Palm Springs for Gay Men: On Cataract Surgery

By Gymbrat, Your Webmaster

Why are you reading this essay? My guess is that you are facing cataract surgery. Why else would you bother? This is not a fun, leisurely reading, even if I will try to lighten it up a bit. This tale is meant to convey an important point when it comes to surgery, even for something as "everyday" as cataracts. You must get a surgeon who is qualified and an eye institute that is suitable for the job, hopefully also with some margin. Most people will just tell you "Hey, don't worry, it's nothing", which tells you that it could be done anywhere by anybody. Don't believe it. You only have two eyes. If one eye goes awry, yes, you still have another one, and you can live a fairly normal life with one good eye. But if you lose the second eye, you lose a major part of your life. Think about it. No driving, no reading, no writing, no sewing, no photography, no computer, no job. Think about it some more. Elsewhere here on Internet you can find many good descriptions of cataract surgery, and I read some of them when it was my time to have it done. You can probably also find case studies in great medical detail, and you can study them until the cows come home. But I am not sure that you will easily find a tale of cataract removal, written by a patient who tells you how he personally experienced first a botched surgery for one eye and later a glorious, successful surgery for the other. Well, here is one such tale. Before you take the easy road, to just go and get it over with, you owe it to yourself and to the remainder of your life to hear what can happen. In the overwhelming number of cases the outcome is fine, and the tales of such cases would be short and simple: "Wonderful!" But you should always be prepared that you may be one for whom it does not go well. For your home or for your car, you prepare yourself for bad luck by paying an insurance premium, even though it is very unlikely that you will actually have any use for it. For bad luck in surgery there is no insurance that you can get by paying money: instead, you buy your insurance premium by finding out where to go, so that you can lower your risk by making a wise choice. Most people will tell you how easy it all is. You march right in, doze off, and after a half hour of comfortable rest you are given a cup of tea and a cookie and home you go. After two days you drive your car again and after a week you are completely restored to your former self, only that you can see clearly now. While my second cataract surgery went something like that, the first surgery most definitely did not. You will hear everything about those two events, and I begin by giving you some basic knowledge about cataracts and their removal. Here is the short of it. First a word on how the eye works. The image your eyes see goes first through the cornea, a transparent shield in front of the eye. Then it squeezes through the iris, which is a (brown or blue or green) circular muscle with a hole in the middle, and the iris muscle adjusts the size of the hole based on how bright the world in front of it is. Then the image passes through a lens right behind the iris. That lens is held in place in a capsule or bag, suspended in a fixed position by strings of fiber. Finally, the image passes through the eye cavity, which is bigger than you think and is filled with a gel-like substance called vitrius. The image ends up on the retina, which is a network of light-sensitive cells on the back of the eye. The image stimulates those cells, and the combined cell reaction is transferred to your brain via the optical nerve. Since the eyes are located at some distance from each other, they see a slightly different picture, and the brain uses that difference to figure out the distance to the observed object. Therefore, for good distance measuring, both eyes need to be in a somewhat similar working order. Now over to cataracts and their removal. When the lens inside its capsule ages, as it does when we do, it slowly turns cloudy, allowing less and less of the image to pass through. This cloudiness is called cataracts, and ultimately they have to be removed to give you your eyesight back. Nothing can be done about the cloudy lens, so it has to be replaced. With what? With an artificial lens, which is actually better than nature (wow!!!), because it can never get any cataracts. This lens replacement is what cataract surgery is all about. Not long ago the surgeon made a fairly substantial cut in the side of the eyeball, removed the old lens with tweezers, inserted the new one with tweezers, and then sewed together the cut. These days all cataract surgery uses a method called phaco-emulsification, where a very small cut is made, just enough for a special tool to pass through. This tool crushes the old lens inside the capsule with ultrasound, sucks out the resulting pieces, and then inserts the new lens at the same place in the capsule. All automatic - well, sort of. The cut is so small that it does not even have to be sewed up. And when that is done, you get your tea and your cookie. My own eyes have an affliction called pseudo-exfoliation, a peculiar word for a condition where the capsule for the lens is weaker than normal, either the capsule itself or its suspension fibers, or both. I had been warned by optometrists for years that any cataract surgery would have to be performed very carefully, very very carefully. I listened to this advice also very carefully, but all the dire warnings drowned when the time for the needed surgery approached. My mind was too busy fighting an overwhelming, primitive fear of "knives cutting into my eyes", during which I would be forced to stay awake with only local anesthesia. Never mind the kind souls telling me that I had nothing to fear, that it is the easiest and safest of surgeries, that I wouldn't know of anything happening, and that it would all be over in no time. It didn't help. For the first time in my life I went to a psychologist. I needed to learn how to overcome this fear, but I found out that no psychology could help me. I was in nothing less than panic. When in panic you don't do rational things. I should have been searching for surgeons with many years of experience in cataract surgery, I should have inquired into their successes and failures in dealing with pseudo-exfoliation, in short, I should have looked for professional skills and credentials. Instead I fell for a young doctor with great people skills and an uncanny ability to calm fluttering nerves. This Dr James Johnson at the Milauskas Eye Institute in Rancho Mirage, a clinic of good repute, was my partner Orlando's ophthalmologist, and he really made me feel calm and collected about the impending medical procedure. While professionally serious, he was full of jokes and humor, just what a scared little rat like me needed. At the pre-examination we discussed my pseudo-exfoliation condition at length, and he convinced me that he could handle it with no difficulty at all. "I've read the book and seen the video"; it would all go well. His easy manner was reassuring: no doctor would ever joke about a procedure that he was not absolutely comfortable with. So I didn't even ask him how many cases of pseudo-exfoliation he had handled in his career. I went into my surgery on November 1, 2000, with my eyes wide open and with my mouth sucking on a tranquilizing tablet that the psychologist had prescribed for me. Local anesthesia, my foot! I may have been wide awake, but it worked so well that I wasn't aware of anything at all during the whole procedure. I remember being softly nudged on the operating table; it was all done, and I could go home now. I was told to come back to see Dr Johnson the following day, exactly as had been said all along. My eye was bandaged and I felt that this was, after all, exactly the no big deal that people had said it was. How could I have been such a chicken? I felt a bit foolish, but I realized that I had not been the only chicken around; many people are just as afraid of knives in the eye. On the next day Dr Johnson looked at the eye and told me that everything seemed to have gone pretty well. He said that both he and Dr Albert Milauskas, the owner of the Milauskas Eye Institute, had "been on the microscopes" during my surgery. Some pieces of the old lens had come out into the vitrius; not a big deal, but he had made an appointment for me for the following day with the Southern California Desert Retina Consultants in Palm Springs to take care of this detail. A Dr Clement Chan there would decide whether anything had to be done about it. That is basically all Dr Johnson told me, and when I had left I never heard from him again. This struck me as very peculiar. One would think that if a medical procedure goes wrong, as of course happens, a responsible and caring physician would be interested in following up about the case, both for his own education and for the comfort of and as a courtesy to the unfortunate patient. This did not happen. Once I was transferred to Dr Chan, I was of no more interest to Dr Johnson and I had totally disappeared below the horizon of the Milauskas Eye Institute. I did not exist anymore. Dr Chan examined my eye and said that it was essential that I undergo vitrectomy to protect the retina from potential damage by the matter floating around in the eye mass. Vitrectomy is a surgical procedure, during which the eye is emptied of all its vitrius (and anything floating around in it) and then filled with a gas to keep the eye in its normal shape, while the body, over a period of weeks thereafter, regenerates new vitrius and refills the eye with it, replacing the gas. A vitrectomy is "real" surgery - you sleep. Any general anesthesia is more risky in and of itself; it must be preceded by a fairly thorough general body exam, replete with chest X-rays, blood tests, EKG, the works. Dr Chan found a time available on November 9, 2000, 8 days after my cataract surgery, but I could also have it done in "emergency session" in the evening of an earlier day. The evening session would have fewer hospital services available. Which type did I want? Better services or shorter wait? Which? Which? It was entirely up to me to make the choice between November 9 and an earlier emergency session; Dr Chan did not suggest which alternative would be best for me. I had literally one minute to make this seemingly important decision. But then, since I was not given any pros and cons about my choices, I could just as well have tossed a coin. In my view, it was totally astounding that this choice was left up to the hapless patient without any professional guidance. But so it was, and I chose the regular time on November 9 rather than the emergency session. The irony of it all is that I should not have chosen either one of the two dates. I have since learned that there was no immediate risk to the retina to have this debris floating around for quite some time. By waiting for a month or two, the body would have its chance to dissolve the pieces all by itself - after all, what was floating around was nothing from the outside, it was just a broken up small part of my own body. If the matter could disintegrate naturally, no need for a vitrectomy, which is a serious operation that can easily compromise the eyesight for the future. But perish the thought: such reasoning could seriously threaten the livelihood of even the best eye surgeon. The days before the vitrectomy were filled with tasks, although I tried to move about as little as possible. I could see quite well with my left eye, but I also saw lots of little black, square pieces slowly gliding downward in front of me, fragments of the broken up old lens. I was scanning Internet for information, useful in my situation. Was Dr Chan my best choice? Did I need this vitrectomy? While much data was available, nothing was really helpful for a quick decision about anything, so I finally gave up the quest. Somehow I obtained brochures about rental of chair and bed supplies for vitrectomy patients. There I learned that one had to stay in a face-down position for the weeks when new vitrius was generated. From what I read, this would be a very trying time, and it really scared me. I believe I got the brochures from Dr Chan's office, but it may have been from Internet. I asked Dr Chan if I should order such equipment, but he told me then that in my case the head should instead be leaning back at a 45 degree angle, while making sure that it did not tilt sideways. Ah, how good of him to tell me! Of course, he did not tell me how to make the practical arrangements for this. Again I was on my own. I had seen air passengers use a special collar when they slept, leaning back in their seat, and Orlando found one for me. It would later help me enormously in keeping my head in the prescribed position without falling to the side. The rest would have to be done with pillows, tons of pillows piled high. To help out the situation, we made arrangements for a nursing aide from the International Health Care Service in Palm Desert to sit and watch over me shile I was sleeping in the prescribed position during the night - Orlando would then be able to get some sleep. Quite amazingly, this scared-out-of-his-wits creature now turned into a bedrock in the middle of a foaming ocean. I had neither the time nor the inclination to feel even the slightest apprehensive: I just wanted to do everything right to save the eye. In the midst of all my important duties I also took time for some frivolities, such as voting in the 2000 Presidential election. From the beginning, I had scheduled my cataract surgery for November 1, so that it would not conflict with this important civic duty. I had planned to be out and about well ahead of the election date. Well, so I was, sort of. For me, the vitrectomy itself was just as easy as the cataract surgery had been. Orlando drove me to the Desert Medical Center with another tranquilizing tablet in my mouth, and I don't remember anything happening until he drove me back. I had been told earlier, that a week of almost round-the-clock sleep always follows a vitrectomy, and I was drowsy all the time just as predicted. Dr Chan had allowed me to get up for meals in a sitting position, only not to tilt the head sideways at any time, so Orlando woke me up now and then, breaking my sleep. My bed had been arranged with every pillow in the house propped up to offer me the correct half-seated position, but it was tough on the buttocks, almost like sitting on them all the time. Therefore I alternated with the living room reclining leather chair, that had been placed next to my bed. I wore the flight collar continuously. Orlando was at my side all the time, and for the night we had the nursing aide. Well, not for very long: in the middle of the first night I happened to wake up and found her deep asleep in her chair. When she left in the morning, we thanked her profusely, gave her the $96 for the night, and asked her not to come back. Orlando said that he could handle the situation and took over the full 24-hour watch. When he had to sleep, I managed to keep awake watching pregnant chads being counted on TV all month long. Orlando kept track of everything, from eye drops to food to doctor appointments, right from the start, and when my drowsiness lifted after the first week he continued to take care of all those necessities. I used a hard patch over the operated eye in the beginning, but after a few weeks, with new vitrius inside, I could see a held up finger with it - great joy! Soon thereafter I could again start using the eye a bit. My eyesight was no longer foggy as it had been with the cataracts, but it was a bit distorted, and everything was also uncomfortably bright. I had to wear dark eyeglasses whenever I didn't cover the eye with the patch. After the first two weeks I didn't have to stay in my rigorous position. As soon as the body had refilled my eye with new vitrius and the gas was gone, there was no more danger to the retina and I could move about at will. Immediately after the vitrectomy Dr Chan wanted to check my eye quite frequently, but after a while it changed to once every other month. He said each time that I had edema in the back of the eye, and that caused me to have a constant inflammation. He tried various eye drop combinations, and some of them raised the eye pressure alarmingly. I remember once when Orlando rushed me to the doctor in awful pain; I sat folded over in the waiting room, and they took me in quickly. My eye pressure was then 35, very high indeed. With the help of some liquid remedy they got it down to a manageable level, but this was not a good time for me. In all I had seven appointments with Dr Chan during 2001, and I never knew if this was a sign of lack of real interest. During one of my visits he let his medical photographer take pictures of my eye, while a dye was injected in a vein my hand, to allow him to follow the circulation in the eye. And on four occasions Dr Chan injected some kind of steroid into my eye (actually into the eyelid, a hair's width away from the eye itself, but who's measuring?) in order to alleviate the edema, but it had little effect. Even with all these measures my eyesight didn't improve much. Dr Chan was never pleased with my recovery, and once he actually warned me that if I continued to have this inflammation, that could in and of itself cause permanent damage to the eye. As if I were a nasty boy who chose to keep my eye inflamed in spite of his orders! Well, in the end he turned out to be right: my left eye does not appear ever to become even remotely normal. All in all, I think it comes through from my saga that the Southern California Desert Retina Consultants office was not a happy place. Of course, a medical clinic of any kind is not supposed to serve as an entertainment center, but this office was a downright gloomy place. Several miniature treatment rooms, two small waiting rooms with a blaring TV where some 20 people could be squeezed in, a crowded administration room, and a narrow corridor; this all gave you a feeling of something very primitive, which of course it was not. The people working there were cheerless, really somber looking, no smiling faces ever, and the receptionists could only be characterized as brusque, in particular one named Tanya. (To be fair, the accountant was a pleasant exception, but she was hidden away in her little chamber.) The two ophthalmologists were terribly overloaded, and the time assigned for each patient was minimal. As a result, appointments, particularly in the late afternoon, could be delayed by two, three, yes, four hours. Most of the time the waiting rooms were stuffed with patients who just sat and sat. They could not leave and come back an hour later, because no word was ever provided as to approximately when they would be called in. In this environment, not only did the doctors appear rushed - the patients became infected by the feeling of time shortage and quite understandably avoided to ask questions that could be seen as unnecessary. When Dr Chan had made his examination and treatment and I had some questions, they were invariably answered with one hand on the doorknob and one foot already in the hallway, so much of what I didn't know remained so. I always left with many question marks buzzing about. We never ever had time to sit down and talk about my condition at length. He never had the time (or interest) to really listen to what I experienced or thought, and he never explained his line of action. There were always a dozen other patients waiting for him. I have said many times that my left eye never really recovered from the catarct surgery cum vitrectomy. What is it that makes me judge my eyesight as bad? Several things. My left eye has not changed much since those days, so what I'll say in this paragraph still applies, and it probably will for the rest of my days. One thing is that an image of something, when seen by the left eye, appears to be much further away (smaller) than when seen by the right eye. If I compare what I see by closing one eye at a time and alternating back and forth, the difference in the size of the image is striking. However, the brain has learned to adjust for this discrepancy, so when I look with both eyes there is nothing obviously wrong: the image appears sized as it does when only the good eye is used, and what the bad eye sees is obviously discarded. Small wonder that I have headaches at times, particularly in the morning, something I have never had before. Also, what I see with the left eye is distorted: some sections of my field of vision appear much smaller than others, and therefore straight lines always appear crooked. And on top of this, the sharpness of detail in a given spot comes and goes. On a printed page I see some letters as very sharp and others as fuzzy, almost gone, and, while I am looking at the page, other letters become sharp and others fuzz up. This is particularly obvious during vision tests: if I am allowed long enough time to look at the chart, a given letter that is hard to identify usually clears up for a second, enough for me to see what it is. Needless to say, my reading with the left eye these days is limited to doctors' vision charts. A second problem with my bad eye back then is still with me, although it's quite a bit better today. The eye used to let in too much light, so the great outdoors was always blindingly bright, and if I tried to read, the whiteness of the paper was so overwhelming that I could often not see any text at all. I had to use sunglasses most of the time. I pointed out this problem to Dr Chan every time, and he didn't seem the least concerned. He suggested that the Vexol eye drops I was taking had a slight dilating effect, meaning that the iris did not contract properly. From what he said I inferred that once I'd stop taking Vexol I wouldn't be blinded any longer. A third problem I had back then is almost totally gone today. Colors looked quite different to the eyes, one saw warm colors - emphasis on red and yellow and green - while the other saw cold colors - emphasis on blue and purple. The result of this difference was quite peculiar if I alternatingly opened and closed the eyes. Once I had recovered a bit, I started to wonder about was what had really happened during my cataract surgery. Of course I knew that the lens capsule had broken, but why did it break when Dr Johnson had been so sure that my pseudo-exfoliation was not going to be a problem during the surgery? This was not a question for Dr Chan but rather for Dr Johnson. I called up Milauskas Eye Institute in April of 2001 to have someone, who was knowledgeable about the details from my surgery, give me the details. Of course I would prefer to get it from Dr Johnson or Dr Milauskas. Now this appeared to be a highly unusual request (Listen to this: Some patient we kicked out wants to know how we goofed!), and it took them a long time to get me scheduled. And even when I showed up for my appointment I had to wait extra hours - of course, I was no longer a preferred customer. When I had been taken to an examination room, a nurse insisted on dilating my eyes in spite of my protests. No, thank you, I'll only be talking with Dr Johnson. But... No, thank you! I'll only... No, you won't!! Are you sure? Goodbye!!! When finally Dr Johnson came in, we had a cordial 10 minute discussion, during which I learned that the surgery had taken 45 minutes rather than the customary 15, that both he and Dr Milauskas had been on the two microscopes during the surgery, that the lens capsule in my eye had ripped apart right after the old lens had been pulverized by the phaco-emulsification tool, and that unfortunately many fragments had been sucked out into the surrounding eye mass. He explained that the new lens had been placed in front of the iris rather than behind it, since there was no lens capsule left there. The good thing about this was that the lens position in front of the iris would give me eyesight just as good, if not better. Duh? Dr Johnson also gave me the statistical percentage of patients with pseudo-exfoliation as well as the statistical percentage of unsuccessful outcome of cataract surgery on such patients. My memory tells me that one value was 10 percent and the other 4 percent, but I do not recall which one was which. Not that it mattered a whole deal. What mattered was that some time after this meeting I got a bill from Dr Johnson for 35 dollars! A physician charging the patient money just for telling him what had gone wrong during his own surgery! All through this ordeal I had maintained an opinion that Milauskas Eye Institute was a weak organization that did its best to hang on, but this greedy bill effectively removed any remaining vestiges of respect. Sayonara! Upon the insistence of a friend while in New York in September of 2001 I went to a well-reputed ophthalmologist there, Dr Eugene Weise, to get a "second opinion". It was such a pleasant experience: He had plenty of space in his office in mid-Manhattan, he had plenty of time for me, even some small-talk as in the old days, and he had plenty of reassurance for me and my eye condition. He saw nothing alarming, told me that the recovery would take a "very long" time, and gave me a much needed eye glass prescription, something that Dr Chan had emphatically told me to delay until the eye had stabilized. I could not help comparing this ambiance to the hurried cubby-holes I was treated to in Palm Springs. After having felt quite uneasy for a long time I again came to believe that I would be totally healed, albeit later than I had anticipated. In December of 2001 Dr Chan changed his explanation of the light-sensitivity of my eye: the problem was due to trauma to the iris muscle, caused by the new lens when being squeezed through the hole in the iris to be placed in front of it during the mopping up after the illbegotten cataract surgery. This trauma affected the ability of the iris muscle to contract in order to reduce the pupil opening efficiently, and the damage was irreversible; the only solution Dr Chan saw would be a special contact lens with a small hole as a pseudo-pupil, which would let through only a limited amount of light. (Of course such a lens would not begin to emulate the ability of the iris to adjust to varying amounts of light. To wear a contact lens of this type was not a willing option for me.) This was a total turnaround from his earlier position, professed for 13 months, that the cause was the dilating effect of the Vexol eye drops I was taking. I don't know which doctor damaged the iris by squeezing the lens through it, but since both physicians were involved during the clean-up after the surgery, one would assume that the experienced man, Dr Milauskas, had taken over at this point. The new explanation seems to be valid, since I notice that when I step from the bright outdoors into a house I can not see anything; the house is temporarily totally dark inside for my left eye. This shows that the iris muscle works badly not only when contracting but also when extending. In January of 2002, I discussed my cataract experience with a lawyer friend, who told me that, since the statute of limitations time for medical malpractice is one year, Dr Chan might have waited for a year to tell me about the damage made to my iris to avoid a malpractice suit against his colleague, who keeps feeding him jobs like mine to correct. However, I was also told that the statutory year starts counting from the time when I became or should have become aware of the fact; this means that the year should run starting in December of 2001, in case I considered a lawsuit. My lawyer friend's opinion was that any personal misgivings about suing about the destruction of my left eye (or at least reporting it) ought to be superseded by my sense of responsibility for future patients who would benefit from more careful medical attention. This opinion had merit, but I already knew that no lawyer in this valley would take a lawsuit against a physician hereabouts - they all play golf with each other. To sue I would therefore have had to find a good lawyer somewhere else, but I did not want to consider it: I felt that by nurturing a lawsuit I would only prolong my swim in this dirty water. I didn't want to do it. My goal was to get my eye healed, and I believed that my body would handle the recovery better without the mental stress of a lawsuit. To be sure, there were times when I felt like standing up and be counted, and that was for the following three reasons: (a) The revelation that the biggest problem for me, the light-sensitivity, would never go away and had not been caused by a clumsy, novice doctor but by what an experienced senior master of his craft did, (b) The apparent attempt to suppress the truth about this major damage to my eye until the perceived statute of limitations time had elapsed, and (c) My admittedly vacillating feeling that my left eye might never improve from its current weak condition in spite of all attempts to improve it. But I also wanted to live a life, and working on legal papers and appearing in front of judges with arguments and counterarguments would not be a choice existence for me. So I never did it. Another compelling reason why I did not proceed with a lawsuit was that I started to get another problem: my right eye began to cloud up during the fall of 2001 and needed soon to be taken care of. With my damaged left eye and cataracts forming in my right eye, my total eyesight was becoming compromised. While I could still drive, it was no longer comfortable. I could see traffic signs well enough (the green little arrow in a traffic light was iffy), and in daylight I could drive pretty well. However, at night I refused to drive where I was not very familiar with lanes and turns. I had to use a magnifying glass for reading (but I still managed to maintain this website; please admire me for that!). Something had to be done, and that was not a lawsuit. Instead I was faced with another cataract surgery, and now I knew a bit about those things. This time I was not going to anyone but the best. For my second eye I had to be as careful as a tennis player during the serve of his second ball: if the first ball hits the net he gets a second chance, but if he hits the net again he loses points. This was my second eye, my second ball. I had taken a chance, albeit unwittingly, with my first eye, and I had lost, but I still had a life with the use of my right eye. But if I lost the right eye as well I would lose those tennis points: in fact, half my life would disappear. So for my second eye I had to be very careful and do everything right, get the very best, at any price. And I finally did it right. Goodbye James Johnson, goodbye Albert Milauskas, and goodbye Clement Chan. To no big surprise, Dr Chan recommended Dr Milauskas! He said that he had never heard of him doing a botched surgery. Yeah, right, he wanted me to go back to the location of my recent disaster. Screw me once, shame on you; screw me twice, shame on me! Evil thoughts told me that with my pseudo-exfoliation the same thing might happen again, and Dr Chan would earn me back for another vitrectomy. But, in all honesty, he probably didn't know any better. He may have never heard of the Jules Stein Eye Institute at UCLA in Los Angeles. But a wonderful nurse among my friends (whom I should have known before the first eye) is nationally certified in ophthalmology and had worked for years in referring complicated cases to just that institute, so she certainly knew where I should turn for my second eye. Of course, surgery can go bad anywhere, but much less so at this renowned institution, and if it did, they would not abandon me, as some other institute did, but instead put all their resources to my disposal. I just called them up cold and got in touch with Dr Kevin Miller, who is regarded as the very best cataract surgeon in the western United States. I got an appointment at the Jules Stein Eye Institute for pre-examination in January of 2002, and when I arrived I was totally taken aback by the physical appearance of the facilities, by the cheerful reception, and by the professionalism that exuded from everywhere. An ophthalmologist was in charge of the actual examination, but several people were involved with me, and I felt totally comfortable with every one of them. I was accepted as a patient; right then I suspected that two items probably helped me to slide in so easily: my pseudo-exfoliation condition and the disaster with my left eye. The place was so soothing and comforting and convincing that I now looked forward to my critical surgery rather than fearing it. They required a full medical examination report by my own doctor, much the same as was required for my full anesthesia vitrectomy: EKG and blood works and stethoscope. Milauskas Eye Institute had never asked for anything of the sort; UCLA was most obviously a serious place! With this report in hand I went for a thorough pre-examination by Dr Miller himself two weeks before the actual surgery. He told me that pseudo-exfoliation cases were common conditions for him - in fact, just as I had expected, all his cases tend to be more involved (and, I assume, interesting), since he has the skills. He suggested the framing of my lens with a small rubber ring to bring extra stability to the suspension, a procedure that is still experimental in United States, while it has been used regularly in Europe for a decade. It so happened that he, Dr Miller, was one of the co-sponsors of the trials conducted by the FDA, and he said that it was totally safe, having been used for so long elsewhere. Of course I was excited to serve as another experimental rabbit. Dr Miller had more cards up his sleeve. For a fee (which insurance companies do not reimburse) he could adjust my eyesight, as long as he did surgery on me anyway, so that I could get perfect vision for either distance or closeup (not both), using a technology called corneal topography, and in this positive atmosphere I said yes to this as well (like most patients I chose distance). His skill level was so obvious that I did not hesitate to accept something that I normally would never think of doing. Since Dr Miller examined both eyes, I let out during our conversation that I would much appreciate if he would take over my left eye. I think I used the wording "to make it simpler dealing with only one eye doctor", and he graciously accepted to do it. I was glad he did, but to me it had not been a foregone conclusion that the would, since he is after all a cataract specialist. But he assured me that both of my eyes were now his as long as I needed him. The surgery took place on March 14, 2002, and a friend drove me to a hotel near the Eye Institute for the two nights framing the day of my surgery. In the morning I was brought in, with the same tranquilizing tablet in my mouth, and in the same amazingly calm mood. I don't remember laying myself down, only getting up and into the car and back to the hotel. On the following day Dr Miller examined the result and was pleased (but of course not surprised) with the outcome. Then we drove back to Palm Springs. As simple as that. Since the lens suspension reinforcement was an "experimental" procedure, it came with stringent post-operative follow-up requirements. Consequently I had to come back to UCLA 2, 4, 10, and 22 weeks after the surgery during 2003. Since everything had been such a success, I was able to drive to Los Angeles on my own already for my 2-weeks-after appointment. And indeed, this formerly near-sighted creature could drive without any eye-glasses at all, just as promised! Coming back to this fabulous place and my skilled, positive doctor was always a pure joy. Let me throw in one incident that so well illustrates the atmosphere at Jules Stein: once when I arrived, the receptionist Paula got up and around her desk and greeted me welcome with a big hug. Wow, what a difference from some other receptionists I can think of! Most of my revisit time was spent on my bad eye that Dr Miller inherited. "His" eye was just perfect. The surgery gave it a 20/15 rating; 20/20 is perfect eyesight, and 20/15 is a notch better than perfect. And so it has stayed since then. But "Dr Johnson's" eye continued to have edema inside, causing chronic inflammation. Dr Miller tried to take me off the daily eye drops for half a year in 2003, but the edema got worse and he had to reinstate the drop regimen. On two occasions during 2002 he had the circulation in my eyes photographed with intravenous dye, as had earlier been done for Dr Chan, but there was, and probably will be, very little he can do to actually cure the eye ailment, my long lasting memento of Milauskas Eye Institute. Not much is probably going to change. My bad eye will most likely stay poor forever. But I have one good eye, and that is all one really needs to live a full life. With small adjustments. My sense of distance is a bit compromised, since two somewhat equal eyes are needed for that. When driving I just have to use my brain a tad more. I use my knowledge of the size of a car to determine the distance to it, and that works very well. But at night I can not see the car ahead of me, only its taillights, and then I feel less confident about the distance to it. So I tend to drive more defensively in the dark, and quite properly so. You adjust your behavior a little bit, that's all. 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