Seeing Things Like It’s My Last Chance To See Them – Thoughts Following Cataract Surgery by Richard Koenig

Many are the ways to die on the way to death—that is, die to the world of the senses.

“Sans teeth, sans eyes, sans taste, sans everything.” So ran the Bard’s dreary catalogue.

But here I’m talking eyes only.

I’m 70. Like millions of others approaching geezerhood or well into it, I’m doing what I can to save my sight. We are fortunate to live at this stage in the history, when eye surgery has become all but a rite of passage. Vision loss is mitigated or put off, dodged or even reversed.

I’m progressing from one eye repair to the next, and each seems a miracle. But who’s to say how long the benefits will endure? You’ve been given an uncertain reprieve. That’s what I tell myself.

Start seeing things like it’s your last chance to see them.


“Can you see me?”

I put the question to a buddy as we waited for a routine eye exam at school: “Can you see those letters?”

He glanced at the eye chart on the wall. “Sure. You can’t?”

I couldn’t. At age 13, I was discovering my near-sightedness.

Later, immediately after I got my first pair of eyeglasses, I was stunned by what I could see as I stepped outside the optician’s office. It was a sign across the street, suspended above the showroom window of a tire dealer. “Firestone,” it said. Its white letters and red background, suddenly crisp and bright, leapt out at me. I felt a quiet thrill.

More glasses, then contact lenses, followed. By middle age, the question was no longer whether I could see most of the letters or even the big “E” at the top of the chart. Nothing was there except indecipherable splotches. One time a nurse stepped between me and the eye chart to ask—whether out of concern or frustration, I don’t know—“Can you see me?”



How different today is. My distance vision is a source of joy. There remains a little issue I’ll come to. But the sights of this world—the sparkle across a snowfield, the “STOP” on a road sign, the irises of my grandchildren’s eyes—now announce themselves as if to demand I delight in them.

What happened?

Some months ago, a surgeon slit my right eyeball. It was a tiny slit in the cornea, no more than a tenth of an inch. There he inserted an ultrasonic probe deep enough to reach the lens, break it up, and vacuum out the pieces. After removing the probe, he folded a pliable artificial lens—“like a taco” is a common analogy—and slipped it through the incision. Once in place, this intraocular lens (IOL) sprang open. The surgeon then positioned it just so, arranging two filaments extending from the actual optic for tissue fixation. All this work of demanding exactitude was done with the benefit of a surgical microscope, of course.

“Of course”—how those words reveal the smugness of someone living at this moment in a wealthy nation! As recently as to fall within my lifetime, early attempts at this kind of surgery were done with only the aid of a flashlight.

Eleven days later, I had the left eye done. As before, the eye was dilated, and I was sedated but conscious. For a moment, I experienced a burst of color—this time a raspberry swirl; at the first operation, stripes in olive and gray. I might say both events were like a psychedelic moment if I had the personal history so to say. (I don’t.)

As you doubtless recognize, what I’m describing is cataract surgery. With age, a cataract had formed in each eye as proteins in the lens clumped together, making the lens opaque. This year roughly three million cataract operations will be done in the United States alone. Sans eyes? No, not yet. Not for many of us.

The benefit of surgery extended beyond removing the opacity. The artificial lens also corrected errors of refraction, both my myopia and my astigmatism. Though I had long lived with these conditions, I wasn’t about to turn to surgery to be rid of them until my cataracts worsened. Then one night I was driving in a rainstorm and my wife, Lin, remarked, “You’ve never driven this slowly before.” It was time.

The morning following the first operation my vision began to sharpen as the dilation subsided. By the time I was on the way to a follow-up exam, things were popping. The mottling on the bark of a tree, the sienna in the fieldstone of a farmhouse, stood out as never before in recent memory.

At the surgeon’s office, I read the eye chart, stopping at the smallest line that came clear.

“Which line is that?” I asked.


I left hungry to see more.


“Jack, tell them all to wear their goggles”

I sometimes imagine a man falling out of the sky over southern England, falling to a place in history greater than he could know.

He was Gordon Neil Spencer Cleaver. “Mouse” he was called by his mates, apparently a nickname that had survived his school days. Cleaver established himself as a top skier when he won the combined championship of the 1931 Hahnenkamm, a forerunner of today’s World Cup races in Kitzbühel, Austria. A Briton, he went on to serve in the Royal Air Force during World War II, surviving a forced landing in France, scoring at least seven kills of Luftwaffe aircraft, and earning a Distinguished Flying Cross.

He must have been a helluva guy. I owe him big time. Here’s why.

August 15, 1940 marked a furious engagement during the Battle of Britain to beat back Germany’s attempt to destroy British airfields. Cleaver flew two sorties that day in Hurricane fighters. On the second, his plane took shellfire. He managed to parachute into the vicinity of Winchester.

By then, however, the damage was done: His eyes were embedded with splinters from the shattered, transparent canopy of the Hurricane’s cockpit, splinters of an acrylic plastic. It has become part of the lore about Cleaver that, when a fellow pilot visited him in the hospital, his first words were: “Jack, tell them all to wear their goggles.” During the scramble before his final dogfight, Cleaver had flown off without his.

Cleaver became one of the pilots under the care of an eye doctor by the name of Harold Ridley. For some patients, there was little Ridley could do. Cleaver, for one, was blind in his right eye, and the vision in his left eye was severely diminished. Nevertheless, from his wartime care for Cleaver and others, Ridley took with him an observation: The acrylic in the pilots’ eyes, horrifically damaging though it was, seemed inert—it didn’t cause inflammation.

From this point, the narrative takes many turns. Ridley implants an artificial lens, designed in collaboration with the Rayner optical company. The date: February 8, 1950. He is initially scorned by the good and the great of ophthalmology. Foreign objects are only to be removed from the eye, no? And what is an IOL but a foreign object? Decades pass before Ridley is vindicated. The good doctor finally becomes Sir Harold.

But for our purposes here, the essence of the story is that the original Ridley lens, which led to the many types of IOLs to follow, consisted of an acrylic nearly identical to that in, yes, in Gordon Cleaver’s Hurricane canopy.

Gordon Cleaver died in 1994. Late in life, he himself had undergone cataract surgery to improve sight in the eye that still had any. That operation was one of 18 done on his eyes and face after the war.

You have an IOL? You owe him, too.


“Purple. And lavender.”

Pre-cataracts, I could see well with contacts—in the best years, 20/20 if the prescription was perfect, if the light was good, if the contacts were clean, if the wind wasn’t drying them out.

But I can tell you, 20/15 beats 20/20. During a recent desert vacation, I can’t help noticing the ruby iridescence of a humming bird’s throat, the translucence of a rabbit’s ears. And, oh, the sunrise—that showy peach effusion, the charcoal streaks racing in the sky like contrails. Nor is the visual delight engendered only by nature. Simply a billboard, the now sharp edges of its lettering, will do: “People’s Bank/Get an account in four minutes/Seven times faster than pizza.” It’s a repeat of the elation induced by that Firestone sign.

I’m now pausing more often to observe. Knowing I can see better, I take time to see better. This greater patience, I’ve come to realize, means even more than 20/15.

In the past, looking out a window, Lin, whose paintings hang throughout our house, would ask, “What’s the color of that shadow?”

Me, feeling distracted from the next thing on my to-do list: “Black, of course. Dark gray?”

Her: “No, purple. And lavender.”

Black to gray to purple to lavender to mauve to … I’ll never have a good eye for distinctions once they become subtle. But these days I do a little better holding up my end of the conversation. I look for the purple.


“A healthy dose of skepticism”

I’ve said I’d get to another issue.

Some years ago, I was raking leaves when I saw over my right eye what appeared to be a speck of dirt on my sunglasses. Removing the glasses, then the contact lens, didn’t help. The speck was still there. Fearing a retinal tear, I got an appointment with an optometrist available on quick notice.

Good news, he said. Your retina is fine. It’s just a floater, a floater called a Weiss ring.

What to do?

Probably nothing you’d want to do. It may settle out. Your brain may adapt to it. You’ll probably get a ring in the other eye, too.


Some people recommend leafy green vegetables. Try spinach.

A lot of us have floaters, those cobwebs that glide in and out of view, proliferating with age as the vitreous gel filling the back of the eye continues to deteriorate. But a Weiss ring is an exceptional hunk of this debris. It has torn off from the optic nerve, and it remains fixed in the center of the visual field, incessantly hovering and twisting, now a ring, now the letter “C,” now a column, now a ring again.

Spinach didn’t work. About a year later, the left eye had its ring, too. I was ready to take a risk. Yet even the least drastic of my options gave me pause: Asking a doctor to shoot laser beams at the floater in an effort to vaporize it. I feared a misfire would hit the retina.

I found a small study of this treatment, called YAG laser vitreolysis, which was generally encouraging but accompanied by a cautious editorial: “ … an open mind with a healthy dose of skepticism is necessary.” When I brought up vitreolysis with a skeptical eye doctor, she squinched up her face but then allowed that a ring would be easier to laser than other types of floaters. The safety spacing in each eye—ring to retina—seemed adequate.

In time, I saw an ophthalmologist who had dedicated his practice to vitreolysis. He took care not to promise the moon, volunteering that he spent 80 percent of his time on re-treatments intended to clear up the residual 20 percent of inner-eye detritus. He had a healthy fear of sharp-shooting near the retina.

Even so, I equivocated up to the day of treatment. What decided me? That morning, as I lay awake in bed, I happened to be looking up at a white ceiling. A white background makes floaters stand out. The rings drifted this way and that in provocation. It was driving me nuts.

During the vitreolysis, a strap kept my head still. An eyepiece prevented blinking. I felt nothing, but with each laser shot, I heard a click. It might have been a video game. I saw the vaporized floaters. Click, click. They looked like dark, elongated raindrops dropping across my visual field. Click, click.

I can’t speak for others, but for me the benefit was immediate and wonderful but not total. I’d say about 70 percent of the gunk vanished at the initial treatment. I’ve been back once. That round got perhaps another five percent.


“You start to go blind”

“You get to my age,” said the woman in the nursing home’s dining room, “and you start to go blind. Everything goes.”

Sans eyes, sans everything.

At the next table, I was having lunch with my mother, aged 97. Her right eye was damaged by wet macular degeneration. The blood leak at the retina had badly blurred her central vision. Every few months, we’d get Mom’s wheelchair rolled into a van for the cross-town trip to a retinal specialist so he could inject a miracle drug into the eye to preserve what poor vision was left there.

The right eye, understand, was the good eye. No treatment existed for a different type of retinal damage in the left eye. The nurse would stand a few feet away and say, “How many fingers am I holding up.” Looking with the left eye only, Mom would squint gamely, but she could barely guess.

Stoic—and, I should like to add, brave–into her tenth decade, Mom only once remarked to me about wishing to be spared any of the accumulating cruelties of age. That was total blindness. For several years, she endured these outings–the joint-rattling van ride, the wait for her turn with the doctor, the shot in the eyeball—though they utterly exhausted her. The right eye continued to test steady at 20/40, 20/50, 20/60, the result varying with ambient light and the kind of day Mom was having. We’d take a 20/50 and go back to the nursing home relieved.

In the last weeks of her life, however, there was no way of getting Mom on that van. One day I stood at the foot of her bed as she lay there, and asked, “Can you see me, Mom?” No answer. I started yelling—“Can you see me? Can you see me?”—and now, near panic, I was waving my arms. Then came the delayed light-bulb moment—I’d forgotten to put in her hearing aids.

I was cursing my absent-mindedness when Mom started to wave back. Maybe she still had 20/50 at the end.

You get to a certain age, and you realize you just might make it to 90. Then you wonder whether you want to. I believe I do. Let’s see how my eyes hold up.


“There’s no free lunch”

What could go wrong?

For now I’m making my peace with what’s left of the floaters. They don’t much offset the benefits of the cataract surgery. I may yet go in for a third treatment.

As for the surgery, I must say I’ve lost a bet. After the right eye was done, the surgeon offered to dial back the refractive power of the lens for the left eye so I’d have better close-up vision, though at the sacrifice of some acuity at a distance. He made that plain: “There’s no free lunch.”

I turned down the offer, gambling that I might still be able to make out the print in a newspaper as I once did with contacts. Wrong. I’m reaching for reading glasses more often these days. But I’m at peace with that, too. Even if I must look out beyond an arm’s length to get it, I’m still thinking 20/15 is what I want. That red maple in our yard, as seen through a living-room window, it blazes.

Otherwise, I’ve skated past any serious post-surgical complications that might have occurred so far. I do see IOL-related starbursts from car headlights, but it’s no big deal.

And there is another phenomenon, more entertaining than bothersome. If I stare at a full moon, its aura encompasses pale concentric circles, something like the concentric design of my IOLs. It’s a show that tops Saturn. No telescope needed.

I’ve asked Lin, who has had cataract surgery with the same IOLs, whether she sees moon rings, too. She doesn’t.

But who is she, or you, to say the rings aren’t there?


“Life is a torture for me”

Understand I’m not complaining.

For millennia, a cataract operation was this: Seat the patient; have someone hold tight the patient’s head; stick the patient in the eye. That was “couching.” The idea was to couch, or depress, the lens out of the path of light entering the eye. The couching instrument might be a needle of finely wrought metal or something cruder. One prominent 18th-century practitioner—the oculist to King George II, no less—incorporated in post-operative eye drops the blood of slaughtered pigeons.

Even long after surgeons had learned to extract a cataract-damaged lens whole, anyone might have reason to resist surgery. Claude Monet did. He wouldn’t agree to an operation until he was in his 80s, even though his painting had been suffering the effect of his cataracts for more than a decade.

The story of Monet’s agony has been told by the ophthalmologist James Ravin, writing for the Journal of the American Medical Association. Colors lost their vibrancy–reds were “muddy,” Monet lamented, pinks “insipid.” Enraged, he took to slashing canvases with a penknife.

Monet finally relented to an operation on his nearly blind right eye in 1922. For 10 days afterward, he was restricted to bed, his head immobilized by sandbags. An attendant spoke with him in the darkness to keep him from going mad. Later fitted for eyeglasses, Monet complained that objects strangely curved. He feared falling. He saw things too yellow at first, then too blue. “My life is a torture for me,” he wrote to his surgeon. Only after trying one pair of glasses after another did he report improved vision. He never agreed to an operation on his other eye.

So went cataract surgery into the 20th century.


“The eye’s jungle”

Vision retains a mystery, it seems to me.

I know: the evolutionists can tell us about the descent of the eye. It originated in the “eyespots,” the light-sensitive proteins, of single-celled organisms. Epochs passed, the design progressed. Came the day when Monet would regard his water lilies at Giverny.

But the retina, that labyrinth of nerve cells at the back of the eye, remains, as an MIT research team has called it, “the eye’s jungle.” It is light’s still imperfectly understood gateway to the brain, triggering the neuronal excitement that becomes what we see—becomes our world. I’ll never comprehend that magic. I dearly want to preserve it.

When I consider the odds going forward, retinal health appears the crapshoot. Better drugs and surgeries may come along. But a retina has nothing like the relative simplicity of the camera-like lens. No one will be replacing retinas, not in my lifetime. So I eat my spinach, if only because I like it. I go on streaks of pill-taking—vitamins, zinc, lutein, the works. I’ve gotten religion about regular check-ups with an eye doc.

And, for now, I count myself lucky, dumb lucky. The chance time and place of my birth have awarded me an opportunity to postpone or even skip years of living sans eyes. I’ve been gifted more looks at the world.

So look hard, I keep reminding myself. At your age, even if your eyes stay good, you don’t have all that many looks left.


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Bio: Richard Koenig, formerly a newspaper reporter and pharmaceutical-company executive, is the author of the Kindle Single No Place To Go, an account of efforts to improve sanitation amid a cholera outbreak in Ghana.