Out from under the cloud of cataracts

Times Staff Writer

Last summer, Ann Forbes noticed that she was waving at more people than she ever had before -- people in cars, on the street, down the block. "Everyone and everything that moved," said Forbes, 60. "I'm sure strangers who saw me thought I was half-crazy."

In fact she could no longer distinguish faces at a distance.

Then, one bright afternoon, staring through her windshield directly up at a freeway sign the size of a stadium scoreboard, she found that she could not make out the letters with her right eye. The familiar "Beach Blvd." sign seemed to be floating in a milky film, just beyond legibility.

That film hadn't appeared suddenly; it had thickened imperceptibly, by shades over the years, as cataracts usually do -- by age 65, at least half of Americans have noticeable cloudiness in their vision. Genes, ultraviolet sunlight, smoking and age can all contribute to this hardening of the lens cells and other irreversible changes.

For months Forbes had compensated for her bad right eye by favoring her left one; but by fall she noticed that that was beginning to dim as well.

The result was that this otherwise healthy woman and involved grandmother could no longer drive safely. She couldn't go to the mall on her own, meet friends at a restaurant, even take the grandkids out for ice cream. "I'm fairly independent, and here I was feeling very insecure and foolish," said Forbes, who lives in Orange. The sensation was strong enough that she began to contemplate a solution that until recently seemed to her radical -- cataract surgery.

Forbes had already tried regular glasses; then reading glasses. It was no good. "I kept putting off going in for an exam, because frankly I was thinking, 'What if I didn't have any good vision left at all?' " she said.

In fact she had plenty left, behind the clouded lens, said Dr. Donald Schwartz, a Long Beach ophthalmologist and Forbes' doctor. Many older people also suffer from macular degeneration, an eroding of corneal sensitivity that robs central vision, and sometimes can't be helped by cataract surgery. But in most cases, like Forbes', the underlying vision is good enough that the developing cataracts aren't noticeable, at first.

"Many people don't even realize they're losing their vision because they're not having it checked, and the brain is so good at compensating," said Schwartz. "Often it's when they fail the driver's exam that they realize there's a problem."

The doctor walked his patient through the surgery, verbally. Under topical anesthesia, the eye is held open, and a tiny cut is made in the front of the eyeball. Using a probe that vibrates ultrasonically, the surgeon breaks up the lens, then vacuums the pieces out, using another instrument. A synthetic replacement lens is then inserted. The procedure typically costs between $2,000 and $4,000 and is often covered by insurance.

Newer laser treatments are also available, as well as conventional surgical removal, which involves a larger cut in the eye. But the ultrasound technique, which is called "phacoemulsification," is the preferred standard.

Forbes' first operation took about 30 minutes. After applying antibiotic eyedrops for a couple of days in preparation, she had her eye numbed with an anesthetic (another eyedrop), then entered the operating room. "They put me on the table, strapped my head down, held my eyelid open, and then all I saw was a bright light," she recalls. "That was it. I was surprised that it didn't hurt at all." The risk of complications, which include infection and retinal detachment, are less than 1% in a healthy person like Forbes, said Schwartz.

For about two weeks after the procedure, patients wear an eye patch when they sleep and continue to bathe the eye with antibiotics. It's a walk-in, walk-out operation, and the results can be instantaneous. "When my husband drove me home, I was looking through the eye patch, which had little holes in it -- and I could see clearly out of that eye, for the first time in ages," Forbes said. A month later she had the cataracts on her left eye removed, and the veil was off.

Not that her vision would be perfect again, as it had been for most of her life. While synthetic lenses are a vast improvement, and continue to get better, they are no replacement for the ones we're born with. The eye muscles can bend, flex and squeeze natural lenses, to help focus vision. Synthetic lenses are much more rigid and cannot change focus. When both eyes are being done, doctors often implant one lens that focuses in the distance, and another that focuses for up-close reading, said Schwartz.

Between 20% and 30% of people who have cataracts removed develop some cloudiness in the tissue in front of their lenses later on, which can be treated with a laser.

Forbes opted for distance focus in her right eye, and in her left. She now uses reading glasses when needed, and enjoys the view everywhere else. "The world really has changed for me," she said. "It's not just clearer, but the light is different, colors are stronger, deeper. I noticed things I hadn't for years, like the trees on the hills near our house." She's cut down on her waving too.


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