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#44709 - 05/26/17 01:24 AM Re: Cataract surgery and IOL replacement [Re: grelber]
ryck Offline


Registered: 08/04/09
Loc: Okanagan Valley
Originally Posted By: grelber
On this side of the border medicare is funded federally through (income) taxes by means of distribution to provinces which provide the health care. (This represents ca 40% of annual budgeting. [I trust that ryck (or others) will correct me if I'm wrong.])

It depends whether you're looking at the federal or the provincial percentage - in individual provinces you are right, the number is about 40% of the services provinces provide. Federally, the number is between 11 % and 12% of GDP.

Percentages aside, in actual dollars our healthcare system is about $6,000 per person. Because our system is paid from graduated income taxation, that $6,000 average is going to be greater or lesser to the individual taxpayer, depending on their income.

However, our system provides equality in healthcare. Any person requiring it - no matter whether they're a millionaire or a homeless person sleeping under a bridge - gets it.


Edited by ryck (05/26/17 01:26 AM)
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#44710 - 05/26/17 07:24 AM Re: Cataract surgery and IOL replacement [Re: ryck]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Thanks for fleshing it out.

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#44711 - 05/26/17 08:23 AM Re: Cataract surgery and IOL replacement [Re: grelber]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: grelber
Somnabeach! It may be a bit premature to report, but ...
I just switched to prednisolone acetate 1% for corneal inflammation. The haziness seems to have cleared dramatically and both eyes have the same focal distance.
Given the blue filter in the IOL, everything seems sharper and brighter via the left eye, especially when I compare it with my right eye (with incipient cataract), which lends a decidedly yellowish hue to everything.
Now it's wait and see if this holds. ...

Man, the eye thing just keeps on and on ...
It's one step forward then one step back then one step forward and two steps back ... etc. One day out of 4 I'm encouraged, 1 day discouraged, 2 days depressed.
Some days the vision is just about perfect, then it goes completely hazy again, then bulbar scratchiness (± pain) ... even with all the meds.
Street lights have a rainbow circle with haze around them; not so with my cataractous eye.
It's going on 6 weeks since the surgery, so I'm close to calling it a "fail".

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#44712 - 05/26/17 08:47 AM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Offline
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
Originally Posted By: grelber
Even with all the meds.
Street lights have a rainbow circle with haze around them; not so with my cataractous eye.
It's going on 6 weeks since the surgery, so I'm close to calling it a "fail".

I can only imagine your frustration but as far as the street lights go, I had problems with street lights and especially headlights for nearly a year after my surgery. More annoying than anything serious, it sometimes made night driving difficult. I found BluBlocker "sun" glasses helped a lot. Later on I found some really expensive amber lens shooting glasses to be better albeit several times more expensive. Even though my surgery was 17 years ago and the street/head light halo long since disappeared, I still wear a pair of amber lens sunglasses when driving at night on all but the darkest country roads. If you try this I strongely urge you to avoid polarized lenses.


Edited by joemikeb (05/26/17 08:50 AM)
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#44713 - 05/26/17 09:08 AM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
The Alcon AcrySof® IOL has UV and blue-filtering — essentially it's an implanted BluBlocker — with all the benefits of the latter and actually better than shooter's amber lenses*, with which I quite familiar being a target shooter and practical shooter.
That's why the on/off haziness due to inflammation is so irksome, not to mention the flare.

* In case you'd like to follow up, there's a good article on same in Eye 2016; 30: 215-221 (at www.nature.com/eye).

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#44726 - 05/29/17 02:54 PM Re: Cataract surgery and IOL replacement [Re: grelber]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Once again, it may be premature so I'm hesitant to comment on it but ...

The (white to white/blue) haziness and lack of reasonable distance focus — especially because these come and go, sometimes even over the course of 10-15 minutes — seemed to indicate that the problem is not inflammation or inflammatory corneal infiltrates, since that is not typical behavior for inflammation (which should get better or worse, not fluctuate). Add to that intermittent bulbar and retrobulbar pain. So I had to think that maybe the various meds, from steroids to NSAID, were more the culprit than the cure.
So I decided to quit all of the meds to see what happens. My last pred dose was over 24 hours ago. Since mid-morning I noticed in the bright sunlight that not only was my left eye no longer hazy but also had better visual acuity and less haziness than my right eye — which heretofore had never been the case — and so it remains as of this writing.
The proof of the pudding will be that the situation remains stable. If so, then my supposition will be accurate and when I see my surgeon in a couple days, I will point at him and say, "J'accuse!" tongue I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.

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#44737 - 05/30/17 08:47 AM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Offline
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
I've got my fingers crossed for your successful experiment. Your rationale seems sound, at least to my non-medical point of view.
Originally Posted By: grelber
I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.

You always have the option to abort, but hopefully by then you will be reveling in the joy of the improved vision in your other eye and eager to have it in both.
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#44746 - 05/30/17 03:13 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
ryck Offline


Registered: 08/04/09
Loc: Okanagan Valley
Originally Posted By: grelber
The proof of the pudding will be that the situation remains stable. If so, then my supposition will be accurate and when I see my surgeon in a couple days, I will point at him and say, "J'accuse!" tongue I will also set up the appointment for the surgery on my right eye (before the end of June), with the option to abort if things go south in the interim.

Originally Posted By: joemikeb
I've got my fingers crossed for your successful experiment.

Hear, hear! All the best for a successful outcome.
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#44751 - 05/30/17 05:13 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Paraphrasing joemike, I've got my eyes crossed for you! tongue

Since you said earlier that dexamethasone is 6.5 times as strong as prednisolone acetate I've been curious about why your surgeon defaulted to such a strong drug, and following your story, I've suspected for a while that your problem could be steroid overdose.

I hope you've nailed it!

Interesting that everybody I know or have run across that has had cataract surgery has had both eyes done in quick succession, while my surgeries were six years apart.
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#44755 - 05/31/17 01:16 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: artie505
Since you said earlier that dexamethasone is 6.5 times as strong as prednisolone acetate I've been curious about why your surgeon defaulted to such a strong drug, and following your story, I've suspected for a while that your problem could be steroid overdose.

The difference in strength is why the formulation with dexamethasone is 0.1% whereas that for prednisolone is 1% — so that the amount per drop is approximately equal (to achieve the same effect).
Still not sure if my supposition vis-à-vis adverse side-effect is correct. The haziness still comes and goes, although with longer periods of clear vision than before; but scratchiness and general bulbar discomfort ~ pain has returned. So there's something going on which requires further medical elucidation.

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#44757 - 05/31/17 02:58 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Oops! Forgot to do the math, not that it changes my guess. (Have oyu ever had a reaction to a steroid?)

At any rate, we're all rooting for you.
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The new Great Equalizer is the SEND button.

In Memory Of Harv: Those who can make you believe absurdities can make you commit atrocities. ~Voltaire

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#44758 - 05/31/17 06:46 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: artie505
... ever had a reaction to a steroid?

Only appropriate (ie, salutary) ones — via all routes: oral, injectible (both regular and depot) and topical.

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#44788 - 06/01/17 02:03 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
I worked in a drugstore in the 60s, and the common sentiment back then was that if the US FDA had been in existence in the 40s, cortisone would never have been allowed to reach ANY market...SCARY stuff, but it sure does an awful lot of good before it kills you. tongue
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The new Great Equalizer is the SEND button.

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#44794 - 06/01/17 07:43 AM Re: Cataract surgery and IOL replacement [Re: grelber]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
OK, latest ophtho consult:

• Haziness due less to keratic infiltrates than posterior capsule opacity — again, due to aggressive ultrasound phacoemulsification necessary for the dense cataract. Underwent YAG laser capsulotomy which should resolve the tissue issue; a couple of weird floaters appeared in the wake of same — annoying little zippets, as a friend who underwent the same procedure recently has labeled them.
But it sure did clear up the haziness. Everything seems outrageously bright and clear ... don't have to go downtown to see the bright lights.
(Strangely, the sowbug-sized vitreous floater which has been my constant companion for a dozen years seems to have taken a holiday in the wake of the laser treatment. We shall see.)

• Discomfort/pain at incision site due to regenerating corneal nerves; this too should resolve with time.

• If all goes according to Hoyle, the cataract surgery and IOL replacement in the right eye should go forward in a couple weeks.

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#44992 - 06/07/17 10:42 AM Re: Cataract surgery and IOL replacement [Re: grelber]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Update:
The eye (a week after the capsulotomy) seems to have cleared considerably, with sharp images in distance vision and very little if any flare or glare. The clarity is excellent more often than not; and I just discovered that the taupe-colored house across the street is actually grey.
The floaters come and go. The discomfort/pain due to incision healing ~ corneal nerve regeneration seems to be controllable with Nevanac® when necessary (ie, once every so often).

The following ought to freak out folk south of the 49th:
I just acquired the provincial fee schedule (of covered services) for physicians.
Exclusive of extraneous prep, cataract surgery is $311.50 + IOL implantation $86; my posterior capsulotomy was $138.

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#44995 - 06/07/17 12:29 PM Re: Cataract surgery and IOL replacement [Re: grelber]
joemikeb Offline
Moderator

Registered: 08/04/09
Loc: Fort Worth, Texas
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.
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#44996 - 06/07/17 12:40 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
jchuzi Online


Registered: 08/04/09
Loc: New York State
Originally Posted By: joemikeb
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.
Sad, but true. My wife and I have had floaters for several years. That's a small price to pay for living long enough to develop them. grin
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#44999 - 06/07/17 01:50 PM Re: Cataract surgery and IOL replacement [Re: joemikeb]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: joemikeb
My ophthalmologist has told me the occasional floater is a fact of life for those who live long enough.

"Occasional" floaters come and go and are usually bits of uveal tissue or red blood cells which eventually disappear. Some floaters — such as the sowbug-sized one I've had for a dozen years as a result of a vitreous separation — one has to live with or have removed via vitrectomy (which can have the serious downside of blindness). Once all my cataract issues have been resolved and have settled down for a period of time, I may have the vitrectomy if the big floater presents more problems; since the surgery it seems to be less obvious, so we shall see whether it's worth it down the road.

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#45018 - 06/08/17 01:28 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Even after having dealt with floaters for close to 20 years I still swat at some of them. crazy

Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.
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#45019 - 06/08/17 01:33 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: artie505
Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.

Those "showers" are likely red blood cells (which can be identified by their being black/dark with a white/lighter center, since RBCs are biconcave) and are likely due to a brief rupture of a capillary — and they dissipate almost as quickly as they appear.

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#45020 - 06/08/17 01:51 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Originally Posted By: grelber
Originally Posted By: artie505
Every once in a rare while I get a "shower" of them, which is pretty disconcerting, but there's never been an underlying cause that my ophthalmologist could determine.

Those "showers" are likely red blood cells (which can be identified by their being black/dark with a white/lighter center, since RBCs are biconcave) and are likely due to a brief rupture of a capillary — and they dissipate almost as quickly as they appear.

I've never been able to get one of them to stand still long enough for me to examine it. tongue

They haven't dissipated at all quickly, though; it's taken several days for an entire shower to disappear, during which time the real bugs have a field day. grin
_________________________
The new Great Equalizer is the SEND button.

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#45026 - 06/08/17 08:22 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: artie505
I've never been able to get one of them to stand still long enough for me to examine it.

If the component bits of the showers/swarms all look the same, even if you can't get a good look at them (which is usually the case) and they're about the size of a bullet (as in bullet list), they're probably RBCs (vs chunks of uveal lining).

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#45027 - 06/08/17 08:47 AM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Originally Posted By: grelber
If the component bits of the showers/swarms all look the same, even if you can't get a good look at them (which is usually the case) and they're about the size of a bullet (as in bullet list), they're probably RBCs (vs chunks of uveal lining).

It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.

I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.
_________________________
The new Great Equalizer is the SEND button.

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#45028 - 06/08/17 09:11 AM Re: Cataract surgery and IOL replacement [Re: artie505]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.

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#45036 - 06/08/17 02:20 PM Re: Cataract surgery and IOL replacement [Re: grelber]
artie505 Online


Registered: 08/04/09
Originally Posted By: grelber
Originally Posted By: artie505
It's been quite a while since I last experienced a shower, but I don't remember the components being either uniform or as big as you've described.
I'll keep your description in mind, but my uveitis has been quiescent for going on two years and seems to have taken floater occurrence on vacation with it.

YAY! And RAH! Much better that way ... and keeping a good thought that it stays so.

Much appreciated! smile
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