About 6 years ago, during a routine check up at the optometrist for some trouble with reading, a cataract in my right eye was discovered. I found it strange, since, though I had a history of diabetes in the family, I was not diabetic (I still am not). After what the optometrist discovered, I decided to see an Ophthalmologist, Dr.1, who confirmed that I had what is called a Posterior Polar Cataract (PPC). And then began my journey into the world of sight and ethics in the field of healthcare.
I spent a majority of the first year in denial - after all I was not diabetic, or aged and was the only one in the family who had perfect eyesight for the longest time. I decided to take a second opinion: Dr.2 who has an eye hospital in the J.P. Nagar area of Bangalore. Now, he was a former neighbour and I assumed that I would have a good experience in his hospital. But right from the moment I entered the hospital the only question I was asked was if I had health insurance, not once, but by every single assistant there. I finally snapped and told the people there that I was there only for a consultation which did not necessitate health insurance and that they were being presumptuous that I would be having my surgery there, in the event that I would need one. The doctor saw me, confirmed what I already knew, decided on the lens that I should have, told me that since the lens was imported it would be expensive and that the insurance would be "managed". I was sent off for measurements required for the IOL (Intra Ocular Lens) implant. I left the place with the memory of distasteful experience.
I had asked both the doctors the reason for my having a PPC. Both said that it was hard to say and that there could be many factors - trauma, extended use of steroids- or that it could be congenital. Not one to accept any explanation without myself confirming it, I spent the intervening years, from then up until now, reading up on medical-research with respect to PPCs. I was so disheartened that at one point I even asked my mom what she did while she was expecting me!
After a year of seeing Dr. 2, I went back to Dr. 1 to evaluate the stage of the cataract. He told me that it had increased in size and that I could have the corrective surgery in his soon-to-open eye hospital. All this while he was a consultant at another hospital where I had gone to see him and which hospital also had the facility for the required surgery. I was terribly disappointed at the demonstration of the lack of ethics and had lost respect for the doctor.
In the meanwhile, I managed my visual needs with a pair of progressive spectacles provided by my very good optometrist and continued my research into PPCs. I saw Dr.3 a year later to evaluate the progress of the cataract and ensure if I had more time before I underwent the surgery. He was a kind doctor and even gave me a CD with photographs of the cataract. He was the first doctor to explain the risks that a PPC had as compared to a regular, age related cataract. Yet, something in me lacked the confidence to have him conduct the surgery. This may be no reflection on the abilities of the doctor, rather my own fear based on incomplete information and understanding of my problem.
I had asked both the doctors the reason for my having a PPC. Both said that it was hard to say and that there could be many factors - trauma, extended use of steroids- or that it could be congenital. Not one to accept any explanation without myself confirming it, I spent the intervening years, from then up until now, reading up on medical-research with respect to PPCs. I was so disheartened that at one point I even asked my mom what she did while she was expecting me!
After a year of seeing Dr. 2, I went back to Dr. 1 to evaluate the stage of the cataract. He told me that it had increased in size and that I could have the corrective surgery in his soon-to-open eye hospital. All this while he was a consultant at another hospital where I had gone to see him and which hospital also had the facility for the required surgery. I was terribly disappointed at the demonstration of the lack of ethics and had lost respect for the doctor.
In the meanwhile, I managed my visual needs with a pair of progressive spectacles provided by my very good optometrist and continued my research into PPCs. I saw Dr.3 a year later to evaluate the progress of the cataract and ensure if I had more time before I underwent the surgery. He was a kind doctor and even gave me a CD with photographs of the cataract. He was the first doctor to explain the risks that a PPC had as compared to a regular, age related cataract. Yet, something in me lacked the confidence to have him conduct the surgery. This may be no reflection on the abilities of the doctor, rather my own fear based on incomplete information and understanding of my problem.
My reading about this over the past 6 years has lead me to understand the problem and the risks that I face. I am sharing some of it here:
Posterior Polar Cataracts are cataracts that develop on the posterior part of the natural crystalline lens due to the clumping of proteins (as in any cataract)that the natural lens is made of, but is in the axis of vision. This results in insufficient light passing through the lens to be able to form an image on the retina, resulting in blurred image and poor visual acuity. My reading also validated what the doctors told me with respect to the cause/s for such a cataract. Interestingly, I also found out that it could be caused by a dominant autosomal mutation, the gene PITX3. I do not know if anyone in my extended family suffers the same problem as I, but I know that my siblings do not. What makes this a bit risky is that during the removal of the cataract (which is done through a process called phacoemulcification, or with the help of laser, wherein the cataract is broken into pieces and removed from the capsular bag), there is a high chance of a Posterior Capsular Rupture (PCR). When this happens, the new IOL can still be placed in the anterior portion of the capsular bag or, if the nucleus itself falls into the vitreous cavity and the capsular bag is damaged and unable to host the new IOL, it is placed in the sulcus. Avoiding this requires expertise, and with advanced laser equipment available (at a high cost, of course), the chances of a PCR and associated complications can be reduced. In the event of a PCR and the nucleus falling into the vitreous cavity, a vitreo-retinal specialist is called upon and a cataract procedure which takes about 10 minutes results in a more complicated procedure taking upto 45 minutes.
By this time I had come to terms with my PPC and was happy with my progressives glasses. But I knew that I could not escape surgery and went to Dr. 4 about a month back to make sure that I wasn't too late! In my case, the bigger and harder the cataract, the risk would magnify, and my vision itself would diminish! Dr. 4 runs a huge hospital in Bangalore. Since by now I had understood that my cataract isn't a simple one, I specifically called the hospital and requested that the senior doctor see me. Here, too, I was asked if I had health insurance cover, but it was only once so I brushed it aside. I was a bit shocked by the lack of hygiene when just anyone administered the drops for dilatation of the pupil and, very strangely, sanitised their hands AFTER doing so and not prior to. Finicky that I am, it bothered me greatly but I consoled myself as I awaited my turn with the senior most doctor. Once my name was called, I was given all of two minutes - first, the doctor expressed surprise at my having a cataract at "such a young age" and then took a very cursory look and asked me to see a cataract specialist in the hospital. Now, with his experience he ought to have known that youngsters could also be affected by cataracts. Anyway, I then met Dr. 5 in the hospital who was a cataract specialist. As a patient, if I have the capacity to understand my health situation, the doctor ought to answer my questions and ally my apprehensions. Well, this doctor told me not to ask too many questions. I was taken aback by his response and told him that it was my right to know about my own health and associated risks. I was told that there's a high risk of an event of a PCR. I thanked him and left.
A week back, on the recommendation of my sister-in-law and my father, I knocked on the door of yet another famous eye hospital. I got a good feel from the place - it was clean and did not look like an eye factory. The senior doctor , Dr. 6, saw me, answered my queries and made me feel at ease. I shall be undergoing my surgery here.
After exploring the types of IOLs, I have decided to go for a simple monofocal for distance vision, that gives me crisp images at a distance beyond 100 cms and preserves contrast. The premium lenses compromise on the visual acuity and contrast sensitivity as also causing greater photic phenomena since the light that enters the eye is split across three or more foci. I will need to correct my vision with glasses or even state of the art contact lenses available today.
Through my journey over the last 6 years, I have experienced the not-so-pleasant side of healthcare in India. This isn't at all to allege that all doctors are unethical or inefficient; I have the greatest respect for most of them. Having a family full of doctors, and a close friend who is one, does not necessarily give rise to that sentiment - it is inspite of them all! They say that having faith in the doctor is important. Mine was lost and found!
Yet, I cannot help wondering how people who do not have the kind of access to information, resources and education that I have had, find themselves placed in this system...
Based on the beautiful Raga Bhimpalasi:
Posterior Polar Cataracts are cataracts that develop on the posterior part of the natural crystalline lens due to the clumping of proteins (as in any cataract)that the natural lens is made of, but is in the axis of vision. This results in insufficient light passing through the lens to be able to form an image on the retina, resulting in blurred image and poor visual acuity. My reading also validated what the doctors told me with respect to the cause/s for such a cataract. Interestingly, I also found out that it could be caused by a dominant autosomal mutation, the gene PITX3. I do not know if anyone in my extended family suffers the same problem as I, but I know that my siblings do not. What makes this a bit risky is that during the removal of the cataract (which is done through a process called phacoemulcification, or with the help of laser, wherein the cataract is broken into pieces and removed from the capsular bag), there is a high chance of a Posterior Capsular Rupture (PCR). When this happens, the new IOL can still be placed in the anterior portion of the capsular bag or, if the nucleus itself falls into the vitreous cavity and the capsular bag is damaged and unable to host the new IOL, it is placed in the sulcus. Avoiding this requires expertise, and with advanced laser equipment available (at a high cost, of course), the chances of a PCR and associated complications can be reduced. In the event of a PCR and the nucleus falling into the vitreous cavity, a vitreo-retinal specialist is called upon and a cataract procedure which takes about 10 minutes results in a more complicated procedure taking upto 45 minutes.
By this time I had come to terms with my PPC and was happy with my progressives glasses. But I knew that I could not escape surgery and went to Dr. 4 about a month back to make sure that I wasn't too late! In my case, the bigger and harder the cataract, the risk would magnify, and my vision itself would diminish! Dr. 4 runs a huge hospital in Bangalore. Since by now I had understood that my cataract isn't a simple one, I specifically called the hospital and requested that the senior doctor see me. Here, too, I was asked if I had health insurance cover, but it was only once so I brushed it aside. I was a bit shocked by the lack of hygiene when just anyone administered the drops for dilatation of the pupil and, very strangely, sanitised their hands AFTER doing so and not prior to. Finicky that I am, it bothered me greatly but I consoled myself as I awaited my turn with the senior most doctor. Once my name was called, I was given all of two minutes - first, the doctor expressed surprise at my having a cataract at "such a young age" and then took a very cursory look and asked me to see a cataract specialist in the hospital. Now, with his experience he ought to have known that youngsters could also be affected by cataracts. Anyway, I then met Dr. 5 in the hospital who was a cataract specialist. As a patient, if I have the capacity to understand my health situation, the doctor ought to answer my questions and ally my apprehensions. Well, this doctor told me not to ask too many questions. I was taken aback by his response and told him that it was my right to know about my own health and associated risks. I was told that there's a high risk of an event of a PCR. I thanked him and left.
A week back, on the recommendation of my sister-in-law and my father, I knocked on the door of yet another famous eye hospital. I got a good feel from the place - it was clean and did not look like an eye factory. The senior doctor , Dr. 6, saw me, answered my queries and made me feel at ease. I shall be undergoing my surgery here.
After exploring the types of IOLs, I have decided to go for a simple monofocal for distance vision, that gives me crisp images at a distance beyond 100 cms and preserves contrast. The premium lenses compromise on the visual acuity and contrast sensitivity as also causing greater photic phenomena since the light that enters the eye is split across three or more foci. I will need to correct my vision with glasses or even state of the art contact lenses available today.
Through my journey over the last 6 years, I have experienced the not-so-pleasant side of healthcare in India. This isn't at all to allege that all doctors are unethical or inefficient; I have the greatest respect for most of them. Having a family full of doctors, and a close friend who is one, does not necessarily give rise to that sentiment - it is inspite of them all! They say that having faith in the doctor is important. Mine was lost and found!
Yet, I cannot help wondering how people who do not have the kind of access to information, resources and education that I have had, find themselves placed in this system...
Based on the beautiful Raga Bhimpalasi:
No comments:
Post a Comment