Cataracts and Working at Sea

by Tom Seymour

2006: Swedish astronaut Christer Fuglesang wears sunglasses during a construction mission for the International Space Station. Eskimos used sunglasses 2,000 years ago to reduce damage to the cornea from bright and snow reflected sunlight. NASA Photo

For anyone between their 40s and 60s, the formation of cataracts is no surprise. And yet, some people make it well into old age before experiencing any great difficulty seeing, while others far younger become visually impaired due to cataract formation.

People such as commercial fishermen fit into the high-risk group, since overexposure to Ultraviolet (UV) radiation, a component of sunlight, can lead to cataracts. Other risk factors concerning formation of cataracts include smoking, diabetes, aging, past injuries, steroid use and being in the sun all day without protective eyewear, namely sunglasses. And not just any old sunglasses either. For the best protection, sunglasses must provide protection from dangerous UV rays. Not all sunglasses have this feature, so it is important to read the label.

But how many fishermen wear sunglasses every time out on the water? Some do, but certainly not all. For many, a long-billed ball cap suffices to keep the sun’s glare from the eyes. But that’s just not enough. The damaging UV rays can still attack the eye despite ball caps. So until all people working at sea begin wearing protective eyewear, and that doesn’t seem likely to occur any time soon, people in the fishing industry will remain a high-risk group for cataract development.

So just what are cataracts, anyway? Well, a basic definition of cataracts is when the lens in the eye become clouded and hard, then the eye has a cataract. People with cataracts can experience blurry vision, ghost images and photosensitivity, or a sensitivity to light and glare. People with advanced cataracts often find it difficult or even impossible to drive at night, since the glare from oncoming headlights can easily blind a driver with cataracts.

Conrad Von Soest using eyeglasses, 1403. The earliest eyeglasses were worn by monks and scholars. They were held in front of the eyes or balanced on the nose. Salvino D’Armate, a glass blower in Pisa, Italy is most often credited with the invention of the first wearable eye glasses around 1284. The earliest glasses were perched on the bridge of nose.

Cataract Surgery

Fortunately, cataracts can be removed surgically and an artificial lens known as an intraocular lens, or IOL, is implanted in its place. This remains in the eye for life. While implantation of an IOL restores vision, it does not correct it. Most people after cataract surgery continue to need prescription eyeglasses or contact lenses.

So how does a person know when the time has come to visit the doctor to discuss cataract surgery? When cataracts interfere with our daily life, when simple tasks become difficult and when even prescription glasses fail to correct our cloudy vision, then it’s time to think about surgery.

Of course a person may choose not to have the surgery. There are some risks, but these are far and few between. In fact, cataract surgery stands as one of the safest of medical procedures.

But choosing not to have surgery leaves the cataract(s) to continue developing. Vision loss will continue to the point that a person in this stage may be considered legally blind. In some undeveloped countries, large segments of the population are, for all practical purposes, blind due to cataracts.

No one wants to undergo surgery if at all possible to avoid. But in this case, avoiding surgery amounts to no more than an attempt to stave off the inevitable.

Fortunately for those who choose to have cataract surgery, most insurance policies, including Medicare, cover the surgery. Medicare kicks in at age 65, so people without insurance with only a few years to go until their 65th birthday often choose to wait until covered by insurance.

Snow Goggles: One of the oldest sunglasses. Eskimos made slotted eye protectors from bone. Sunglasses as we know them today were invented in 1929 by Sam Foster. Photo © Canadian Museum of Civilization

Firsthand Account

The author recently underwent cataract surgery in both eyes. These were spaced three weeks apart. In this case, another procedure occurred during the cataract surgery. Glaucoma, or excess pressure within the eye, had finally defeated all available medications meant to treat it. There are numerous types of treatment and surgeries for glaucoma, but a brand-new device called an iStent Trabecular Micro-Bypass Stent was chosen. The stent, a miniscule object the size of a pinprick, works on the same principal as those far larger stents used to prevent strokes and heart attacks. That is, when blood vessels get clogged, a stent provides access to vessel flow.

In glaucoma, the eye’s drainage system becomes clogged and no longer functions properly. This leads to increased intraocular (inside the eye) pressure and that, in time, damages the optic nerve. There is no reversing such damage. But a stent can stop further damage in its tracks. The iStent creates a permanent opening, which in turn improves fluid outflow.

Fortunately for patients with both cataracts and glaucoma, the two procedures can be done at the same time. First the surgeon implants the stent and then removes the cataract. It sounds fairly simple and in fact, takes only a short time.

Here’s what a patient going into cataract surgery can expect. First, a second person as a driver is a must. No driver, no surgery. Then, on the way to the surgery center the patient begins a two-dose regimen of pills designed to quell anxiety.

Upon arriving, the patient is prepped. Vital signs are taken, a surgical cap is placed on the head and a different kind of stent, this time a needle with an opening for medication to flow, is placed in a vein of either arm. On the way to surgery, an anesthesiologist begins the process of slowly administering a mild anesthesia. This does not put the patient out, but it does make the cares of the world as well as the pending surgery seem less important.

When in surgery, the patient lies on a gurney and a bright light is placed over the eye being treated. With that, the patient feels some gentle pressure on the eye. After that, the patient is wheeled to a recovery room and made ready for the trip home. It’s a short, relatively painless procedure.

Back home, the patient wears a protective, plastic shield over the eye that was operated on to prevent turning on that eye at night and disrupting the healing process. It also keeps the new lens in place, something very important. This shield is worn for five nights after the procedure.

Finally, after one or two return visits to the surgeon to evaluate how well the eye is healing, the patient takes a series of eye medication for from three to four weeks. After that, the patient can visit their regular eye doctor to be tested and fitted for prescription eyeglasses if needed. It is possible that some time later, the lens will have “settled in” and a new eyeglass prescription may be necessary.

As per vision quality after catarac surgery, the patient is expected to have improved vision. The author experienced a time of photosensitivity, where white and even light-colored objects were intensely bright. This softens over time and colors, while brighter than before the procedure, return to normal. Eventually, living with new lenses in the eyes becomes part and parcel of everyday life.

In the author’s case, vision was enhanced by an end to prior cloudiness or blurred vision and also, a marked improvement in contrast. The world appeared fresh and young again.

We all need to have our eyes checked regularly, if only to make sure that glaucoma hasn’t set in or that cataract formation isn’t at the point where it needs to be addressed.

So for all those who work on the water and everyone else as well, don’t put off dealing with cataracts, glaucoma or both.

Oh, one final thing. The day after cataract surgery, the patient is allowed to resume all everyday activities with the exception of swimming underwater. So for hard-working people on the water, treating cataracts will not unduly interfere with precious time best spent out fishing and making money.

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