All right, everybody, I’ll fess up-I’m an ophthalmologist. I retired
last year after 42 years of practicing and teaching cataract surgery
all over the world (well, at least over most of it). I’m also a
longtime metalworker/jeweler, beginning as a sub-teen. I happen to
be well along in the writing of a piece that, I hope, will help all
who are interested to understand their vision and various aids, all
the way from simple readers (a fantastic bargain) to real microscopes
(the incredible solution to many problems).
Linda began this thread, stating that she is quite nearsighted
(myopic). Others have found that simple readers have worked well
because they don’t wear glasses ordinarily. This points up that we
are individuals with a vast range of different characteristics.
Matthew raised another point, when he said, “see an ophthalmologist”.
Most optometrists are very capable at measuring for eyeglasses, but I
don’t know any who are adept at recognizing intermittent angle
closure glaucoma, choroidal cancer, early Fuch’s dystrophy of the
cornea, etc. I have to agree with him, if you are going to take the
time and spend the money on an exam (which we all should do
occasionally) it makes sense to see a real expert, just in case you
have something you don’t know about.
In order to avoid taking the Katrina Prize (cat 5 verbal hurricaine)
away from other deserving posters let me address just a few points:
1, Video microscopy is not here yet and will likely be very
expensive when it arrives. I worked with Cannon on such a project
about 15 years ago, it is getting closer. However optical microscopy
is so easy and very affordable (a comparative term).
Cataract surgery is remarkably safe and most patients feel that
they see better than they can ever remember.
Your individual needs are critical to finding an appropriate
solution. That means understanding your work habits, your basic
visual optics and any limitations, your body size, working posture,
age and presbyopic status (sorry there’s one of those big words), the
list goes on.
Being retired, which just means I now set my own schedule, I’ll be
happy to help any of you; on the list for general questions, off
list for personal circumstances if you wish. Perhaps there will be
some issues raised that will become part of my (tentatively titled)
Microscopy for Jewelers.
If you have complex vision problems, I suspect that you also have
found that the optometrist or the opthamologist wants to prescribe
glasses in 20 minutes (not counting dilation time) and gets upset
when the patient “isn’t cooperating” or wants to ask about doing
strange things with their glasses.
If you have complexl vision problems. I suggest you find a optometry
college or medical school that likes patients who will work with
students. It takes quite a while as the students freak and the
professors go in to check what they are doing. But they will talk
about your presciption and work with you on how you can adapt your
glasses to do things you want to do.
I’m guessing there are cheaper versions around also. Many dentists
start with a lower magnification and work up, as it can take a bit of
getting used to. Loupes come in different focal lengths depending on
your normal working distance.
Sorry I’m late in getting back to you. My guess is that you’ve been
talking to optometrists and not opthamologists. The reason for my
guess is that optomotrists don’t do surgery, and opthamologists do
very delicate surgery along with neurosurgeons and some ENT docs.
Hence, the opthamolgists who have vision problems often have loupes
attached to their glasses, and if you explained the intricateness of
your work, would understand you aren’t talking about your standard
trifocals.
See if you can ask your optician if he knows what surgeons do for
their glasses. Maybe he/she can ask around.
Dear Dr Mac & others who were kind enough to reply.
Allow me to have just a small freak out here!.!.!.!.!.! Gasp, thanks.
Let me now say that I thought cataract surgery consisted of removing
scar tissue from the surface of the lens, making it all shiny and
new again. I had no idea they would remove my lenses and give me
artificial ones!! What are the replacements made of? Do they every
go bad, degrade, cloud up, fall out???
When I heard that they’d been doing cataract surgery since the time
of the Pharaohs, I was pretty sure that the Egyptians had no polymer
lenses laying around to refit. I really don’t want the ancient
surgery methods, but I figured there wasn’t much more to it than to
use a lazier for a nice buff and polish, like zam, only with
photons.
On the other hand, things are getting blurry and my eyes are
continually strained. I don’t see that I really have much of a
choice.
Yours,
as ever
Marya
(who just got back from the Cleveland Clinic, where the GI big shots
had nothing much to offer.)
...I thought cataract surgery consisted of removing scar tissue
from the surface of the lens, making it all shiny and new again.
That’s the cornea: the front surface of the eye. The focussing job
of the eye is done by the cornea as well as the lens. LASIK-type
surgery is where the shape of the cornea is altered to allow better
vision. A recent improvement in cornea surgery is to lift up a
section of cornea surface, do the laser-shaping to the cornea, then
replace the flap. It’s still a risky operation.
I had no idea they would remove my lenses and give me artificial
ones!! What are the replacements made of? Do they every go bad,
degrade, cloud up, fall out???
On the other hand, the safety and effectiveness of cataract surgery
are generally well established. They remove the old lens and put the
new lens in through a tiny 3mm stitch-less incision at the edge of
the cornea (not right in front) and the new lens is ‘shrink-wrapped’
in place inside the same neat capsule where the old lens was. The
liquid gel inside the eye is untouched, as it’s behind the lens
capsule.
Simple diagrams of the operation:
If you're a lifelong myope like me you've really appreciated
being able to read without glasses. I recomend you stay a myope
(up to -1 diopter) when it's your turn for cataract surgery. The
alternative is perfect distance vision but a constant need for
reading glasses, due to the new lens lacking accommodation.
Brian
B r i a n A d a m
e y e g l a s s e s j e w e l l e r y
Auckland NEW ZEALAND
www.adam.co.nz
Cataract surgery was indeed practiced in antiquity. Some bronze
instruments were found in Mesopotamia (dated about 3500 BC) which
appear to have been used in the procedure. I have a copy
(translated) of a MEMORANDUM BOOK OF A TENTH-CENTURY OCULIST, Ali ibn
Isa of Baghdad. It details their procedure. Most of the early
techniques amounted to pushing the opaque lens (the cataract) out of
the normal position clearing the visual pathway through the pupil. I
saw that method still being used in China on my first trip in l981.
None of those were elegant procedures and there were lots of
complications.
The basis of current cataract surgery came from France in 1752
although the instrumentation is now very different, we understand the
anatomy and the surgeon can see what he’s (a non-gender term) doing.
Artificial lens implantation began in England in 1949 and has been
greatly refined since then. The first material used was
polymethylmethacrylate (like plexiglas). It is still in use along
with a great many other polymers and hydrogels. Once the implant is
in place it is not going to fall out, go bad, etc. Reports are very
rare of problems caused by lenses made of legitimate materials. It is
an operation and there is always some risk, however, cataract is
generally considered to be the most uniformly successful procedure in
all of surgery.