But the harsh reality is that even if you take care of your eyesight from childhood, it is still not eternal (the statement is true for sight, and for childhood and for everything else in this world). Therefore, even if you do not look at welding or through a telescope at the sun, sooner or later it begins to fail - natural age-related changes in the optical system of the eye will make themselves felt.
Habr is visited monthly by 8 million users - I am sincerely glad that the bulk of them (aged 25 to 44) will be able to read this article without problems and only for general development. But invite your mothers, fathers, and grandparents to read it - will they cope with this task as easily? Or will they have to squint for better focus, enlarge the font on the screen, or even get special equipment in the form of glasses? Well, here's a visual illustration for the first two paragraphs of this article.
In this article I will share my experience of returning the sight of bate - he was the co-author of my first post on Habré (yes, about an unkillable flash drive) some 12 years ago .
You need to start this post with two backstories, where the second flows smoothly from the first (and vice versa).
The first
In the summer of 2018, I made myself a laser correction using the ReLEx SMILE technology, which I talked about on Habré (in the same blog), but did not talk at home. More precisely, I just came home one day and said, " Well, congratulations, I made a vision correction and now I see everything well ." If I had started a conversation before the operation, I would certainly have stalled: on all sorts of questions (some of which I myself did not know at the time) and on counterproductive “ well, talk to your neighbors, they also did vision correction for themselves and they say ... ” ... In general, perhaps it was my most spontaneous decision, but there was some confidence in the need to do it ... and now I can safely say that this was my best decision in recent years.
It’s not me that you click on the links above, although the information on them is really valuable) The first question to my statement was “ when did you do it, since you already see everything? ”- no one could think of it (and even me) that after the operation it was not necessary to lie with vegetables for several days. Most of all, my father showed interest - somewhere with an interval of a month, he asked me, “ Well, how is your vision? hasn't gotten worse? is there any discomfort? "- in these questions, both experience and curiosity were considered. But after two years of these questions, I realized that behind all this was the deteriorating vision of the parents (especially for the father) and this was noticed more and more often.
And if once Nokia Lumia with its large contrasting interfaces seemed to be a godsend for parents, then after my correction I finally understood that the problem was not in the interfaces. And that it would be necessary to solve it. And that we should start saving. True, none of us then knew that laser correction would no longer work and two years of questions were in vain.
The second
This article definitely would not have come out if it had a story about another laser correction - they wrote about this on Habré more than once. Surely not come to it in the case of replacing the lens with an artificial lens (IOL) - about it also was . But here you are reading an article - what's the matter?
It's all about the second backstory, which happened long before the first. In 1987, my father had already performed an operation called radial keratotomy (RK). The essence of the operation was to make blind radial (like spokes in a wheel) cuts on the cornea with a scalpel. Under the influence of intraocular pressure, the configuration of the cornea changes → refractive ability changes → visual dysfunction is corrected. In Russia, this method of microsurgery was introduced in 1977 by Professor Fedorov (in whose clinic the operation was performed), but due to the high risk of complications and unstable results, the technology did not take root. By the way, now keratotomy is also done, but only in rare cases with a laser.
I knew about this episode from my father's life before, but I found out all the colors only during trips to the clinic. It became clear where the roots of questions about the side effects of correction and the timing of rehabilitation grew. For comparison: after correcting both eyes, I immediately got behind the wheel and drove home, and his eyes were covered with blood for several weeks (the second eye was operated on a week after the first), after which he was discharged from the hospital for several months and imposed all sorts of restrictions (on dusty work, weight lifting, etc.). And all this was considered a successful outcome of the operation.
* * *
In conversations about vision, I am often asked where I did the operation and if I can recommend this place. If two years later I again came to Tatyana Yuryevna Shilova, but with my father - is this considered an exhaustive answer? )
Not much has changed since my last visit to the clinic, except that branded masks and sanitizers have been added to the free shoe covers. As they say, free medicine starts with paid shoe covers, paid medicine - with free ones. And, well, there were more photos of celebrity patients on the walls - from ST and Assol to Grigoriev-Appolonov and Kuzmin.
Diagnostics
Before the operation, the patient's eyes are studied in much more detail and in depth than in the case of any other problems. The whole diagnostic process takes about 3 hours: during this time, several doctors study vision and eyes on a dozen devices. I have already written about some of them in my article, so I will be brief - so that those who are reading for the first time are not afraid to enter the office.
1. Automatic tonometer Reichert 7 - it is used to study intraocular pressure. That piece of iron that makes "puff" in the eyes. The pressure is slightly increased.
2. OCULUS Pentacam anterior eye segment analyzer is a device that builds a 3D model of the anterior eye segment in a few seconds, analyzing up to 25 thousand elevation points. At the output, it provides information on the following parameters: the curvature of the anterior and posterior surfaces of the cornea, its thickness, total optical power, depth of the anterior chamber, optical density of the cornea and lens.
3. Reading the electronic version of the ophthalmological table (the original version is called the Sivtsev table - in honor of the Soviet ophthalmologist who developed it in 1925).
4. The tables are read first with one's own eyes, then with the help of optometric glasses and a set of lenses for them. Typically this kit is used to screen for vision abnormalities (myopia, hyperopia, astigmatism, presbyopia, strabismus, and color blindness) and glasses / lenses.
If the readings of the previous devices are more understandable to the doctor, then the readings of the table are closer to the people: without glasses, Dad saw only the top line with his right eye - this is 10%, with his left eye a third, that is, 30%. Although we remember that visual acuity is evaluated in a logarithmic relationship - therefore, the difference between the first and second lines is much greater than between the ninth and tenth. In optics, there was a + and astigmatism with the same sign.
5. NV-100 is a small device for checking visual acuity in “everyday” conditions at different distances and with different letter sizes in text fragments.
6. Optical coherence tomograph Optovue - a device for obtaining images (sections) of optically transparent tissues. Based on the principle of spectral interferometry, the tomograph allows "digging" through the entire vitreous body to the retina itself, and quickly (26 thousand scans per second), with high resolution and safe for health - for example, to track the dynamics of a pathological process.
7.ZEISS Humphrey Field Analyzer 3 (HFA3) - I didn't have that. It sounds like the third part of some shooter, but in fact this device is a visual field analyzer and is designed to determine the boundaries of this field and assess the light sensitivity of the eye. I didn’t look inside, but if I understood the idea correctly, it works like this: we look motionlessly into the beautiful far away (although the direction of our gaze is tracked), while the device displays around the point - every time you see a new one, you have to press the button. Points are displayed in different places, which allows you to "grope" problem areas of the field of view of each eye. The results obtained are compared with the established age norms and glaucoma databases, and at successive visits to reveal statistically significant visual impairment.
8. Konan NonCon Robo Specular Microscope is another device that I haven't looked into. As the name suggests, this is a microscope, but not a simple one - specifically for the cornea, so that you can study it at the cellular level (the endothelial cell layer). The key features are auto-alignment, autofocus, auto-capture, autoanalysis, automatic pachymetry (measuring the thickness of the cornea) and the ability to remember exactly where the "photograph" was taken (because it is non-contact) of the cornea - so that during further examinations you can see the same area (otherwise What is the point).
9. Optical biometer IOLMaster 700 is another device for non-contact (based on the method of optical coherence tomography) measurement of eye structures. Scans the anterior and posterior segments of the eye, which allows you to better understand the anatomy of the eye and more accurately calculate (including for IOLs) the refractive result of the operation.
10. The final examination was the examination of the eyes through the Huvitz slit lamp - it was carried out by Tatyana Yurievna herself. It is not so much a lamp as it is almost a microscope with a camera, giving from 6 to 40 times magnification. The device allows you to examine the visible parts of the eye - eyelids, sclera, conjunctiva, iris, lens and cornea.
A good set of information can be collected by contactlessly looking inside the eye, right? I don’t know about you, but my phrase “identification by the iris” has sparkled with new colors. By the way, Wikipedia reports that this is one of the most accurate methods - unlike the same prints, the iris hardly changes with age, and the theoretical probability of the coincidence of two shells is 1 in 10 78 (not googol, but already warm).
* * *
At the end of the study, readings from all devices are printed on a color printer and pasted into the patient's medical record. Then she falls into the hands of Tatyana Yurievna and she carefully studies her, and then communicates with the patient. How can you quickly study a stack of documents, where each number or letter can become decisive in a person's life? Well, probably the same way as an experienced administrator can scroll through megabytes of logs, or a developer is a browser console) The ability to analyze all the individual features of the clinical picture, identify symptoms and combine disparate phenomena into a single whole just determines the qualifications of a doctor.
After studying the documents, Tatyana Yuryevna develops a complete picture of the patient's eye condition and she can tell in detail what and how he sees. Tatyana Yuryevna tries to explain everything in the most simple words, using various analogies and examples; and if the patient is savvy, he can tell everything in a purely medical language.
Our result is moderate myopia operated on (condition after radial keratotomy in 1987), hyperopic shift (that is, postoperative hyperopia), complex hyperopic astigmatism and incipient cataract. Although a recent "physical" at work showed none of this, it is even surprising . This means that the option of laser correction will definitely disappear.
Having told about possible options for further actions, you can immediately sign up for the next appointment or go home to "think". We collected the lens brochures and headed home.
Fuck cataract, come on here
The most common eye disease in people of mature age (over 50) in the world is still cataract, and by the age of 80 it can be diagnosed in almost every person with a natural lens. A beautiful name for an ugly disease; in Greek, cataract means "waterfall".
What is this beast? Quite simply, this is a clouding of the lens (which is normally transparent) due to denaturation of the protein that is part of its composition. At first, a person begins to see through dusty glass, it is worse to distinguish colors and to feel a particularly pronounced deterioration in vision in conditions of poor illumination, but the final result is the same - blindness; the period of "maturation" of a cataract can stretch both for many years and for several months (and sometimes days). It is always a progressive disease, that is, if this process has begun, then "it will not go away by itself," just as therapeutic methods will not help - you cannot turn the "cooked" protein into the former transparent one.
But I don’t want to frighten you too much and will even try to please. If even 10-15 years ago this diagnosis was incurable and led to irreversible blindness, now there is a solution and it consists in replacing the old (natural) lens with a new (artificial) one. Once again: not a drop, not a pill - only surgical intervention (the best and only method recognized in the world), which, by the way, in most cases (in the absence of other diseases) allows you to completely restore vision.
According to the booklet, the decomposed solution to the batin problem looks like this: Half of the quest looks like it was completed, hurray!
[ DONE ]
↓
[ DONE ] ( )
↓
[ TO BE ]
↓
[ TO BE ]
Oy cabbage soup seems to have completely forgotten about the keratotomy mentioned at the very beginning of the post. Scars left after decades spoil everything - from possible unpredictable visual effects to the possibility of corneal rupture during surgery. So it turns out that the most difficult (and expensive) is yet to come.
* * *
A couple of interesting snippets from Wikipedia :
- One of the first mentions of cataracts is a statue dating back to 2457-2467 BC. It was found in 1860 in Sakkara and represents the figure of the priest Kaaper with a white spot in his left eye. It is assumed that this is a developing cataract, which the author was able to depict in detail.
- « , » (800 ). .
- II . . , XIV — -.
- . , , ( ), . (), 8 1950 45- .
By the way, remember Professor Trelawney from Harry Potter and her glasses with thick lenses? Once upon a time, one of the methods of treating cataracts was to remove the lens without installing anything instead - to compensate for this "hole" in the optical system, you had to wear similar glasses with lenses as thick as a finger, which took over the function of the lens. It's hard to imagine what kind of distortions there were and what their owners felt ...
Lens options
Before visiting the clinic, I asked all the staff (from the reception to the assistants) not to name any amounts aloud, just as they will not be in the article. Firstly, for any person, the amount above his salary will not be very comfortable, not to mention the employees of the Federal State Unitary Enterprise. And, secondly, the parents would have tried to shove them back for a long time at every meeting, and I hate these battles in the hallway. And since parents will read this article up and down, I responsibly declare: I still simply did not find those suitable words that could be used to express my gratitude to Tatyana Yuryevna for doing everything for free)
Depending on the generation of the artificial lens, the cost of its installation starts from 40,000 â‚˝ - more accurate prices are available on the clinic's website or based on the results of diagnostics.
* * *
At the end of the diagnosis, it was necessary to think about what kind of vision and in what scenarios is most in demand. For example, drivers need to see well into the distance, computer users need to see at a medium distance, and those who like to read need to see up close.
A few days after the meeting, Tatyana Yuryevna sent in WhatsApp possible options for lenses:
| , ! ) . :
1. , ( ). Zeiss Asphina — ( ) Tecnis AMO LUCIA ZEISS. 2. , . , , 1.5, . 3. , ZEISS LISA tri 839 — , , . Rayner RayOne, , . , «» . 4. Oculentis Custom — , , , . . , «», , — . , , ) . |
Ultimately, the decision was up to the father. I do not know why, but he was inclined to 1 option - to see well in the distance, but to wear glasses close. Moreover, he does not drive a car, and for work at a lathe, "close distance" is more suitable.
I saw more logical option "FullHD up close and with glasses into the distance".
The brother asked if it was possible to make one eye for the near distance, the second for the far)
But everyone, without exception, liked the last option - to close the question once and for all (about “forever” this is not an exaggeration - the artificial lens does not fade). It is easy to guess that it is the most expensive. But only he allows you to completely get rid of glasses and enjoy a clear picture at any distance. Actually, in the end, we settled on this option, because health is what it is better not to save on.
In general, these lenses are very different from the usual lenses that you can buy in any supermarket - in characteristics, shape, materials, price - in general, everyone. Therefore, I offered Tatiana a topic for a blog on Habré - to tell about what lenses are, how they differ and how they are made. She found it interesting, they requested all the information from ZEISS (and maybe from other manufacturers) - let's hope that the article will appear soon.
Operation
In the process of communication, another weighty argument appeared to do the operation in Russia, and it was with Tatyana Yurievna. It consists in the following: while Fedorov made from 6 to 18 incisions in each eye, in some countries keratotomy was already banned with might and main. Therefore, now, decades later, when people are faced with the natural aging of lenses, there is a whole wave of those in need of surgical intervention. This means that in other countries the necessary experience is simply not there and is unlikely to be (for happy owners of scars there, in most cases, they shrug their shoulders), while in Russia this experience is abundant and it is becoming more and more.
Perhaps you did not notice how you read 15+ kilobytes of text and looked at ten megabytes of pictures - it's time to take a break. Well, or paraphrase: it was decided to publish the part about the operation as a separate post, so that all the scary pictures are separate and somehow loaded. No need to wait, the post has already been published . The code word "Habr" will give a small discount on primary diagnostics, and "Bumburum" - a 5% discount on the operation.