More Medical Decisions

I made it into my 50s with hardly ever seeing the inside of a hospital. Then my medical fun started with the eventual discovery of prostate cancer. That got me started on medical decisions when I was offered four choices of what to do next, one of which was nothing and three of which offered some sort of fix. I found that decision very easy – surgery, rip the rotten thing out. I had my  radical prostatectomy [just making sure I can still spell it] in December 2010. Subsequent PSA tests will continue for about 10 years but, I’m pleased to say, thus far indications are good, i.e. the readings have been effectively zero. I’m very confident that I made the correct decision.

In my first post-operative year, 2011, I began to notice a slight fuzzing of the vision in my right eye. Initially, I was really only aware of it whilst reading a book at night. At my next yearly eye test, I mentioned it to my optician. Yes, I had the beginnings of a cataract developing. Oh joy! Development of these things, I was told, could be slow or could be fast or, indeed, somewhere in between. Well, that pretty much covers all eventualities. Mine was not yet anything like bad enough to be referred for treatment so we’d wait and see how things went.

I waited throughout 2012, still managing to track and photograph insects, as is my wont. Fortunately I happen to be left eye dominant and my left eye was still working properly. 35mm camera design is actually better for right-eyed people but that’s another issue. I use mine with my left eye and all continued to be well. There were two main reasons for what may have been protracted waiting:

  1. I didn’t want to get referred and go through the lengthy wait for me to percolate up to the top of the NHS list, only to be told to go away ‘cos my cataract wasn’t yet severe enough (the old term “ripe” sprang to mind) to be operated on;
  2. I’d eventually have to choose between a long-distance lens implant or a close-focus (reading) lens implant and I was by no means certain as to which I’d prefer (I was currently short-sighted in both eyes and used to being so).

I used the waiting period to discuss things with Mr. Optician and talked about the option of going private. Mr. Optician, who is also a personal friend, seemed less than keen on the private route for me, largely because, should any corrective treatment be necessary following the operation, that would also have to be done privately and costs could mount up considerably. He had one such patient who had already spent over £20K, though such things are mercifully rare. I should point out that, being retired, private health insurance is not a luxury I have. “What’s it cost, anyway?”, I enquired. “Oh, about £2000, I think”. “And how long would the wait be?”, I asked. “About 6 months on the NHS but you could have it done next week if you went private”, was his answer. [Remember that.] So, I continued to wait.

Then came our seemingly interminable 2012/13 winter. Only with the late beginnings of what we rather laughingly this year call spring, did I really notice that my right eye had deteriorated noticeably. Most of my winter tends to be spent inside doing close work rather than outside viewing the distant countryside and critters. In this situation, the effect of the cataract was less noticeable. Also, deterioration is actually very gradual, unnoticeable on a day to day basis; you just get used to it. Driving gave me one clue, if I covered up my left briefly. I could see the yellow of number plates of cars I was following, at a safe distance of course, but almost nothing of the black characters upon them. I wasn’t, however, experiencing any light scatter as described by some sufferers when driving at night. I really noticed when I started searching for critters to photograph again. “Surely I didn’t go through last summer like this”, was one thought that sprang to mind. The other thought was, “where did that damn critter go?” Now my cataract was adversely affecting my hobby; now I wanted it fixed.

The way the referral process works appears to vary by postcode. Where have we heard that before? Since I’m in Bedfordshire, my optician, in Buckinghamshire, apparently couldn’t refer me direct but had to send a note to my GP practice. That happened on March 14th. It can take 2 weeks or more these days to get an appointment at our GP practice but fortunately their eye specialist had two un-grabbed slots early the following week. I nabbed one and saw him quicker than expected on March 19th whereupon he referred me to a consultant. It’s a rubber stamp job, really, that just sticks a delay into the process.

Decision point: the NHS, bless it, is gloriously free but it’s a drawn out process and, worst of all, you have no way of knowing just how drawn out it will turn out to be. We had a 3-week trip to Spain coming up on April 24th, just over a month away. I could see an initial NHS consultation appointment landing on my doormat the day we left for Spain and my missing that appointment, thereby ending up back at the bottom of the pile after a second referral. I tried to phone to give them the dates of my absence but could speak only to the general appointments line at Stoke Mandeville hospital; apparently the person dealing with NHS ophthalmic scheduling didn’t take phone calls. The lady on the phone added that I had to work around them, not the other way around. OK, no concept of a customer but fair enough, I suppose, though I was just trying to save wasted time and a potentially wasted appointment slot. I also discovered that the NHS “was not hitting the 18-week target”. So, the six months or more on the NHS was looking like reality. I’m 60, for Darwin’s sake, I didn’t want to spend one of my precious summers, should one actually ever turn up again, twiddling my thumbs waiting, unable to book anything lest an NHS appointment letter land on the doormat while I’m away. I switched horses and elected to go private, mainly to get some scheduling control.

With a combination of my prevarication, our trip to Spain and Miss Consultant taking a vacation, I eventually saw her for my initial consultation on May 13th, after Spain. I could actually have seen her a few days before Spain (on April 18th) but we decided to wait ‘til we returned. That was a mistake and here’s why. The next thing that needs to happen following the initial consultation is to get some eyeball measurements performed to calculate the power of the lens implant required. However, contact lenses tend to distort the eyeball’s natural shape a little so I now needed to wait two weeks, without wearing my lenses, before seeing Mr Optometrist for those measurements. Had I known that from the outset, I’d have grabbed the one remaining appointment slot with Miss Consultant prior to Spain and used Spain as my 2-week eyeball recovery time sans contact lenses. A clear case of 20/20 hindsight. Never mind, Miss Consultant was about to go away on yet another vacation anyway, during which time I eventually saw Mr. Optometrist on May 28th.

The measuring of the eyeball is when you need to make the final decision as which type of lens you want: close focus, long distance or new-fangled multifocal. (The latter is not approved and not available on the NHS.) I’d been put very firmly off the multifocal route by a Dutch acquaintance who had one fitted and hated it. Since I’m used to being short-sighted, my initial, maybe natural, inclination was to get the right eye matched to my left eye, continuing with my familiar naked eyeball reading and using contacts/spectacles for long sight correction. However, Miss Consultant thought she may have seen the glimmerings of a cataract forming in my left eye, too. Since I dislike wearing glasses, especially outside in the rain, maybe if I needed the second eye done in another two years or so, long distance eyeballs might be good. The interim time with one long and one short eye would certainly be interesting, though I have a cousin who has deliberately chosen that format. Now came Mr Optometrist’s input which confused the choice even more. It seems that calculating the required lens power, even after eye measurement, is not an exact science. This is because there are still unknowns. Apparently the lens in the eye is only about 60% of your focusing (I thought it was 100%) with the cornea doing about 40% of the focusing. I’m assuming that the use of the word “about” is the rub. It appears that their calculation must include some sort of average value somewhere in the equation rather than a precisely measured value. So, in opting for a long distance lens, Mr. Optometrist says things like, “we will try to get your prescription as close to zero as possible”. In other words, you might still end up needing glasses for fine tuning. So, if I might end up having to tweak my long sight anyway, might it be better to go for a reading prescription where the fine tuning would be the distance at which I held the book, then continue to correct for distance as now? Arghhh, I hate decisions!

Based on the possibility of needing eye #2 done eventually and being drawn to the possibility of avoiding glasses in the rain shoud I at some pooint be unable to wear contact lenses, with heart in mouth I opted for a long distance lens and trusted to luck. Mr Optometrist was going to disappear and calculate/guess at my prescription then order a long distance toric lens to correct my slight astigmatism into the bargain (don’t think toric lenses are available on the NHS either). Meanwhile Miss Consultant would be finishing vacation #2. Back at home, I was not at all confident that I had made the best decision.

Now, here we are at May 28th having been referred by the Optician on March 14th. I’ll cop for 2½ weeks of that delay because of Spain, and I’ll add another 1½ weeks for my initial prevaricating. So, that’s a month wasted by myself. it’s still taken six weeks though, some of which are Miss Consultant’s vacations. So much for, “you can have it done next week if you go private”.

Knowing my luck, my focusing percentages will be way off average and … well, we’ll find out when Miss Consultant returns again.

Isn’t aging a fun process?

Posted in cataract

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