Day +1353: Report from Opthamologist Appointment

Keri and I went to see Dr. Good, Mina's opthamologist, on Friday to discuss his recommendation for surgery to treat Mina's cataracts. It went well. There is always some possibility of complications from any surgical procedure, and he discussed some of them with us. The main potential problems are infection and retinal detachment. Infection is apparently more common in eye surgery than in other surgeries, and they will monitor her very carefully in the days immediately after the surgery to look for any signs of it. Each person's eye heals differently, and sometimes some inflammation occurs that can cause some side problems. There is also an increased risk of glaucoma in the long term, which combined with my family history is not a very happy development. They will do one eye at a time as a result of some of the complications, with 1-2 months in between the surgeries.

The surgeon will make an incision in the surface of Mina's eye, remove the lens, and sew it back up. The cataract is forming in the lens, which is the critical piece that refracts the light and focuses it on the retina. Focusing your eyes in part involves changing the shape of the lens to change the focal distance. After the surgery, Mina will no longer have this ability. Her vision will most likely be good for distance, but she will need very strong (+12) glasses or contact lenses for focusing up close. Most cataract surgeries end with the surgeon implanting a new lens, but this can lengthen the recovery time and increase the risk of complications. It can also be problematic for young kids, whose eyes are still growing. After discussing it thoroughly, the only apparent benefit of a lens implant is reduced dependency on glasses or contacts. Since Mina's vision should be correctable to normal withouth the implant, Keri and I both agreed that it didn't seem worth the potential complications. Her glasses will be thick, but she can start wearing contact lenses whenever she is ready to take care of them. So we are not going to have the lens implant, even though Dr. Good said he thought 70-80% of his colleagues would recommend it even for young kids.

Dr. Good said there is no real urgency in the timing. Keri had been worried that the three-month delay in scheduling an appointment might have had some effects, but Dr. Good assured us that was not the case. He says the big issue is that her cataracts are worsening and will eventually need to be repaired, and it is probably better to do it sooner than later due to the brain development issue. So we will probably try to schedule the first surgery for March after we get back from our trip to the Northwest. Dr. Good thinks Mina will probably see some immediate benefit from the surgery in terms of improved vision, even before going to get her glasses. It's tricky -- Keri and I have both had the sense that Mina doesn't see well, but it's hard to know how much this is affecting her because there are definitely things that she does see even at distance.

One other thing Dr. Good said is that cataracts are very common -- something like 70-80% -- among patients who have had radiation therapy. Apparently the radiation breaks down some of the tissue that protects the lens, so fluid and other foreign substances can penetrate and build up around the lens, causing opacity to occur. We did know that this was a possibility, so it doesn't really come as a surprise to us. And as long as Mina can avoid any of the complications, this shouldn't affect her quality of life too much, other than having to go to an opthamologist 2-3 times per year for the rest of her life. As we have said many times, if this is the worst thing she has to deal with we will all be very thankful.

We had a very nice weekend. Friday was our company holiday party, and we had a ridiculous meal at a fancy local restaurant. Saturday morning we dropped the kids off at their friend Calvin's house in their pajamas for a play date. Keri and I used the time to have brunch at a restaurant and do some shopping. Then today we enjoyed the sunshine and 65 degree weather while on a hike at Pt. Reyes. It's funny -- the kids were moaning and complaining for the whole two miles down to the beach about how it was too hot, too long, they were tired, why do we take them on such long hikes, etc. etc. etc. Then when we got to the beach they immediately stripped off their clothes and were sprinting around on the sand playing tag with the waves. The ocean was amazingly calm today, one of the few times I've seen the Pacific really live up to its name. After running, playing, digging, etc. for only about 45 minutes or so, we headed back up toward the car and the kids' attitudes had changed 180 degrees. Even though the way back was much steeper and harder, and the kids were supposedly more tired, they didn't complain a bit. Go figure.