I know that, if I move, the parts that reflect the light will be different, so that the apparent distribution of colours on the table will change. It follows that if several people are looking at the table at the same moment, no two of them will see exactly the same distribution of colours, because no two can see it from exactly the same point of view, and any change in the point of view makes some change in the way the light is reflected. 
For most practical purposes these differences are unimportant, but to the painter they are all-important: the painter has to unlearn the habit of thinking that things seem to have the colour which common sense says they 'really' have, and to learn the habit of seeing things as they appear. Here we have already the beginning of one of the distinctions that cause most trouble in philosophy—the distinction between 'appearance' and 'reality', between what things seem to be and what they are. The painter wants to know what things seem to be, the practical man and the philosopher want to know what they are; but the philosopher's wish to know this is stronger than the practical man's, and is more troubled by knowledge as to the difficulties of answering the question.
To return to the table. It is evident from what we have found, that there is no colour which pre-eminently appears to be the colour of the table, or even of any one particular part of the table—it appears to be of different colours from different points of view, and there is no reason for regarding some of these as more really its colour than others. And we know that even from a given point of view the colour will seem different by artificial light, or to a colour-blind man, or to a man wearing blue spectacles, while in the dark there will be no colour at all, though to touch and hearing the table will be unchanged. This colour is not something which is inherent in the table, but something depending upon the table and the spectator and the way the light falls on the table. When, in ordinary life, we speak of the colour of the table, we only mean the sort of colour which it will seem to have to a normal spectator from an ordinary point of view under usual conditions of light. But the other colours which appear under other conditions have just as good a right to be considered real; and therefore, to avoid favouritism, we are compelled to deny that, in itself, the table has any one particular colour
Other Possibilities

Assuming that I suddenly can see colors as never, ever before, what could cause this? Furthermore, do I see colors differently than most other people? In "The Ambiguous Existence of Color" by Jeffrey P. Bignam speculates with regards to Russell's thesis:
Additionally, just because a color-blind person and a person wearing colored spectacles receive a different sense datum when viewing an object does not mean that the color of the object itself has changed. The human eye is only able to detect three wavelengths of light and the brain combines and interprets these to come up with the colors that are perceived. A color-blind person is usually missing one or more of these detectors, which means that he or she can detect only one or two unique wavelengths and, therefore, can combine them into far fewer distinct colors. Furthermore, a small number of people are able to detect four wavelengths of light, which allows them to distinguish many more colors than people with "normal" vision can. While such a person may not be able to see what those with normal vision consider to be "red", for example, they still see the same color whenever they are presented with something red.
Perhaps the blue-tinted lenses that I wore post surgery combined with the shifting polarity of dominant eye and the neural processing involved in Reprogramming the Human Operating System for visual acuity at a distance rather than near viewing, have given me a gift that I shall never overlook. I wish you well in your vision quest.

You may also be interested in my more recent articles

Spinach Diet Vs. Cataracts.


+RonNolan, Human Cyborg?

My Eye Care Recommendations

Dr. David Farberow
Plaza Lane Optometry

1537 Pacific Ave., Suite 100
Santa Cruz, CA 95060

Jason Luksich, M.D.
Palo Alto Medical Foundation

Main Clinic (Santa Cruz) 
2025 Soquel Avenue 
Santa Cruz, California 95062

I extend my sincere thank you to Dr. Luksich and his the great staff at Palo Alto Medical Clinic and Dr. Farberow at Plaza Lane Optometry for bringing new light into my life.

© 2014  Ron S. Nolan, Ph.D.
All Rights Reserved. 

Cataracts, Contacts & Rainbows is
dedicated to Michael Henry Dashwood Dormer 
a good friend who is much missed.
Perhaps I am beginning to see color like he did?


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