The Space Odyssey – Tryst with Cataract Surgery

All of a sudden, my imagination was phenomenal. I felt that I was inside a space ship. I could feel that I was entering a bubble with multiple rainbows and streak of yellowish light blessing me with goodness and wellbeing. The stars, milky ways, and meteors zipped past with the speed of light. I could feel the presence of Trinity – Lord Vishnu, Brahma and Mahesh welcoming me to their planet. Alas, this grandeur lasted for just about 30 to 45 seconds, when doctor announced that the lens is in its place.

You are just fine

When I was diagnosed with “early” cataract at 70 years young, I found that my most difficult counselling challenge was my doctor, known to family for nearly a decade.

I believed that eye’s cloudy natural lens must be removed and replaced with an artificial one, known as an intra ocular lens or IOL. Jigish Gandhi, my eye surgeon, believes that any risk of cataract surgery complications, no matter how slight, is too great when you can still see this well without the need for surgery.

My doctor, Jigish Gandhi is a conservative eye surgeon. This meant waiting until a patient’s visual acuity was at least 20/50 or worse, before he had the serious discussion with me regarding possibilities of cataract surgery.

During night driving, I had the classic symptoms of cataracts: seeing halos around lights and headlights, and a little glow around street lights. The contrast between dark-coloured cars and the dark night background made it difficult to delineate the true outline of the cars in front of me.

Notwithstanding these symptoms, Jigish Gandhi still said, “Just fine.” That was around January 2021.

My altered vision did not hinder normal daily activities. But when I worked on my laptop and mobile, as a professional trainer and coach, I noticed that I definitely was slowing down due to loss of contrast sensitivity. Because I no longer could see well with both eyes, I also experienced decreased depth perception.

The Final Straw: Time for Cataract Surgery

The cataract is a common eye condition that occurs when the lens of your eye clouds over. As light cannot get through the lens to the back of the eye (retina), this can blur or decrease your vision and also cause glare. Since my biggest complaints with the cataract were glare and halos, the D-day arrived on 2nd September for right eye and 8th December 2022 for left eye. Doctor’s choice of a mono-focal intra ocular lens (IOL) over a “premium” multi focal IOL was simple. Mono focal is easy to insert with miniscule chances of complication post-surgery. Whereas high level of expertise is required on part of surgeon for multi focal lens.

Suture less clear corneal incisions (CCIs) have become the standard of care when performing routine cataract surgery due to multiple advantages. The laser surgery is at times is associated with peripheral thinning, can weaken the cornea and compromise wound healing. The incision and cataract fragmentation are done with laser device. But the insertion of the new lens is done manually.

However, in phacoemulsification process, the surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed. The ultrasound vibration is delivered at a high speed to dissolve the cataract into tiny fragments that are gently sucked out of the eye. The cataract is then replaced by a clear plastic lens which helps improve your vision.

The decision to have a laser cataract surgery instead of traditional cataract surgery is also based on the Surgeon’s preference as well as the density of the cataract. I had traditional surgery and sharing below is my tryst with left eye procedure.

What happened during cataract surgery?

On the day of my surgery, I was given dilating eye drops every 15 minutes for one hour and antibiotics to prevent possible eye infection and swelling. In the operation room a small intravenous line was placed on the back of my hand and the surgeon or anaesthetist gave an injection beside my left eye. During the operation I was made to lie down flat on my back for up to 45 minutes. My eyes and cheeks were covered with a paper drape, but I was free to breathe through nose and mouth. In addition, Doctor and the staff were communicating regularly, I guess to avoid anxiety and the emotional aspects of cataract surgery. I love communicative Doctor since I am excited to know what is happening.

The visual sensations experienced include perception of movements, flashes, colours, changes in brightness, or the sight of surgical instruments, the surgeon’s hands or fingers, or even the surgeon.

Cataract Procedure

On the day of surgery, I am happy that I wasn’t given any medication to calm since I was normal. Rather I was excited to remember the surgery and recall as many details as possible. I remember the walk into the operating room and my surgeon, anaesthetist and assisting staff saying “hello” to me and then I was prepped and draped.

Someone asked me to look straight up at the light, where I saw two thick, whitish pale 3D half circles slightly offset and separated by a space.

During the procedure, my entire view was whitish pale, as if I were in a space ship looking through the window. This view never changed. I was listening to the sounds of the phacoemulsification machine and observing the changes in my vision as my lens was broken up (emulsified) and then sucked out.

Because of the brightness of the operating microscope light, my view remained virtually unchanged. The surgeon commented that my cortex (the soft, peripheral part of my cataract) was a little more stubborn than he had expected from what he saw on the microscopic eye. But everything was going fine.

The surgeon then announced that my cataract was removed. I believe it took 3 to 5 minutes. I looked up at that moment and tried to see what vision was like without a lens. But I still couldn’t make out any details. Everything looked the same.

All of a sudden, my imagination was phenomenal. I felt that I was inside a space ship. I could feel that I was entering a bubble with multiple rainbows and streak of yellowish light blessing me with goodness and wellbeing. The stars, milky ways, and meteors zipped past with the speed of light. I could feel the presence of Trinity – Lord Vishnu, Brahma and Mahesh welcoming me to their planet. Alas, this grandeur lasted for just about 30 to 45 seconds, when doctor announced that the lens is in its place. Later when I asked my eye surgeon, he said that the aspheric IOL (intra ocular lens), CT Lucia (Zeiss) 621 PY, was inserted.

The last time I saw this phenomenon was in 1982. I was flying Kamov-25 helicopter, 200 kms from the shore in Arabian Sea and about 50 kms away from mother ship, a destroyer, exercising with submarine. When we were on a mission to locate submarine, my helicopter less than 300 feet above water, on a pitch dark night, there a was thud and one engine stopped. As per standard operating procedure, the only alternative was to ditch in the sea. That was the time I saw the stars, milky ways, and meteors zipped past with the speed of light. Touch wood, with great presence of mind and professionalism, we created a history by landing on the deck of a moving destroyer. Practice! Practice makes you perfect, whether you are an eye surgeon or a pilot.

Once again, I started seeing the 3D whitish pale half-circles, exactly as I had seen them at the start of the procedure. Objects like pumice stone texture, were now visible, as my space ship was about to land on the mother earth.

Would I need another procedure? I hoped not.

I tried to recall everything I could about clear corneal cataract surgery, the type of procedure I had undergone. I reminded myself that corneal swelling typically induces a myopic shift until it resolves.

I decided I would wait to say anything, although on the way home I continued to fret about the possibility of a less than optimum visual outcome. But on the positive side, and while I was busy second-guessing my surgeon, I did notice the colour contrasts in the distance were amazing.

Recovery After Cataract Surgery

By mid-afternoon, my vision quality had improved dramatically. But all in all, my day of surgery was totally uneventful. I took my prescribed eye drops to prevent infection and reduce swelling and hoped for the best. I met my doctor in the evening as planned. Dr Jigish Gandhi was very encouraging and assured me a change by next morning.

But my visual acuity still was less than expected. I wanted what the television and social media ads promised: “Off-the-table 20/20…!” I was still more myopic and unhappy about that. I woke up on the first day after surgery and could not wait to remove my eye shield. My vision was much better and there was no corneal swelling.

My near vision was pretty good and perhaps better. I kept taking my eye drops. And by afternoon on the first post operative day, the view through my left eye was like nothing I had ever recalled seeing before: clear and colourful in ways that even my best eyesight in younger years could not duplicate.

I had my right eye surgery on 2nd September and left eye on 8th December 2022. Clearly, I was no longer myopic now. The sharp contrast between any two objects of different colours was absolutely outstanding. On my first and second days after surgery, it seemed that every hour was better than the previous hour.

Ever grateful to my ophthalmologist Dr Jigish Gandhi, anaesthetist Dr Neha, optometrists Pooja and Misba and the staff of IRIS Eye Centre at Juhu, Mumbai for their loving tender care.