TL;DR

Jan 16, 2017
Not quite a year ago, I had been told by my eye doctor that I had a cataract developing in my left eye. At the time I was using contact lenses in a monovision set-up. One eye was corrected for distance vision (the right) and the other for closer vision (the left). This was the reason I was having some trouble reading. My left eye could see no better than 20/50 under any scenario. (For comparison, my uncorrected vision is somewhere around 3/200 meaning what a "normal" person can read at 200 ft. I can read at about 3 ft. My contact lens prescription was -7 and -7.5.) Now, my vision in my left eye was very annoying. In high contrast situations, I saw triple. Using a computer or reading, I was reliant on my right eye. For watching TV or driving there were no issues. I made an appointment to see an ophthalmologist; the same one that had done all four eyes of my parents.

I arrive for my appointment and am told I need a refraction (a basic eye exam to determine your prescription). This is not covered by insurance. I tell them I've already had an eye exam. They tell me that since it wasn't done my them, I need another one. I pay for the exam which is done by a tech. Then I am examined by Dr. Alpha. (I will use pseudonyms for now.) He tells me I have a cataract in my left eye and it is obscuring my vision enough to be operated on. (So far, I have learned nothing I didn't already know.) He starts discussing options. Instead of using a knife, they now have a laser that can do the main cutting. This is not covered by insurance and costs around $1800. There are three lens options: 1) a basic lens with a fixed focus (covered by insurance), 2) a multifocal lens which may allow for vision at multiple distances which he does not recommend due to my young age or 3) and accommodating lens which is hinged and moves to allow some variability focus distance. He highly recommends this option. Both options 2 and 3 cost in the neighborhood of $1700 extra, not covered by insurance. He gives me some brochures and tells me the scheduler will contact me schedule my surgery.

~Jan 20, 2017
I get a call from the scheduler. I am told many things. I'll need to get a my regular doctor's OK for surgery. I won't be able to eat after midnight the day of surgery. My pre-surgery appt. date, post surgery appt. date and follow-up appt. date. When I'll have to start eye drops. So many things I can't even write them all down. My notes are a jumble but frankly none of it sounds important that I need to do anything before the pre-surgery appt. except my doctor's OK.

~Jan 23, 2017
I receive paperwork from the eye doctor with lots of forms to sign. There is a form for the accommodating lens that explains it is not covered by insurance. There is a form for the laser that explains it is not covered by insurance. There is a form that explains the eye drop schedule and many others including how much I'll have to pay at my pre-surgery visit. It is based on using the laser.

Jan 31, 2017
I visit my regular doctor who OKs me for surgery because I am a perfectly healthy person. (There goes another $200.)

Feb 1, 2017
I go in for my pre-surgery appt. I first see the scheduler to sign all the documents. I don't sign the laser document because I decided I don't want the laser option. I am told that Dr. Alpha only does cataract surgery with the laser. What? I don't understand. The doctor claims he takes my insurance but won't do the surgery without using an uncovered piece of equipment. In my view, he doesn't accept insurance. I've already paid for an uncovered refraction. I've already paid for pre-surgery doctor's OK (which according to them needs to be within 3 weeks of surgery). I refuse to sign (or pay) until meeting with the doctor.

The doctor first explains that he told me he only does surgery using the laser. (He did not. But he should have and that should have occurred when I was making the original appt.) He starts to explain why I should use the laser. I explain that in my research I found the laser was better only in its accuracy of vision without correction (meaning you had a better chance {much better actually} of not needing glasses for distance if you used the laser). This was not critical to me and certainly not worth $1700. He explained that laser surgery reduced complications from the cutting part of surgery by 50%. It took me several tries to get him to tell me the complication rate without the laser was 1 in 1000. Therefore the rate for with the laser was 1 in 2000. No thanks, not worth it. Ah, but for my highly myopic eyes it was higher! How much higher he wouldn't say. How much lower due to using the laser, he didn't know but was sure it was significant. These are not the numbers you can find in studies but all surgeons just know! After arguing for at least fifteen minutes about complications and statistics and studies and anecdotes, he brought in another doctor to argue further. He tried the same arguments. He tried some new ones. "If you were my brother I'd tell you to get the laser." They offered interest free financing (as if that somehow meant I wasn't still paying for it). The entire discussion/argument took close to thirty minutes. The final result was I did not think it was worth the money and he would not do the surgery. I walked out of the office exhausted. I cannot imagine that many people could withstand that barrage. Given that he can practice with such a policy in place means either that plenty of people do actually think it's worth it or that at least some are being duped.

Already out $300 and not wanting to start the whole process over, I decided to use a different surgeon in the same office who still did traditional surgery.

Feb 14, 2017
I meet with Dr. Beta who examines my eyes. He also explains the benefits of the laser and the accommodating lens. Knowing my history we have only a short discussion about using the laser. The lens discussion is a bit longer. I explain I don't think it is for me because, being so nearsighted means I will have a low power intra-ocular lens (IOL) put in and therefore I can expect less of a range of benefit. He disagrees. I explain why he is wrong like this: The accommodating lens works by moving the lens forward or backward a tiny bit depending on whether you are focusing on something closer or farther away. (We agree on this.) The more nearsighted a person is, the lower the power of IOL inserted. (We agree on this.) I probably need an IOL of about power 10. (We agree on this.) If I was even more nearsighted I might need an IOL of power 0. (We agree on this.) If you move a power 0 lens (meaning flat like a window), moving it will not change your vision at all. And that is where the doctor changes the subject. (Note that the lens offered goes as low as 4 diopters. Regular IOL lenses go down to at least -10 diopters.) Fortunately, we do not argue long.

I note that I'd like to shoot for -1 diopter (slightly nearsighted, you can see clearly at 1m/{diopter}). I also note that I'd consider anything from 0 to -3 diopters to be successful. At anything in that range there'd be something I could see without needing glasses. I do not want to end up farsighted. He agrees to shoot for -1.

Feb 16, 2017
My follow-up with Dr. Beta. No issues and surgery is scheduled for 2/20. That keeps me within the window for the pre-op ok from my regular doctor. That also means I need to start 2 drops tomorrow (Vigamox and Ilevro). I'll start a third (Durezol) after surgery. They hand me a prescription. Since my insurance deductible is so high (~$7k) I pay for the entire surgery at this time. The amount billed to insurance was ~$15k. The amount allowable by insurance was ~$2k. This is totally insane.

I head over to CVS and find out that, although I can pay for my insurance at CVS, CVS is not the pharmacy in my plan. I head over to Walgreens. They take my prescription and say they'll be ready around 1pm.

I return around 2pm and, of course, they are not ready. I wait around while they get them (they are eye drops so it's not like there's much to do) and when I go to pay the $350+ I am told they don't have one and that they'll get it tomorrow. Of course, it is one of the drops I need to start tomorrow. Problem is, I won't be at my house tomorrow. I call another Walgreens and they have it and I arrange to get it from them the next day. It'll cost another ~$150. In researching these drugs I find they are the latest thing in cataract surgery drops and, of course, the most expensive. There are older drugs that are now generic that basically work just as well (but likely don't have attractive salespeople who buy the doctors lunch). It is too late to do anything about that.

Feb 20, 2017
I go in for the surgery. I haven't eaten since 10pm the night before. There are a lot of drops. A lot. Maybe 50 before I am wheeled into surgery. This one of those "awake" surgeries. I don't really recall much but some occasional pressure on my eye and maybe my eye being rinsed.  An 8.5 diopter lens is inserted to replace my natural lens.  All seems well.

Feb 21, 2017
Follow up for my surgery and things look good. I am already seeing close to 20/40 in that eye.

Feb 26, 2017
I notice a shadow at the bottom/left of my vision in the operated eye.

Feb 27, 2017
I call the eye doctor, tell them about the shadow and am told to come in.

Since Dr. Beta is in surgery, Dr. Alpha checks my eye. He does the normal looking around and also does an eye sonogram. He notes that my vitreous has shrunk and is pulling on my retina. He says he doesn't want to say "He told me so but...". I had no interest in arguing. After some pictures, he decides to send me to another doctor, a retina specialist. He is in another office but I head over to see him that afternoon.

Dr Gamma exams me similar to Dr. Alpha. He also presses on my eye with a little metal spatula to get a better look at the edge of the retina. It is not detached but he wants to see me again in ~two weeks.

Mar 2, 2017
I have my second follow-up with Dr Beta. I am in the waiting room for over an hour before being seen by the tech. After that I wait another 30 minutes before seeing Dr Beta. He does his usual exam and says he'd like me to see Dr Gamma. I say that I've already got an appt. with Dr. Gamma next week and from my point of view my vision is exactly the same as it was the last time I saw Dr Gamma. He repeats that he'd like me to see Dr. Gamma. I go back to the waiting room. After waiting for a while (I have now been here for 2 hours) I decide to leave. At the same moment, my name is called and a tech takes me to a machine for a picture. Then I'm sent back to the waiting room. Fifteen minutes later, I tell the receptionist that I'm leaving. She takes this like it is meant as a threat and should she go check on Dr Gamma's availability? No. I already have an appt next week; I'll see him then.

Mar 7, 2017
At home that evening watching TV, I notice that what had been a shadow at the far reaches of my vision is now covering maybe 20% of my vision. I decide if it is still like this in the morning (or worse) I'll call the eye doctor.

Mar 8, 2017
Perhaps 25% of my vision in my left eye is now blocked. I'll call Dr Gamma and set an appt for that day (instead of waiting until my appt. the next day).

It is bad news. My retina has detached. By the time I see him it is blocking over a third of my vision. I will need immediate surgery. He will check if he can get into the surgery facility the next day. If he can't he will call Dr Delta at Bascom Palmer in Miami and get me in there. He is gone for some time and when he returns he says Dr Delta will call me later that day with details for surgery the next day.

The call comes and Dr Delta tells me I'll need to be at BP at 8:30am. That means leaving around 6:30 and driving in the worst of the day's traffic. There is no other option except go blind. No eating after midnight! I don't get much sleep because I don't want to miss my 5:30am alarm.

Mar 9, 2017
We head down to Miami arriving just a few minutes early. My vision is now about 45% blocked. We meet Dr. Delta and go to check-in and then we find out the Bascom Palmer doesn't take my insurance! No worries, we'll go through the emergency room.

In through the ER, Dr Delta escorts us away and does an eye check. My vision is now 50+% blocked. My retina is tearing off at an alarming (to me) rate. They will need to do vitrectomy, retina reattachment and they will use a scleral buckle. After surgery I will need to keep my head pointing straight down for at least 50 minutes of every hour for at least a week. They recommend I get a special vitrectomy chair. (A vitrectomy chair is a massage chair that rents for ~$200 for the first week as opposed to a massage chair which can be purchased from Amazon for <$100.)

Next I need another pre-op check which they will do right in BP. But first I need to pay. Now I find out that since my insurance is accepted this will be an out-of-network event and my completely separate, out-of-network deductible is ~$14k and after that I pay 50%. How much will the surgery cost? They don't know. This surgery, which they perform 50-80 times a day, but they don't know how much it will cost. She says I will have to pay the $14k today; can I do that? Sure! Do you take cash?

I call the insurance company. I can barely understand the person I talk to. I explain that I was sent here by my in-network doctor. I explain that I was sent because I need emergency surgery to prevent me from going blind. He asks me what is my diagnosis. I saw my retina has detached. He asks me to spell RETINA which I do. I tell him if he can find me a in network doctor to do the surgery today then great! He then puts me on hold. After waiting a few minutes, I hang up. I later get a message from the same guy that "Retina detachment" is not covered by my insurance (which is wrong). Anyway, I go back to talk to the financial person who offers an all-in single price. I don't exactly have any time to debate or check for other options. I agree to pay, splitting the enormous amount (which I also had to agree not to disclose) across 2 credit cards.

The pre-op check goes fine and then I go to wait for the surgery. I'll be the last one of the day for Dr Delta. It's already afternoon and I'm starving. I go into the pre-surgery area and have to put on a hospital gown and get some electrodes attached. Everyone asks me which eye I'm getting operated and when I tell them "left" they write their initials on that side. I don't know what time I got wheeled back but this is another "partially awake" operation. If I feel anything I should tell them. When they start I feel a pinch and tell them. They put some more numbing drops on my eye. I don't remember much else from the operation except one of the doctors asking for "another hook" several times. Also the doctors conversed as they used the laser to re-attach my retina ("Go all the way along that line and all the way along the other.") Finally, when they started to close, I felt a sharp pain from the stitch and told them. They dropped in some more numbing drops. That done, they rip the sheet off my face (did I mention you are covered with a sheet except a hole for your eye?) and send me off to recovery. And there it starts.

In recovery I must keep my head down, looking straight at the ground. I will need to do this for a minimum of 45 minutes per hour/50 minutes per hour/as much as possible for the next week at least (I get different numbers from different people). In the recovery room it's not such a big deal. Put your arm on the table in front of you. Rest your forehead on your arm. Simple.

Since all the liquid in my eye was removed and replaced with a mix of air and C3F8 I have to wear a warning bracelet that says I am not allowed to fly (or do anything that would significantly change my altitude, though that is not much of an issue in Florida) nor get N20 (I didn't look up why). This will be the case for 6-8 weeks, until the air bubble is completely gone and my has refilled with fluid.

I have not eaten or drank anything in close to 24 hours. They give me some apple juice and chicken soup. The apple juice is easy to drink with a straw. The soup not so easy with a spoon but I manage. After a while I change back into my clothes and they decide I can be released. They wheel me downstairs where my GF waits with the car. I get in. Now I realize we will be driving for over an hour in rush hour traffic and I won't be able to look out the window. We are not even out of Miami before I start to feel nauseous. About half way home, I tell my GF to pull over somewhere and she does. We sit there for 5 or so minutes until I feel good enough to start moving again. We make it about 90% of the way before we need to pull over again. Another 5 or so minutes later I feel good enough to go again. We get to the entrance of my GF's apartment complex when I tell her to pull over again. She says we're practically there. When I repeat that she needs to pull over she does. This time I lose it and there goes the only food I've eaten in the last 26+ hours. I'm too nauseous to anything the rest of the night.

One really great thing was that my GF's co-worker happened to have a massage table which he brought over. At least I would be able to sleep in a semi-normal position. Not keeping your head in the proper position is the biggest preventable factor for the surgery failing.

Mar 10, 2017
Today I have a follow-up appt with the retina specialist I'd seen beofer (not the one in Miami who did the operation). It is at 1pm and only about 10 minutes from my GF's place.

I don't get much sleep despite being quite exhausted. First, it is not easy to sleep face down. Second it is not easy to sleep with a giant plastic cup taped to my eye. Third, cats. I probably spent about 3-4 hours on the table. The rest of the night I just sit on the couch with my forehead on a pillow. My neck is killing me.

In the morning I have a slight headache, possibly from dehydration. I'm able to sip a little watered down Gatorade and take two bites of toast but I'm still quite nauseous. My dad calls to says he'll meet us at the eye office at 10:30a. And not the eye office near my GF but the one that's 30 minutes away. What? There's been a mix-up and now we are scrambling to get ready and get out the door in time for the appt. My GF, who is quite the trooper, folds up the massage table, drags it down two flights of steps and throws it into the car (I'll be staying with my dad for a week or so). I am not allowed to lift anything heavy.

We are driving north on I-95 when my dad calls around 10:15. He is already at the office and he is calling to tell us that the parking lot is just crazy and he had to park in the garage. I tell him there is no garage at that office.  He insists there is and that he parked there. And then we realize we have made our second mistake. We are not going to the office 10 minutes away (gurgle), not the one 30 minutes away (gurgle gurgle), but the one that is, based on the route we are one and hour away (hurl). I am despondent.

I make it to the office (around 11am) without hurling but I'm as nauseous as I was the day before. A tech takes the cover off my eye and then I put my head back down and wait for the Dr. Gamma. My dad comments that it looks like I got beat up. I snap a selfie so I can and wow is my eye messed up. Not the area around my eye so much (except the lid) but my eye itself. There is no white. The is the pupil (black), the iris (hazel) and the rest is red (or should I say incarnadine). The good news is that although everything is a terrible blur I can actually see light. When asked to read the eye chart I cannot see the E just a white blur.From about 4 feet away I can barely identify the number of fingers some is holding up.

Dr. Gamma likes the way things look. I tell him they gave me drops in Miami which he wants me to use 4 times a day (I don't know what they are because before writing it down, the alcohol sanitizer we use before putting them in had washed the lettering off the bottle). He also give me a prescription for atropine to be used twice a day. We set an appointment for a week. He emphasizes how important it is to keep my head down.

After driving home (during which I looked up several minutes to try to keep my motion sickness somewhat under control) my dad heads to the pharmacy with my insurance card and the atropine prescription. He also gets some Gatorade, Emetrol and Ensure. With my insurance the atropine was $50. I look it up on GoodRx. Without my insurance it would have been less than $20. Wtf?

As the day goes on, I'm able to take a few sips of watered down Gatorade. I even sip a dose of Emetrol every so often. Later I even take a few sips of Ensure. (Did the Emetrol work or did the nausea go away on it's own? Who knows?) My neck is killing me. Every few hours I have to interrupt my dad's life so he can put drops in my eye. (Normally I would the drops myself. It's no issues. But I'm not even supposed to look straight up, even for a moment, which makes the drops impossible for me to do myself.) I wander back and forth between the couch, where I use a couple pillows on the arm to rest my head on, and the massage table, which is now harder to use as it pulls on my face and indirectly puts pressure on the eye. I can use my phone and that's about it. I decide to order one of the massage chairs. Even though they start at around $60 I order one that is about twice that since I can get it faster (Monday). Had I known, I would have ordered it on Thursday after seeing Dr. Gamma and likely would have had it Saturday. My other alternative was to rent one for a week for $200 (I could have it the next day) but what if I need it for another week? That seems ridiculous.

At some point I find out that my sister and 6 year-old nephew are coming to visit. A week from Saturday, right? No, this Tuesday. My sister offers to stay at a hotel but my dad thinks that's nuts. Hopefully I'll feel a little better by then.

Around 3am I wake up on the massage table and drink the rest of the Ensure I started earlier. The nausea has finally gone but after eating and drinking almost nothing for 50+ hours I can't really eat very much.

Mar 11, 2017
Nothing too exciting. My day is pretty much the same. Back and forth from the couch to the massage table. My dad built a head holder (a piece of wood with pieces of pool noodle glued on it) so I can also sit at the kitchen table. I catnap everywhere because I can't really sleep anywhere. My neck kills. I hop on a scale to find I've lost about 7 pounds. I drink another 2 Ensures during the day along with more watered down Gatorade.

Mar 12, 2017
Basically the same as yesterday. I drink 2 Ensures and eat something light for dinner.

Mar 13, 2017
I start eating more normal food. In the afternoon, the massage chair arrives. It is thankfully fully assembled. We set it up and now I have 4 places to move between! But other than at night when I might sleep for a couple hours, I can't stay in one place too long.  I'm too fidgety.

As far as keeping my head down I feel I'm doing great. I probably don't have it down for maybe 30 minutes out of the whole day. Without hard statistics I feel I should err on the side of face down. But my neck is just torture especially as the day wears on. By evening my mood is sour; I am just counting days and each feels longer than previous one. I find I sleep best in the massage chair. The table gets less use.

March 14, 2017
The usual morning. My sister and nephew arrive that evening. Things are OK to start but the reality of life is that 6 year-olds are just noise making machines. They can't possibly understand the torture you've been through the past few days and even if they could I'm not sure it would matter.

As I mentioned, I'm very nearsighted. I haven't bothered with my glasses or contacts because there is nothing to look at and I can't sleep while wearing either of them and I seem to fall asleep at any time, if only briefly. Being basically blind, I have things arranged on the coffee table and just remember where everything is without having to look.That system works great until people start moving your stuff. Especially in the name of "just tidying up". Don't tidy up. Please. If you need something of mine tidied, tell me. I'll tidy it and then I'll know where the box of tissues is when I wake with a runny nose in the middle of the night. I'll know I won't spill my glass when I grab for my phone. For goodness sake, don't move a blind person's stuff!

Also, don't leave your shit lying about. But, six-year-olds so what can you do.

The next couple days are basically the same.

March 17, 2017
My second follow up with Dr. Gamma. I decide I will keep my head up as needed to prevent from getting car sick. I don't want to get stuck in that loop again.

Dr. Gamma examines me and says things look good. He steps out and calls the surgeon that performed the operation but is only able to leave a message for him to call back. He continues the exam when the surgeon returns his call. He steps out and as he walks down the hall I hear him say  what sounds like he sees oil in my eye.

I'm a bit concerned because after a vitrectomy, the eye can be filled with either gas (like mine) or silicone oil. I had asked Dr Delta about it and he said they only use it for the worst cases because it requires a follow-up surgery to remove the oil. Did they use clean instruments on me? Did they start filling me with oil, realize the mistake and switch to gas.? Or maybe I'm a worst case but they ran out of oil? Frankly, I wish I didn't know so much about vitrectomies at that point. Dr. Gamma returns and says everything is fine but I don't ask about the "oil". I simply decide not to care and assume my doctor knows what he is doing. That's a difficult thing for me.

My new regiment is to go from 4 to 3 drops a day. After a week do 2 a day. After another week 1 a day for the final week. He doesn't mention the atropine so I assume no more of that (it takes one to two weeks for the dilating effect to wear off in normal people). Also, no more head down! My only restriction is that I should sleep on my right side. I feel like I just out of jail.

April
I've since seen Dr. Gamma twice more and things are going well. My eye is over half filled with liquid and so I can actually see things straight in front of me (and above and to the sides. It is kind of like looking through a glass of water and I get a glare that reflects off the surface of the liquid that can be a bit distracting. I can also see that my retina is not in the exact location it used to be. If I look at a grid, there is a slight "vortex" in the middle pulling everything in just a bit. (My GF likes this because it makes her look skinnier.) Also, if I look at a very high contrast, black-on-white, horizontal line (like in a crossword puzzle) the line looks a little jagged. I don't expect that these things will ever correct themselves but they are quite minor.

And here's how things progressed over the first few weeks.