Seeing the World As It Is

Waking up one morning in 1975 I saw my roommate’s dog Casey, an Irish Setter, sitting against my bedroom wall.

“Casey.  Good morning.  Come here girl.”

I made that smooching kissing kind of sound we make to call dogs to us.  She didn’t move.

I was in the smallest bedroom of a country house I shared with two other guys.  I was there temporarily.  Well, we all were there temporarily as it turned out but I was the most temporary of the three.  I planned to leave in the spring for South America, a plan I carried out.

In my little bedroom was a twin bed mattress and box spring, a wooden barrel, some books on the floor, and a backpack with very few clothes on top of it in the corner.  I was covered by a sleeping bag.

“Casey, don’t be silly. Come here.”

I stretched out my arm and wiggled my fingers, promising to scratch her behind her ears which she liked so much.  She was about three feet beyond my outstretched hand.  Still she didn’t move.  I pushed out from under the sleeping bag, closing the gap between us and touched her.

When my fingers touched her I realized it wasn’t Casey but my brown wool sweater.  I had mistaken my sweater for a dog, and was reminded how bad my vision was without correction.  It’s sobering, but you learn to live with it.

I first got glasses, for myopia, in 1960 when I was in third grade.  When I left the eye clinic in Bloomington wearing them I looked down the street and said to my Mom

“I can see every leaf on those trees.”

I loved wearing glasses.   I never took them off.  As I got older my glasses got thicker.  I got contact lenses in 1968 because my coach thought contact lenses would improve my peripheral vision.  He was right.  With them I could see if the base runner leading off first was leaning towards second when I pitched.  When basketball season came I became more aware of the whole court.  I experienced little discomfort, and wore those contacts as much as I possibly could, which was probably a mistake.

 

My vision became more of a problem in 1972.  After spring finals at ISU I went to my eye doctor because I thought I had scratches on my contact lenses.  My vision was annoyingly blurry, both near and far, as if I was looking through something.  I cleaned the contacts, the old hard kind, little pieces of blue plastic, several times but could see nothing on them.  Turned out it wasn’t my contacts but my eyes.  I was looking through scars on my corneas, like stretch marks.  My corneas had become cone shaped.  I had developed an eye disease called kerataconus. When corneas lose their uniform curve and shape they not only scar but they distort your vision.  There’s no getting around that.

I was fit with special contacts that held back the cone but at the same time irritated my eyes more.  I learned to live with that.   As the years went on with the help of excellent eye doctors I made use of every new technology available.  I was fitted with gas permeable contact lenses which allowed more oxygen onto the surface of my eye and lengthened my wearing time.  But my eyes continued to change.

 

I flunked the vision portion of my driver’s test in 1990 and went to my trusted eye doctor for a more extensive exam.  He passed me, allowing me to drive, but only after exacting a promise that I would visit an ophthalmologist who specialized in cornea transplants.  Turned out I was a prime candidate for such surgery.

My corneas were replaced a year apart in 1990 and 1991.  After each surgery I snapped that eye’s hard contact between my fingers, the little bastards that caused me so much discomfort, and vowed to never wear contacts again.  The transplants gave me not only a clear surface to look through but reduced my astigmatism as well.  After it was all done my new glasses, rather than being coke bottle thick, resembled those of a normal person.  I thought the transplants would eliminate my eye disease.  But I was wrong.

It crept back.  Astigmatism became the problem.  While my corneas remained clear something about my eye caused them to again lose their shape.  My prescription crept up again, and not uniformly in each eye.  My eyes became very different one from another.  The eye doctors worked so hard to help me see.

I would attempt to explain to my eye doctor, now the son of the man who insisted I see the surgeon, what it was like to see through my eyes, so he could understand what was happening.

“Don’t try,” he said.  “Vision is a hard thing to put into words, especially the vision of people with kerataconus.  Looking through non uniform corneas, each eye different from the other, and each patient’s eyes different from the next, causes unique individual distortion.  It’s distorted in an infinite number of ways.  Your brain can accommodate many of those differences.  But convincing me what it looks like for you is not really helpful to me.  It’s interesting, but not important.  My job is to produce vision for you as good as possible given your eyes, and when I can no longer do that get to someone who can make your eyes better.”

He gave me a prism in one lens after I complained that my eyes watered at night while reading.  Even with it I reported that occasionally the vision of one eye or another suddenly wildly diverged, the print on one side of a sentence jumping way higher than the other side making it impossible to read.

 

“That is your brain taking a break.  The difference is too great and your eyes go out of focus temporarily.  Your brain can’t hold it together any longer.”

If I stood in front of a wide banner with print trying to read it across, one side of the banner, usually the left, would be clear while the right side blurred out.  I found it better to close the right eye and move my head to scan the entire width with the left.

 

Occasionally things that I knew were concentric, say targets with equally spaced rings, the kind you shoot arrows at, would not be so.  On one side the rings would scrunch together.  On the other side they would bow out.  But the worst part of living with so much astigmatism, which requires such a strong prescription, is the lack of depth perception.  There was a time before I flunked the driver’s test that I desperately relied on “stop ahead” signs.  Without them I would slam on my brakes at a rapidly approaching stop sign believing I had plenty of time.  No one has told me this but I think corrective prescriptions with high minus make everything appear smaller, yet in relative proportion.  It allows you to see the world more clearly, but not as it really is.

A few years ago my young cutting edge optometrist introduced me to an innovation called Synergize (brand name) contacts.  It’s a gas permeable lens surrounded by a soft contact skirt.  That skirt allows your eye to push the lens out to the curve it needs while the rigid lens stays in place over your pupil.  They fit tightly so extended wearing time is not recommended.  With them I saw amazingly well.  But as time went on I could wear them less and less.  And when I took the contacts out and used my glasses they didn’t function well because of something called corneal molding.  Even when that subsided glasses could not replicate the vision afforded by those advanced contacts.  Finally I had to abandon the contacts because blood vessels began to grow onto the iris in an attempt to bring needed oxygen to the surface of the cornea.   When that happened I was once again referred to a young and respected ophthalmologist.

Beginning this summer he performed a series of procedures to both eyes, incisions which relaxed my cornea and allowed it to take a more normal shape.  He risked cutting into my transplanted cornea, a risk not all professionals of his kind will do.  He was relaxed and confident.  I like him a lot.  I think his confidence comes from not only his skill and experience but because he has the best equipment available, all the latest technology, and a team of people around him who supply him with very accurate information and take no shortcuts.  I felt immediately comfortable in his office, believing I had arrived at a good place.

This past week he concluded his work, performing two cataract removals and replacing my God given lenses with corrected Alcon Toric lenses.  Each of those lenses has six diopters of correction for my astigmatism.  That puts correction inside my eye, in the small lens in front of my retina, rather than on or directly in front of my cornea.  It’s an outpatient procedure done while you are awake.  For the second eye I turned down the pre op offer of Valium so I could pay better attention to what was going on.  I was at the Center for Minimally Invasive Surgery in Mokena, a nice unassuming place by a warehouse off Route 80.  My doctor asked where I wanted the surgery done.  I replied that I wanted to be where he most liked to be.  Totally his call.  He picked CMIC.

In preparation I needed only to strip to the waist before putting on the funky gown.  I even kept my shoes on. They put little booties over them.  A nurse writes something on my forehead above the eye I’m having done, most likely “Cut this one!” and puts both dilating and numbing drops in that eye.  Another asks me to look straight ahead and puts a dot on my eyeball for the doctor to use as a reference when placing the Toric lens.

“Is that a Sharpie?”

She smiled.  “I don’t know.  Sort of.  It’s a felt tip marker of some kind. Special though you know.”

Bianca, a nursing student, was my transporter each time, wheeling me from the staging area to the hallway outside the operating room.  She wrapped a warm blanket around me while I waited.  I was operated on early last Saturday so we talked about the snowstorm and snow removal as we waited.  I was lucky to have made it to Mokena from Ottawa.  Bianca and her family lived in a nearby unincorporated area notoriously bad at plowing snow.  She felt lucky to be there too.

Inside the operating room they tilted my head so the eye being worked on was properly positioned and clamped into something of a soft vice before forcing my eye open with a speculum.  Before I was clamped in I looked at the equipment instruments, big overhead lights, and a giant machine on a massive arm that looked like a movie camera.  On the side of it was the word “Leica.”

“Hey,” I said to no one in particular.  “It’s a Leica.”

“You familiar with the microscope industry?” A nurse asked.

“Not at all.  But Leica used to make very good cameras.  Professionals used their stuff.  I hadn’t heard of them in years.”

While travelling in the 70’s with a Minolta I would run into  world travelers with money carrying Leicas.  They were proud on the verge of snobby about them.

“Well that is a spanking new digital Leica microscope that makes all this work possible.”

“Good to know they’re still around.”

My doctor came in and shook my hand.  He looked different.  We were both wearing hair nets for one thing, and he sported orange crocs on his feet.   He asked the nurse to put the music on.  It was mindless pop.  He sang along to “You Shook Me All Night Long” by AC-DC as he got ready to work.

“Doc, how about telling me what you’re doing as it goes along today?  I didn’t take the Valium.”

“I’d be glad to.  Let me get this instrument in position.  We’re about ready to go.”

He put an extremely bright light directly above my fully dilated eye.  Inside the brightness were three rectangular brighter lights.  It was so bright everything seemed to be turning red.  Nothing I could do about it.  Above me the doctor pulled the camera into position and looked through two eyepieces.

“I have a great view of the interior of your eye thanks to this machine.  Your eye is fully dilated and I can see your lens very clearly.”

“OK, I’m making a 2 millimeter incision on the side of your eye, and inserting my probe through that incision.  Your lens has a diameter of about 6 millimeters.  First I dissect it, then I apply radio waves that break  up those large pieces into bits small enough to be sucked out by the probe.  It’s called phacoemulsification.”

I felt nothing.

"This is going well.  Now I’m beginning to clean this out.  I’m vacuuming out your old lens in a sort of sac it rests in while leaving the snug place it fit into intact.  I’ll insert the new lens in that same place and in time it will incorporate itself into that same place.  The eye will grow around it somewhat.”

As he did this a sound like a video game came from my right side.  Bloops and bings of various length and tones  burbled along.

“What’s that funny noise?”

“The machine gives me some audio feedback on material entering and going through the probe. Along with what I’m seeing it helps me know when I’ve gotten all the loose material.”

“OK.  I’m done with that part.  Now I’m putting your new lens into my probe.  I’ll put it near the site and then release it.  When I do it unrolls and takes shape.  It has a diameter of about 6 mm like your natural lens with arms of another 7 mm that are used to hold it in place .  So in total its 13 mm.”

“And you get that thing all rolled up into a cylinder that fits through a 2 mm incision?”

“Yep.”

“That sounds like magic.”

“I know it sounds like magic but it is actually wonderful material and great science.”

“I forget about great science sometimes.”

“It’s easy to do that.  But in my work I see firsthand what a difference it makes.”

“OK your new lens in nicely situated.  Now I’m going to rotate it to the proper axis.”

“Is this where the dot on my eyeball comes in?”

“Yeah.  Not high tech at all but very effective.”

“OK.  One more look around.  Like leaving a hotel room and making sure you didn’t forget something.  OK we’re done.  That went well Mr. McClure.  I think you’ll have a good result.”

“Do you glue the incision shut?”  I knew I didn't have a stitch the previous time.

“None needed.  It’s so small.  It should close and heal nicely on its own.”

“So that’s it?”

“Well, your careful compliance with the follow up regimen of drops is important. But other than that I’ll see you tomorrow, and in a week, and then my job is done.  You do know to call me if you have any kind of emergency at all, right?”

“Yes.  What would that emergency be?”

“Anything you think is a problem is an emergency.  Call if you have any concern but especially in the event of pain.  You should experience little if any pain.  Perhaps some discomfort for a while after the numbing drops wear off, like a speck of something in your eye, but nothing serious.  Just call if you have a worry.  See you tomorrow in my office.”

And with that he was gone, off to take care of the next person in the hall.  Bianca wheeled me out, gave me coffee and snacks.  Another nurse went over discharge instructions, and before you knew it I was back on Route 80 headed home.  I was there just over an hour.

That was a week ago today.  I’m writing this now with no glasses, no correction at all.  I’ve been driving in town.  On Thanksgiving I drove the Buick to pick up my son at the train station in Joliet.  Hell I used to drive to Springfield and Chicago with corrected vision much worse than this.  I’m pretty confident I could pass the test at the Driver’s License place right now.  I think I’ll need a slight correction in the end, but it’s evident that I am seeing better than I have seen since before I was nine, and maybe ever.  I’m amazed.

Given that I will need these eyes for only twenty more years, give or take five or so, this could be my last big fix.  (Knock wood.)  Even if my eyes deteriorate and my prescription changes I’m starting at such a good place I may never need the kind of correction I needed just four months ago.

 

And so this Thanksgiving I am glad to be living in these times when such technology is available.  I’m thankful for these caring doctors:

              Dr. Tim Ortiz, Optometrist - Ortiz Eye and Hearing Center

              Dr. David Lubeck, Ophthamologist - Arbor Eye Care

And I’m thankful for the staff that support these doctors.  Like many who lead or have led organizations, they may in the end be only as good as their staff.  Those two doctors are surrounded by good people.

And while I’m at it let me express my thanks to the Alcon company, and Leica, and all the producers of the equipment and materials that go into these amazing new technologies and procedures that have been developed.  I can and do criticize our health system for many things: high costs and profits, lack of access, and other shortcomings, but when I realize all it has done to enhance my life and the lives of others it shuts me up some.

So yes I’m thankful for the insurance company and the structure they work within.  I had fallen into a gap between my wife’s teachers insurance and Medicare.  She qualified for Medicare while I did not, and I was no longer eligible to ride along on her policy.  So I took out a Blue Cross/Blue Shield policy to get me by.  Thanks to Obamacare it covered all my preexisting conditions.  This deal cost me some, but given the outcome that cost is ridiculously low.  How do you put a value on clear sight really?

At this time last year I was on a solo road trip to Florida via two lane roads through Kentucky, Tennessee, and Alabama.  This year, to celebrate these new eyes, I’m going to take a similar trip, in a new used Buick with a gas gauge that works, going further east before heading south.  I hope to catch West Virginia, North Carolina, all of Georgia, and central Florida.  The Blue Ridge Mountains are out there somewhere as are the Appalachians.  I’ll leave January 4^th and blog along the way, reporting on what I see.  If you are familiar at all with that route and have suggestions for places to visit by all means let me know.

Trust me, I am very grateful to be able to make such a trip again.