News

I can see clearly now

Kelly Langevin recently underwent cataract surgery to repair damage to his left eye. Here is his story.

What you need to know about cataracts How cataract surgery is performed The anatomy of an eye About the Eye Care Centre of Excellence Web extra: Cataract surgery video

BY KELLY LANGEVIN
Winnipeg Health Region
Wave, May / June 2010

For over 30 years, those random letters one finds on an eye chart have proven elusive to me. Time and again, I would visit my optometrist and take the test, hoping somehow my left eye would see the letters. I always felt a little guilty when I was incapable of telling the optometrist what those fuzzy symbols were, like a test I never studied for and the teacher giving me a nasty stare.

But on December 15, 2009 (a day before my 48th birthday), for the first time since the third grade, they were as clear as day. No lenses, no contacts, no visual aid necessary. There they were, and the line beneath them and the letters and numbers below them all rolled off the tip of my tongue like I had just solved the hermetic code.

Pardon the pun, but I literally could not believe my eye.

And to think that just under 24 hours earlier, those letters and numbers looked to me like they could have been Greek symbols on parchment.

Prior to having cataract surgery at the Winnipeg Health Region's Eye Care Centre of Excellence at Misericordia Health Centre, my left eye required highly concentrated lenses to see even the back of my hand. My eyesight has been slowly deteriorating since I was eight years old. By the time I was 16, I was able to wear contact lenses, which slowed the deterioration. But some five years ago, the vision in my left eye suffered a mishap in a beer league hockey game. A tenacious forechecker in my younger years, I often played with reckless abandon. Never giving much thought to the use of a face shield, or eye protection. But I would pay the price for these delusions of imperviousness. While forechecking an opposing player along the boards during a casual pick-up game, an errant puck flipped up off my stick and hit me square in the eye. I dropped to the ice like a sack of coal. I recall seeing stars floating under my eyelid, but not much else. I left the ice that evening with a purplish-black eye, swollen shut. The next morning when I gingerly pried it open with my fingers to look in the mirror at the damage, all I could see - rather, couldn't see - was blackness.

My doctor immediately set up an appointment with Dr. Marilyn Ekins, an ophthalmologist at the Winnipeg Clinic. She didn't like what she saw when she peered into the blackened hole of my eye.

Following the accident, I was deemed legally blind in my left eye. After about a month of healing, I was still able to vaguely see out of the eye, but my eyewear prescription was nearly off the charts at -12.00 diopters.

Over the years, I tolerated some blurred vision in my left eye. The right eye compensated and, between the two, I could pretty well function normally in my office job. Damage to the iris kept it fully open all the time, which made it difficult to go outside in any weather without sunglasses.

Regardless, I adjusted and didn't think much about the problem for a few years following. I bought a protective eye shield for my helmet and have kept playing recreational hockey, although today I'm a little less reckless, and not as tenacious in the forechecking efforts.

Over the past few years, age has been creeping up on my eyesight (along with my hairline), and I required reading glasses. My damaged left eye, however, progressively got more cloudy and blurred. A regular visit to the optician brought up the subject of cataracts.

The lens of our eyes is made up mostly of protein and water. An eye injury, or in 90 per cent of the cases, the aging process, can cause cloudiness on the lens.

Due to the damage of the lens in my eye, the earlier onset of cataracts was affecting my vision. Once again my eyesight was at risk, but once again new healthcare technologies and techniques would come to the rescue.

My optician referred me to Dr. Daniel Chin, a cataract surgeon who practised out of the Medical Arts Building. He told me he could surgically remove the cataract, which would improve the sight in my left eye. He discussed with me the risks of surgery, especially with the eye previously damaged.

The procedure involves using some aesthetic jelly to freeze the eye. A small incision, 2.6 mm, is made in between the cornea and sclera. Through this incision, the surgeon installs an ultrasonic probe, smaller than the size of a pen tip, which he uses to break up the lens of the eye into tiny pieces. Another instrument is used to suck out the "emulsified" pieces of the cataract. With the old lens removed, a new artificial lens - rolled up like a soft taco shell - is injected through the small incision. The new "artificial lens" also has arms on two sides of the lens that spread out after insertion into the eye. The arms help hold the lens in place so that it is centred. Once the artificial lens is properly centred, it allows light to flow through the eye and project images onto the back of the eye just like any "natural" lens.

Because of the damage to the support of my lens, Chin also added a circular supporting ring into the eye to help keep the new artificial lens steady.

The surgery was actually painless, which is somewhat ironic because when I looked at the photos of the procedure, well, the quote from Jack Nicholson in Terms of Endearment: "I'd rather stick needles in my eye," came to mind.

During the surgery I was fully conscious and aware of the procedures being performed. I received a number of eye drops to disinfect and anesthetize the eye, to help keep it steady and prevent me from blinking. I was wrapped tightly on a bed sheet with my arms discreetly tucked and rolled into the sheets - I surmised that was to keep from lifting my hands up to instinctively remove any instruments inserted into the eye.

For much of the procedure, I recall lying on my back on the gurney, staring into a very bright light - the light above the operating table. During most of the surgery, the light appeared very bright but more of a dulled haze and with little refraction - until after the lens was inserted. Suddenly, the light established a sharp texture, with the element of the bulb briefly becoming clear just before an eye patch was placed over the eye and the surgery completed.

I was wheeled out of the surgery room to a post-op area where I was able to rest and served toast and juice by very courteous staff.

Normally, this surgery procedure takes about 15 minutes and patients are in and out of the Misericordia Health Centre within a few hours. According to Chin, due to the damage of my eye, the procedure took almost an hour, and was more complex than most cataract surgeries.

Regardless of these complexities, the end result was, in my "eyes," miraculous. I currently only wear one contact lens in my right eye to balance out my vision, and on occasion, by force of habit, I've fished into my left eye for a contact lens that isn't there.

While the return of my sight made me appreciate and value the precious gift we all have to visualize our world, I also gained a lot of respect and fascination for the healing power of the eye. In concert with the right technology and the right skills found at the Eye Care Centre of Excellence, the eyes have incredible resiliency and potential for recovery. Of course, not everyone can see, nor appreciate that. But as we all age, and our eyesight gets a little cloudy . . . you will.

Kelly Langevin is Manager of Communications and Public Affairs for the Winnipeg Health Region.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the May / June 2010 issue of Wave