Wednesday, September 30, 2015

saving your eyes -- a slight update

First eye stuff, then some reflections on politics and such....

Six days after cataract surgery on my right eye, I know more things which
are important to us "users" which somehow are hard to find on the web or even in all but very few doctor's offices.

One thing stays -- IF you don't have cataracts, or if you are marginal, DO use sunglasses a lot,
and do take lutein/zeantanin supplement (like Costco's orange plastic jar, much better than Ocuvite)...


I thought it was a mistake that I did not buy the $18 three-pack of reading glasses from Costco years ago, so as to reduce eyestrain when reading. After cataract surgery, I thought I would use them a lot
(due to lack of distance flexibility of standard "monofocal lenses" which I strongly recommend for now).  But this week (from last Friday to today, Wednesday) I have done LOTS of experimentation on my vision, and I did buy reading glasses form Costco. They simply did not do what I expected.
For images (like books) between, say, ten inches and two feet from my face, I expected NO CHANGE in image size or quality, but CHANGE IN HOW FAR IT SEEMED TO BE.
So if I read a book 20 inches away, I would expect it to look like a book twice as big with letters twice as big 40 inches away. (The same "angular resolution.") NO way. A big disappointment.
Above all, they worked only in a narrow window, for books something like ten inches from my face.
Also, even when I took care to clean the lenses a lot, the "noise" (blurring) through the glasses was noticeable.   In conclusion: needing glasses for driving has been no problem at all for me, they worked well, but I doubt I will use reading glasses much no matter what I choose next.

On the positive side, the EnVista intermediate range lens worked quite well.
No need to rely on weird imprecisely specified numbers from tricky eye tests.
I can just switch between my untreated (dominant) left eye, and my treated right eye.
I especially remember looking both ways at a tree far behind my house, our "totem"tree, which looks just like a totem pole with no leaves and two faces carved in it , carved somehow by nature.
The new eye has at least a factor of ten more resolution! When I use my old driving glasses on the left eye... even still, the right eye without glasses seems maybe a factor of 2 better.

But it was a great downer on my last Friday first checkout to move some book... form about 24 inches to 20... and see a blur in reading which I never had before! That was truly awful.

There is a tendency for all businesses and government enterprises to fall into routines, and try to make one size fit all. Since most older people suffer from "presbyopia" (far sightedness), they can immediately see the improvement when they get far-range lenses implanted after cataract surgery.
Doctors may feel insecure if patients deviate from that script, and it took some resolve on my part to
insist on intermediate instead of far for my right eye. I am VERY glad I was so resolved!

T%he lifestyle questonnairre in his office did help some. It asked -- which is more important to your lifestyle and happiness - playing golf (far), working with computer or TV (intermediate), or reading (near). I thought it was a no-brainer that reading and computers are 'way more important to my life than playing golf, which I do not play at all. OK, I like to ride a bicycle without glasses, but I could do that already; only driving REQUIRED far glasses, and, OK, some conference talks with small
print on slides. And so... with my right eye at intermediate, I ALREADY have a big improvement and all I really need on the far side; the question is how much I need to cut back on things involving intense fine reading.

Fortunately, I can read a book now reasonably well 26 inches or so form my eyes, even with just one eye really tuned to that distance. I also find that "two eyes are MUCH better than one," that even my old myopic left eye fuses with the right in a way which strongly increases reading ability, So I can continue reading WITHOUT reading glasses.

But what of the choice between TWO eyes treated for "intermediate" versus one intermediate and one near? I am even now vacillating on that. Eyestrain (and adaptation) has something to do with defining the right choice, but I have the impression that eyestrain damage... is like Li ion battery lifetime... an arcane subject where almost everyone is just guessing or imagining. (One of my last actions at NSF was to recommend funding for a highly recommended proposal that could have changed that, but bad guys who support clients in the Middle East and oil patches said "no way." This had a lot to do with my retirement, but growing eye problems also contributed, along with many other factors.)

The doctors warn that some people have real problems in coordination and binocular fusion when
one eye is far and another near (a common option, called "monovision"). They want people to try it with contact lenses to see  if it works for them. But today.. one web page says "near": is optimized for abut 12-14 inches, FURTHER than the present focal length on my (very myopic!) left eye.  Since I am having no problems in fusion this week, I would expect none next week. A tiny bit of dizziness? I don't know, but my eyes NATURALLY adapted to this kind of specialization years ago....

How important IS it to put an equation in fine print or a puzzle with my little annotations 14 inches form my face (or read labels in medical packages in fine print)? Is that important enough to warrant "near", for the next part of my life, versus the advantages of two "intermediate" eyes?

Now that I see people aren't ready for 1+1=2, how much should I tilt my plans to enable more equations?

12 hours to decide...

See the bottom for the story one day later.


Meanwhile, we all keep up with Presidential politics, and I "listen to the wind."
There is a curious Hindu perspective. Of course, the nation which "owns" the Upanishads should appreciate the very basic idea of trying to see through many eyes at once, for truly powerful fusion of images. (And yes, my left optic nerve seems to be part of that for me!) But the images here...
well, there is a less elevated, older, more mythological part of Hinduism, as in Mahabharata.
I own it, but have never read it much; I found it much more natural to read Journey to the West, a similar tall tale for Chinese Buddhism. But my brother showed me a very well-written children's book, Ramayana, which I read in his house, and which fit nicely with what we actually saw in India in March/April.  A tale of Gods and demons, more or less. The demons usually have sneaky plots in mind, and appear as humans, until they get power and cackle and show their claws and wheels and bad friends.

And so.. image of a Republican cast mostly made up of exactly that kind of demon (like the ones who cackled as they gave Cheney many green lights to screw up many things)... but three main exceptions: (1) Donald Trump, acting as an incarnation of Siva; (2) Kasich sort of an incarnation of Vishnu, but with limited support as with his friend Boehner, as we all see preserving the status quo is not good enough now; (3) Carson, a pious itinerant monk, due for great lessons and great struggles but not quite ready for the Presidency -- unless we wish to share those struggles. (Actually, "W" was in a way halfway between his brother and Carson... and he did have some struggles, and did learn a few things.)

AS this came to me, I asked: "What of Democrats?" On this stage, Hillary Clinton strikes me as very much a real human being. It's curious how much of an oddity that now seems. But those folks might say... an election between Trump and Clinton might be a lot like a popularity contest between Lakshmi and Siva.

You may recall... HIndus tell me Siva is both destroyer and creator.  That makes me nervous..
but this past week, Trump has done a number of things to suggest he really is capable of both.
Suing the Club for Growth... well, I am surprised he did not get more media credits for that.
Since I worked in Specter's office, and that Club was the force that knocked him out...
I still remember their VERY AWFUL unAmerican antidemocratic dirty tricks, like when they were caught organizing disruptions to Specter's town hall meetings, a rightly sacred institution in the US.
The second I saw that growling first questionner in Trump's town meeting.. it seemed very familiar... I couldn't help wondering...  that club IS on a short list of an important threats to the Constitution and the American way of life, in my view (analogous to folks who wear a cross while engaging in sodomy).. and they have done lots of dirty tricks before... Maybe this time, maybe not, but I couldn't help wondering, as it was just TOO perfect... but do advertizing dollars buy them a lot of help from the media?

More seriously... Thursday news reminds me how many people value their personal hatred of Assad over the minor question of the Third Caliphate movement destroying the entire world. McCain says "Russia has bombed a group trained by the CIA." That's nice. But wasn't Osama bin Laden (Al Qaida) also funded and trained by the CIA? When I said that, Luda responded, "No, this one was just affiliate of the same group." The real threat in the US is from folks who still would fund Al Qaida, who thing that a few hugs from an oriental rug dealer make him their 100% ally and friend forever.
Bush is still that naive. Trump has shown he is not, and that Third Caliphate is more than just an empty slogan to him. Whatever other pros and cons... that is certainly not one to be ignored!


As for Sanders... I think of him as Obama II, or candidate for the position of Queen of England: well intentioned, but not with the kind of experience it would take to rescue an admin situation as scary as what we are in.  More could be said, but no reason to now.

AS for Biden... this is not a time to relive my childhood. Of course, he is/was a kind of neighbor...
in a world not at all like India, but capable of even more Sivaesque action than Trump if and when the demons press too hard.  Beware the munchkins if their back is to the wall.

Reminds me of the curses of Moses hitting the shariacs this year... and some other evident actions of the noosphere.


More eyeball stuff, Thursday, after doctor's appointment.

Right eye tests as 20/30 for distance vision, correctable with -1.something lenses to 20/20.
I asked: "Could it be corrected to better for far vision?" Answer: "We don't do that. Perfect is good enough." (Luda just smiled. She mentioned how her father took the "far" option, and was 20/15 coming out of the operation, without correction. BUt for me, it was a VERY conscious choice, that intermediate and far vision are more critical to my life, so long as my far vision is good enough,)

Issue of intermediate versus near for the left eye... was hard. Luda sometimes gapes as she sees how fast and decisive I can be when I have a clear basis for going ahead... but on this, I didn't. I had a deadline, I felt, in order to get the surgery scheduled as soon as we should (October 22), so I needed to MAKE a decision, but I kept on seeing pros and cons up to the end.

In such a case... wanting the right decision, I naturally felt I should have a serious "talk with God and talk with Luda."   I told Luda: "God is more patient with all the precise technical details?"
"Ah, but does he even care?" "Good question, but at least he has practice 'drinking from a firehose.'"

So at about 3AM today, I felt I really should shift from my preliminary decision back toward "near," my immediate first impression back when I saw the "lifestyle questionnaire.' Lots of complex thoughts. One -- that I HAD a nearish left eye and farish or intermediate right eye, back when I was at Harvard (probably late graduate school),  when I had much more powerful vision than most people but my eyes had become more myopic due to hours and hours pouring over computer printouts looking for bugs. "Myopia was NEVER a bad thing. Back then, it was a natural adaption to the real needs I had, and not so extreme to interfere with things like driving or mountain climbing.  Two or three years ago, when it became MUCH worse, it was still a good adaptation to growing opacity in my eyes, as nature tried to make the best of a difficult situation, and I needed to read to do my job at NSF." (Not that the new Bo Xilai type cheerleaders would deign to read much themselves.)

And so, at 3AM, I thought... let me be real. Specialization between left and right eye was my natural way, optimally adapted to my real needs.   Even with a weak left eye (6 inches focus now, and correctable only to 20/40 or 20/50)... I fused both eyes very well this week, and having that left eye "miraculously" improved the quality of my reading two feet in front of my face, improved it a lot compared to using the right eye alone. With a STRONGER left eye, focus at the "usual near lens distance of 12-14 inches," it should be much better. If reading is the biggest gap n what I have right now, that should get attention. If I can fuse that old left eye well enough even with distance (as I do right now), then a "near" better left eye should work fine. A lower risk solution, allowing me to hold a few things closer to my eye (like equations or contracts, where it helps to fill my whole retina with the desired image). And then, if even EnVista lens should get a little cloudier through the years, I could still read with reliability.

Some folks would say: "Hey, who ever needs to fill the whole optic field with the desired equation? Isn't it enough just to make it out clearly from 24 inches away, and let the brain handle all the rest?" That sounds good, but as I observe myself solving hard puzzles.. it's amazing how simple things like quality of lighting affect quality of my   reasoning. Many people always feel that they are "all there" all the time, and at their peak by definition. I know better, both form science and form experience. So, to help this little brian do its best, at a time when it is often stressed to or beyond its limits, why not choose "near", to improve what I see on paper (including what I write myself in notebooks)?
Why not restore what you had after all the debugging at Harvard? Sure, I then become very dependent on my new right eye for distance vision... but risks of people killing me are probably greater than the risks of me just losing that right eye somehow.

Then the discussion with Luda, who was a bit put off that I would reconsider so late in the game. "Didn't you tell Irena yesterday over the phone that you decided on intermediate?"
"No, I was ready to just go along with that in the email last week, but on the phone, in the discussion which mattered, I only committed to surgery on October 22. I asked for one more day, to decide on near versus intermediate AFTER some further discussions, such as discussion with the doctor."

One key question: "As the week goes on, can't you ALREADY read well enough? Wouldn't another intermediate eye make the fusion even better, and let you read more? Do you want to pay all this money (85% from insurance) just to replace one myopic left eye with another?" And I had images of her and me riding horses in the wild, with far vision to support it... and wondered if we had ever done just that in some past life. (I once met an old mystic of a central Asian school who said we had both had a time in such places... but in this life, Luda's family comes from "the people of the horse," and mine do not.) But: "I don't expect us to do that in this lifetime. That's not a major consideration. Nor even jigsaw puzzles, which also go at intermediate distance."

Yet... I don't have much reason to expect EnVista lenses to deteriorate. They have yet to be around for decades, but I did pick them exactly to get minimum deterioration. Luda notes -- simple chemical deterioration is a factor with plastics, natural or artificial, so even with her sunglasses she can't be sure this will never happen to her. In the worst case, if they do, there are still reading glasses.
The full power of binocular vision is not to be underestimated. AND... "intermediate" is ALREADY a bit "myopic" by normal vision test standards (as I saw in the tests this morning)! If my optimum mix at Harvard was SLIGHTLY myopic, then shouldn't double intermediate ALREADY do as much as what nature already wanted to assist even tasks like debugging based on microscopic scrutiny of printouts in small print? So wouldn't "near" be overkill?'

I also told Luda: "You are more important to me than my eyes anyway. So if you would feel bad about my taking the "near" choice... intermediate is certainly good enough... I will choose that just for that reason. I do not want YOU to be upset." But she then said: "Well, if you pick intermediate and then feel bad about the quality of reading for the next 20 years, I don't want YOU to be upset." So in a way, we just reversed, in the car, going to the doctor's appointment. "Hey, this is just like that O'Henry story, where both sides ... consider their feelings about what makes the other one happy. But this time, BOTH possible endings are happy really, so it's not so bad." I also mentioned an economics professor I had decades ago at Harvard, who said: "People spend two much time agonizing over choices which are difficult because it's hard to tell which has more 'utility.' When the two choices are so close in value, it doesn't make much difference anyway.'" Ah, but sometimes the agonizing is because we need to reduce our uncertainty bounds, so that we get a better idea which is better... and one MIGHT be a whole lot better, if only we thought it through.

First step in the doctor's office was eye exam for the right eye (and a little on the left.). The 20/30 to 20/20. A friendly Latina (Rosie?) did the test, asked about my experience, and answered a few questions. Yes, I am "totally off restrictions." Cheer number one -- now I am allowed to bend over again. (Not til I lived with that did I see how much of a hassle it was!) Cheer number two -- I can take a full shower, including my head. (Because infection was such a concern, I DID take showers this week -- while wearing sunglasses in the shower, lowering the showerhead to make sure no water flowed onto my head, and using baby wipes carefully for cleaning my head away from my right eye.)
Cheer number three  -- only two eyedrops per day for the next month, instead of seven. Some folks continue with drops like Visine to make water/tears forever after cataract surgery, but a lot don't, and I am hoping to be in the latter group.

I explained that I am more than happy with my far vision, and all vision form two feet on out, but am deeply worried about how WELL I can read, especially since reading glasses don't work for me. She suggested that the +2.5 reading glasses I chose from Costco might well be too strong, and that +  1
or +1.5 might work better. (Costco's "eye bar" to choose the strength of reading glasses does not do the job!). But she also said it might well be pushing it to do two intermediate. She also told me how -1.x glasses get me to 20/20 now (in the right eye).

After she left, I asked Luda to let me quietly stare into space and digest the new numbers before the doctor came in. IF -1.x gets me to 20/20, and if -2 would get me to optimal far vision, then could it be that intermediate is indeed ALREADY as myopic as the best my natural body came up with at Harvard? Didn't that support Luda's position? And yes, I had -2 glasses for several years, from about 2000 to a few years ago, before the cataracts became catastropic. But then... I didn't need driving glasses BEFORE 2000 or so, suggesting that quiet cataract type deterioration had already set in by 2000. And what of the RISK aspect, as EnVista has not been tested for decades? At one point, Luda said: "The doctor has seen hundreds of cases by now. Why not just trust him and leave it at that."
I said: "But he may be missing some of the key numbers as much as I am. And how much does he see the whole longitudinal picture of his patients and what they experience afterwards?"

But when the doctor came in... I explained precisely what my uncertainties were,and why.
It is hard for me to predict how well I will read if I have just two intermediate eyes (let alone deterioration issues, which I did not raise). Yet certainly I appreciate the huge power of image fusion. He said a bit more about the experience of people who choose "monovision," like one eye far and one near. "With such a gap, the eyes sometimes cannot work together, the drop out for a bit; some people freak out at that, but some people are not bothered." Maybe I should have noted: I am NOW
working with a MORE NEAR left eye, and have never had any drop out at all, even with very far distances (e.g. in the car with Luda looking far ahead)."

Then I was surprised. It seems that IOLs do NOT come in only three ranges (near, far, intermediate).
It is basically a continuous variable. So he proposed a "more near" IOL, nearer than what I have in the right eye, but close enough to make image fusion near guaranteed. I just said yes, and thanked him. And in general... when and (the expected utility of two options x and y) are close but worrisome because of uncertainty, simply picking (x+y)/2 is one way to reduce risk. 
I don't know whether that was the BEST decision, but as of now, that's all the past, for me. Time now to worry about fusing other types of images, at other levels.

I did also ask myself how this choice would interact with the spiritual side of my life... but we will see. That got into even more uncertain stuff, like what I will really do with my next few years.




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