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Craig's InSights

A forward looking attempt at acquiring a clear view of what's to come and where we've been. (and she even got a haircut!)

The Art of the Possible

What is possible, and what is not?

Clarity is elusive!

What is the right choice?

The one that meets your needs of course!

Plow ahead towards that goal.

EXERTION!

Dig deep into your soul. Find what you really want.

Take your time.

Settle on it.

Decide.

And make it happen.

Ruminations

I have none.

(just kidding, as it was opposite day for some of us after all (Thank you Spongebob!):)

Carmel Roundabouts

You come to a circle and a decision awaits. What are the turnoffs?

Allegories

Parallelism in meditation is quite a good thing. Things happening in your immediate life will often parallel a long-term trend in your life. Connecting the dots may be a key way to resolve life's biggest issues.

Love Your Work

Life is short? No, I don't think so. 40-80 years of life could only be defined as short if you were trying to achieve something on a scale of centuries instead of days, weeks, months, or years. We can experience life's pleasures now, but...

...eventually all of that will fade.

In 500 years who will you love? In 1,000 years?

Does it matter?

I'm not sure that it does. I think that we're all globbed together in this globe called earth. The earth won't last forever, so let's make the most of it while we are all here together.

The American Buck

Growth lies ahead, but why?

Pretend that the entire world used only U.S. dollars. That's actually not all that far off from reality, in some ways.

When the US Govt wants to see more economic activity, it has many options! It can print money, and surprisingly we've actually seen that, for the first time that I can recall in my lifetime. But it's all good!

It's the money supply that drives things. Capacity and demand are what counts. In theory printing money won't harm anyone if the labor markets absorb the excess demand.

not Too Young For Cataracts!!!

2008-12-19
Miraculous
I'm looking out my second floor window. The window frame is crystal clear, as is the view from the distance - and they are both clear at the same time! Few people have ever seen through eye upgrades like this! Eyesight is so important that its a really miraculous feeling when you get an upgrade on this front. But it wasn't always like this.

Developing cataracts at age 40 is certainly not the worst thing that can happen to a person, and, in retrospect, it was probably more good than bad for me. But having my natural born lenses ripped out and replaced with (even very soft) plastic lenses was unsettling. Googling and searching blogs only made the decision of what lens to choose more difficult. Unhappy bloggers dominated and information was scarce. I only plugged into old data dominated by unhappy people. In my workplace, a much smaller community to be sure, the conversations were vivid, interesting, engaging, and real. Yet the search results that I found online left me feeling empty. People griped a lot, but didn't give the info that I needed then.

I eventually ignored the blogs and followed my doctor's advice that a premium Intraocular Lens (IOL) was my best option. I hope that I can help future "youngsters" in their 40's, 50's, and 60's by providing insights to assist in navigating the frustratingly contradictory information that even a thorough researcher will encounter.

Premium IOL lenses have only in recent years been available for production use, and there are few young people who can write from actual experience about what having them is really like. A year after surgery, I often feel the need to shout out that the good qualities of premium IOL's should be celebrated more than they are, as I can now see both near and far at the same time without needing to focus on any single distance, providing a level of depth perception and clarity beyond anything I could previously have imagined.

Bifocals
I have had conversations with eyecare professionals wherein some of the lens options available to cataract sufferers were referred to as "bifocals". "Bifocals" doesn't even come close to accurately conveying how and how well the lenses available today work. People wearing bifocal glasses need to adjust their lenses or their heads to correctly focus the incoming light on that part of the lens that was created for light coming from that distance. The IOL lens replacement options available today are so much better than this that they should never be referred to as bifocals. The term "trifocals", or "multifocals", gets closer, but they still don't adequately convey the magnitude of superior vision which many will find they have getting a premium IOL vs. using classical bifocal glasses.

Crazy
I know 3 people who have had traditional lenses (not CrystaLens, ReZoom, or ReSTOR) implanted, wherein they had one lens placed in one eye that allowed them to see up close, and another that allowed them to focus well at distances in the other eye.

That's nuts! Certainly the human mind could not possibly accept this crazy arrangement!

But they all seemed to be really satisfied with the result. One raved about how great it was, and the other two expressed satisfaction while still admitting that they wish they could see close and far from each of their eyes. Both mentioned how taking a photograph with the dual lens option was both good and bad - good when viewing the lens appropriate for the distance, and bad when using the other.

It must be the same psychology at play that allows me to see both near and far with a single eye as that which allows a person who has had different distance monofocal lenses placed in each eye to see all distances clearly without thinking about it.

While I'll never know for sure, I'm happy with my lens decision.

The Eye's Lens
We have a single lens within each of our eyes. For a while after my eye problems developed, I believed that the cornea also served as a lens. I now recognize that the cornea is only a protective coating for the eye for most people. The popularity of Lasik surgery led me to confuse the cornea's potential for refocusing light with its natural organic use. Manipulating the cornea to correct the defects of the eye's lens is kind of like installing a permanent contact lens as it merely compensates for the visual flaw of the actual lens. Cataract sufferers do not have the Lasik option, because the very lenses themselves are diseased, and its therefore the lenses themselves that need to go. Something caused the build up of something deep within the eye that we eventually called a cataract. What is it that we did that led to or caused this to happen?

Accommodation
Our eyes naturally adjust to focus on that which we wish to see clearly. This expansion or contraction of our god given eyes is called accommodation. In days gone by, this ability to focus was lost forever by those who had cataract surgery. They were given lenses that could see either near or far, but not both. Technology advanced, and by 2005 a "premium" IOL branded Crystalens entered the marketplace. Crystalens used the same accommodation approach that we naturally have to allow patients to see both near and far without wearing glasses.

Aftermath!
Your eye's lens is held tightly in place by a "film" behind the lens. Often, some residue from the cataract will remain behind on this film after your lenses are replaced (think "peeled off"). If this residue affects your vision significantly, then your doctor will recommend a followup operation which uses lasers to destroy just the piece of this film that is clouded. I have some of this "gunk" on my left eye, and this may explain why my eyesight still goes south at night.

Normalization
Could long-term satisfaction from IOL replacement surgery be measured by how much you think about it, or conversely how much you don't?

That's a thought worth considering. I'm writing this blog ~ 13 months post op, still thinking about my new eyes. Not thinking about it a lot, mind you, and a lot less than before. But obviously enough to create a blog post.

What would a blog by a totally happy camper look like?

Like this I suppose? But still with questions.

Costs
You can probably pay as much as you want to for the premium lenses available. The variability of what you pay extra to get lenses that allow you to see both near and far simultaneously is quite high from one provider to another. But you'll still get the same lenses regardless of how much you pay. Pay more only for who is putting them into you, not for the lenses themselves. Unless you are cash strapped don't even worry about it! You will have these lenses for so long that the cost per year will approach nothing! But if you are struggling, know that there are excellent doctor's out there who will give you the premium lenses for fractions of those who are asking for more, so ask around. My doctor was more than reasonable, so I felt no need to shop around. I paid $1.5k extra per eye to see both near and far without glasses.

Money well spent.

Batman
I'm a Marvel comics guy and not DC, but I really wanted to see the Dark Knight. I splurged and saw it at the local Imax theater about 8 months post-op. Watching this movie was like seeing through the eyes of normal folks who need to focus on just a single point at a time - the constant shifting of focus on such a large screen distracted me from being able to enjoy the movie. I am no longer accustomed to seeing things in the background as blurry, and only in theater's can I re-experience that effect. Soon, I will rent this movie so that I can watch it on my 20 inch TV where I hopefully won't even think about things like focusing and backgrounds.

Ayn
Can eye implants change your political views? Yeah, they might, but only if you let them. Twenty years ago I was bigtime into Ayn Rand's objectivism. Rand was excellent reading for those of us growing up during the Cold War. Ronald Reagan and Ayn Rand sang the same song, and I still love both of their music! And I may stand alone in still supporting the penultimate objecivist, Alan Greenspan, even after his recent grilling by congress - which made me mad!

But times change. We age, our eye's stop working, and we move on.

Its the government bailouts for car companies and banks that has led me to question my political views. I support the bailouts, but I never would have before. By saving the poor planners are we making a big mistake in the interests of expediency that we'll really regret later?

I think so, but in the interesrest of expediency, it feels right for now.

Longevity
Everything that has come my way suggests that these lenses don't wear out and will in fact last your entire life. But finding definitive answers on this front has proven difficult, probably because there aren't ANY people out there who have been using these lenses for decades. I'm not really concerned about this, but I have found that many people in the market for new lenses ask this first.

Aspheric
"There will definitely be better lenses available in 10 years, but you don't really have the luxury of waiting for them."

True. I needed to see better now, and not in 10 years. But I feel lucky that in between the time when I was diagnosed and the time of my surgery, a new version of ReSTOR lenses went to market. Called "ashpheric", they have a slightly different curvature of the lens which improves color contrast a little bit.

While people will in 10 years time be getting much better lenses than mine, I was happy to get even this small bump-up in technology.

HDTV
Peyton Manning has had an excellent year, and he will likely earn the title of NFL MVP for 2008. But in 2004 Peyton had an over-the-top performance that might qualify as the best that there has ever been. I bought a 50 inch high def tv in 2004 only because I wanted to watch Peyton display his magic as clearly as possible. Then I suffered through the New England Patriots beating the Colts in the most unsatisfying of ways. The game felt like it ended before it began.

The excellent picture quality was almost a distraction. The real measure of satisfaction is if your team wins.

I had no satisfaction.

Presbyopia
After being diagnosed with cataracts, I learned that 100% of people experience difficulty seeing up close as they age. This is called presbyopia. I did not have this problem as cataracts got me at 40 years young. 45 is the more typical age that presbyopia begins to set in. ReSTOR IOL's come in a one size fits all package for near vision, and its called + 4 diopters. Your doctor will test you to determine your distance vision, but the closeup part of the equation is a given. I have no idea how the intermediate vision pieces of the lens are determined.

I experienced some real pain, post-op, as I tried to see with the standard + 4 diopter close vision enhancement that I had no choice but to get. I was younger than the target audience for this lens, and it took some time for the relevant eye muscles to decay enough for me to really appreciate what I got.

My distance vision deteriorates pretty dramatically at night in my left eye. I don't understand the mechanics of what is happening yet, but it probably relates to eye fatigue, how much the iris is open in night versus day, and a residual cataract resiue that affects many post-ops for cataracts.

But even at night I can read clearly, I can see the dashboard of my car clearly, I can see distance clearly. I drive by restaurants and can see the people inside with a clarity similar to what I used to have when I sat next to them. And I can now see more distances simultaneously than anyone without the ReZoom / ReSTOR option implanted will ever know.

ReZoom
ReZoom works very much like ReSTOR. They both divide the eye's lens into concentric circles to give the eye different inputs that it needs in different situations. A percentage of the light that the eye gets is devoted to near vision (things closer than, say, one and a half feet), another percentage is devoted to middle range vision (a foot and a half away to maybe a few feet farther out on top of that), and another percentage is devoted to distance range, which is everything beyond the intermediate. ReSTOR is said to excel up close, while ReZoom is said to excel at intermediate distances. But the intermediate vision that I've gotten using ReSTOR has never been as bad as I had feared from reading the blogs written by those who were unhappy, and my intermediate vision just keeps getting better as time passes.

RESTOR
I had ReSTOR aspheric Intra Ocular Lenses implanted in each of my eyes. ReSTOR uses an entirely different approach than Crystalens.

While Crystalens "accommodates" like a normal human eye, the ReSTOR lens sends multiple light inputs to the brain by splicing the lens into concentric circles, each of which sends light from a different distance perspective through to the retina, and resultingly to the brain. With ReSTOR, its just the mind that decides what to pay attention to and therefore see clearly. It sounds crazy, but it really works.

Using the brain to accommodate instead of the eye's muscles is a dramatic change in approach which can affect you more than you think. The muscle contractions which previously helped me see began to stand in the way of my seeing clearly, and sometimes they even led to pain. These muscles were no longer needed and it took quite a while for them to atrophy to an acceptable level.

Reading
I read less now than before I had cataract surgery, maybe because, or due to:

- Better vision means more real-life experiences vs. reading about experiences.
- Struggle to keep focus using new approach as eye moves horizontally from word-to-word.
- Poor intermediate vision in low light settings.
- The written word becomes less interesting with age.
- Addictive quality of "focusing" on the words themselves now gone.

In bright light I now see everything as good, and probably better, than I ever have. When the lights dim, however, I can't comfortably read anything further away than about 15 inches. While I can still read if I need to, it is just not that pleasant. Things appear darker when light is scarce, but I guess that makes sense since the light entering the eye is getting spliced into different distance categories.

Happily, the problem that I had viewing the computer at a comfortable distance has now diminished to the point of non-existence, but it only happened slowly and with the passing of time.

I bought a number of reading glasses after my surgery in an attempt to get back to reading like I was accustomed to. Amazingly, I could pick glasses of any diopter setting from the racks at Walgreen's or Walmart and see well with any of them. Apparently the different light inputs my brain received just adjusted (with the help of the limited accommodation ability that I'm told I still have) to whatever input it received. But I soon learned that wearing reading glasses helped in such a limited way that I was better off without them.

I believe that the biggest reason that I now read less is because reading just feels different now. While before I had to focus my eye with intensity on the page, now I must instead relax my eyes. That is a significant change.

This feels like what entering middle-age should be like, but I would have been OK with it happening at least 5 or 10 years later than it did.

Depth Perception
Depth perception can be tricky. I have known people who don't have much of it, but they are nevertheless unaware of their inadequacy. You can usually tell which of two items are further away even if you don't have the real abilitiy to percceive depth. The mind develops the ability to see depth at a very young age. Those born with a wandering eye will typically never see with depth perception even after the wandering eye is fixed, because the problem is discovered after the critical window for learning to see this way has passed.

I lost this ability after my cataracts became advanced, but I obviously had it at some point in my life, because my ability to experience depth returned with grandeur!

Sometimes its only after you experience something really nice that you realize what you were missing before!

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