Cataract is a common problem. A simple explanation is that cataract is a clouding of the eye's natural lens (which sits just behind the iris, or coloured ring in the eye). It is not a disease, but sometimes cataracts can form more quickly as a consequence of disease or treatment of disease. Other things that increase the rate of cataract formation are poorly controlled blood sugar (diabetes), smoking, trauma to the eyes and exposure to ultraviolet rays (sun, welding, tanning beds, others). Like dust accumulating on a windshield, cataract creeps up on us slowly until we have great difficulty seeing much of anything, even with glasses. Rarely, cataract can form quickly in one eye alone.
In the end, cataract is simply something that comes with a long life and it's density depends on time, health and how we have treated ourselves over the course of a lifetime. It is fairly easy, for example, to be able to tell how much a person has smoked over their lifetime simply by studying the appearance of the eyes' natural lenses. In a similar fashion, we can see history of trauma, drug abuse or longterm pharmaceutical use and diabetes. Regardless of the reasons for dense (sometimes called 'ripe' or 'mature') cataract, the result is essentially the same: Decreased ability to see fine detail and contrast.
Cataract surgery is common and carries very little risk. It also provides one of the best returns on investment (ROI) in healthcare. If people can see, they are able to exercise, interact with others and keep their minds active. They care for themselves better and can give more effective feedback to caregivers. Ironically, at the end of long and productive lives, many seniors are reluctant to entertain the idea of surgery. Some of this is anxiety surrounding surgery in the eyes, but frequently it is a sense of not wanting to burden the healthcare system. One gentleman put it succinctly in a golden frankness all too rare nowadays: “I'm too old for this. I'll be dead soon anyway, and so what's the point?” (FYI, Education provides the best ROI for healthcare, more on this later).
John, a 96 year-old patient, recently had cataract surgery through our clinic. He had had trouble reading for more than 10 years. Even with repeated changes in glasses, his vision was declining steadily. John had been a teacher in Saskatchewan and spent time during WW II working as a counsellor to 'shell-shocked' soldiers (Post Traumatic Stress Disorder or PTSD in current parlance). After the war, he became Principal of Ryerson Institute (business college in Toronto), then worked at Shaw College (Toronto) as a recruiter and trainer and was helpful in establishing their program. He also worked in insurance and was very successful in business. In his final career, John worked for SAIT for 36 years and was eventually offered the presidency. Sadly, he had to refuse this due to time commitments.
For an academic with limited mobility, this lack of reading has been a struggle for John as it is one of the few things he can do to engage his imagination and mind in his longterm care facility. Yes, he can watch TV, but suffice it to say that this provides less than adequate stimulation for an intelligent man with an active mind. With poor vision, it also became next to impossible for John to move about in his facility in order to get exercise or meet with friends. John's clouded vision became a virtual prison in some regards. After considering the risks and benefits, John agreed to proceed with surgery.
Since his surgeries (right and left eyes now done and healthy), John has been able to engage in a world of possibilities he thought was lost forever. He reads the newspapers again and even challenges himself to exercise more. From a medical-economic perspective, there is no question that it is more beneficial to overall physical and mental health if a person can see well enough to be independent and to engage in stimulating activities. The more expensive alternative is to manage depression and other ailments that arise from a stagnant and immobile existence.
As importantly, we are morally obliged to assist John for all of his contributions over his lifetime as a humane and caring society. This means that we need to manage our limited health resources well and manage our own health issues better. It's not unreasonable to expect that we should avoid unnecessary health risks and take better care of ourselves to leave enough resources available to those who can truly benefit from the privilege of publicly funded health care.
Dr. Boulet is a former teacher and now operates Diamond Valley Vision Care in Black Diamond where he continues to work with children with learning difficulties.
Call 403-933-5552.
www.dvvc.ca and www.LearningManagement.ca
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