Why Did Two 10 Minute Cataract Surgeries Take 7 Weeks

Why Did Two 10 Minute Cataract Surgeries Take 7 Weeks

My review of Williams Eye Institute in Merrillville, IN

 

Let’s start with the basics:

 

Levels of Vision

20/20 – Normal vision. Fighter pilot minimum. Required to read the stock quotes in the newspaper, or numbers in the telephone book (if you can still find one).

  • 20/40 – Able to pass Driver’s License Test in all 50 States. Most printed material is at this level.
  • 20/80 – Able to read alarm clock at 10 feet. News Headlines are this size.
  • 20/200 – Legal blindness. Able to see STOP sign letters.

Read more

 

In March 2018 I visited Envision Eye Care at the Costco located on Clybourn Avenue in Chicago.

 

It was determined that I had astigmatism in my right eye.

 

I could get corrective lenses in the form of contacts or glasses.

 

For those of you who don’t know me, I am an avid motorcyclist.

 

Mitch on Triumph Rocket 3 in shed

 

I keep a minimum of three opacity sunglasses (clear – amber – dark) on my motorcycle.

 

The thought of ordering a thousand dollars worth of prescription sunglasses for three opacities plus a pair of daily readers at $300 or $400 made no sense especially with one of the rules in my life.

 

“The price I pay for sunglasses is inversely proportional to how quickly I lose them.”

 

ie: $89 Ray-bans will disappear on the same day I buy them.

 

$5 Kmart camo eye shields – Will be available for at least a year or more.

 

I opted to go with monthly (vs daily at triple the cost) contacts having two prescriptions as I needed more correction in my left vs my right eye which meant 2 contacts or $100 for a three-month supply.

 

I was a miserable patient trying to negotiate these little plastic discs into my eyes.

 

I would get confused and place 2 contacts into one eye then they now blurred my vision beyond repair.

 

Envision Eye Care was very patient and with practice, I learned how to live and improve my life with contacts.

 

One of the last things that I was told on my final visit was “we can see the beginning of cataracts and you’ll probably need to get them corrected within the next year.

 

We hope to see you a year from today”.

 

When you are old like me you take great comfort in small wins like the ability to walk into the grocery store and read box labels without using of glasses.

An ulterior motive for wanting to wear contacts was not to look like an old man.

 

The following is absolutely not a political statement.

 

A while back speaker of the House Nancy Pelosi and Sen. Chuck Schumer met with Pres. Trump in the White House.

 

On the left side of the camera sat Nancy who is 79.

 

She sat erect with a typical Nancy glow in her eye.

 

Trump (and VP Pence) were kind of in the middle, on the right, was Schumer.

 

Trump meeting with Schumer, Pelosi erupts over border wall funding

 

He sat hunched over.

 

I do not want to look like Sen. Chuck Schumer.

 

The Senator is 68, only a year older than me.

 

Senator Chuck Schumer with reading glasses

 

He seems to do everything he can to make himself look old – in front of the camera.

 

I am clearly less visible but surely vainer.

 

Envision Eye Care proved to be prophetic.

 

By the fall of 2018, I was back to keeping readers in my pocket.

 

The degradation of my eyesight due to cataracts had become increasingly perceptible.

 

I wanted to get them taken care of but that whole moving to Indiana thing got in the way.

 

Fast-forward to July 2019 and a visit to Cosco optical in Merrillville Indiana.

 

Dr. Perez confirmed what I suspected.

 

My left eye degraded to 20/60 vision.

 

No more night driving or motorbike riding until the eyes got fixed.

 

I was offered corrective contacts but he suggested it would be best to seek a consultation for cataract surgery.

 

I was referred to the Williams Eye Institute down the street (Rt 30 and a tad south on 55) from Costco in Merrillville.

 

File under “nothing is easy.”

 

Begin review of Williams Eye Institute

 

Operated by Dr. Williams and his wife Dr. Williams a.k.a. Dr. Doug and Dr. Ann.

 

Dr Doug and Dr. Ann Williams

 

They also have a facility in Hammond Indiana.

 

I called to schedule an appointment which was made for August 1, 2019.

 

About a week prior to the appointment I received a packet with all the paperwork that needed to be filled out.

 

I liked that because no one enjoys paperwork let alone sitting in a doctors office filling out forms trying to remember half the answers like my wife’s cell number.

 

With this method, I showed up with all the forms filled out which made for a rapid onboarding experience.

 

So far so good.

 

Thursday 08/01/19

 

With my paperwork submitted and a brief wait, I was invited into an examination room from one of the nurses.

 

I didn’t take notes but she brought me into at least two additional examination rooms each time testing my eyes for different functionality.

 

BTW – those letters that you have to read and then decrease in size until they get to be almost invisible are called the Snellen Eye Chart.

 

If you are all about “screw the years of medical education, expensive equipment and buildings I’m going to test myself” here’s how you can do that.

 

If you prefer a more conventional approach, the Williams Eye Institute staff will lead you to at least three exam rooms and then a small conference-style room.

 

This is where Dr. Ann (Williams) will give you the “talk” about cataract surgery.

 

What you can expect, the dangers and procedures of cataract surgery.

 

 

“Cataract surgery is the most common surgery performed in the United States with more than 3 million procedures done annually” explained Dr. Ann in an even tone.

 

I nodded politely and agreed to understand everything she had to say.

 

She led me into the final examination room.

 

This is where I met Dr. Doug. for the first time.

 

He proceeded to perform additional examinations with his binocular indirect ophthalmoscope (below), calling out numbers that Heather (a nurse) sitting in the room, entered onto a form.

 

binocular indirect ophthalmoscope

 

His was wired.

 

This was analog at its best and I love analog.

 

After the brief exam, Dr. Doug removed the coalminer/space explore apparatus from his head and proceeded to say all the words his wife said, almost verbatim.

 

We would begin with my left eye because that was the worst of the two (remember I said that).

 

This begged the question so I asked: “What exactly is my eyesight in the left eye?”

 

“20/70 Dr. Doug replied”

 

I did not prolong the conversation but apparently multiple examinations and the cost of $180 (at Williams Eye Insitute) versus the $100 that I paid to Costco for a 10-minute exam came to a more precise conclusion than Costco’s 20/60 diagnosis.

 

Another way of looking at the 20/XX thing is:

 

If you have 20/40 vision that means what you see clearly at 20 feet is what somebody with perfect vision sees at 40 feet.

 

Medicare part B and United healthcare plan (AARP) part F was whitelisted during the exams ensuring that both procedures would be paid for with no out of pocket expenses.

 

I was sent home with a new packet of papers including eyedrop instructions.

 

Two days prior to surgery I was to begin putting three different prescription drops in my left eye.

 

Three times daily

 

Inveltys – to help relieve pain and swelling

 

Bromsiteper their website:

“BromSite® is the FIRST and ONLY topical ophthalmic nonsteroidal anti-inflammatory drug (NSAID) indicated to prevent ocular pain after cataract surgery

 

Polytrim – This medication is used to treat bacterial infections (such as blepharitis, conjunctivitis) of the eye. It contains 2 antibiotics. Polymyxin B works by killing the bacteria. Trimethoprim works by stopping the growth of the bacteria.

 

My first surgery for the left eye was scheduled Thursday, August 15 meaning I was to start the 3 drops Tuesday the 13th.

 

3 drop eye drop schedule

 

On Monday (8/12) of that week, Williams called to say that Well Future, their pharmacy partner had left two messages but I had returned no phone calls and needed to order the medication.

 

I checked my phone and saw there were no 312 numbers listed as recent calls.

 

I called Well Future, here’s how the conversation went.

 

Me “Hi I’m a patient of the Williams Eye Institute and I need to order eyedrops.”

 

WF “Yes we have your prescription here, the three bottles of drops will be $137 but we think you should double your order.”

 

Me “Why’s that?”

 

WF “So you have enough.”

 

Me “I’m looking at my 48 hours of dosage and it appears that I don’t need more than six drops of anything.”

 

WF “You can’t be too sure.”

 

Me “Actually I can be absolutely sure, just tell me how many drops are in each bottle.”

 

WF “I don’t know.”

 

Me “How much liquid is in each bottle.” (I know that there are 20 drops per .5 mL)

 

WF “I don’t know.”

 

Me “Send me one of each for now.”

 

Neither Williams nor Well Future mentioned that I would be taking some of these drops post-surgically for six weeks per eye – but we’ll get to that.

 

Early the next morning Catherine heard knocking at the front door.

 

She went downstairs and there was a delivery van in the driveway with the driver on the phone trying to call us.

 

She (the driver) explained that we weren’t picking up.

 

When Catherine asked what phone number she was calling, she learned they had the last two digits reversed.

 

Well Future had gotten the phone number from Williams eye Institute.

 

Williams eye Institute was able to call me so we now knew the source of that problem.

 

Friday 8/15/19 – the day of my first surgery.

 

I didn’t spend much time in the waiting room filled with about a dozen patients, friends, and family.

 

A nurse escorted me into what was both the busy pre-op and post-op room.

 

I was asked to “pop a squat” in an armchair.

 

The nurse administered drops from nine bottles based upon my memory which was confirmed during the second surgery.

 

What I didn’t understand was why I was told to put the pre-op (at home) drops in at least five-minute intervals so they would not wash away the next one.

 

Getting these pre-surgical drops rapid-fire, I asked why and was answered with “these are all meant to work together.”

 

My vitals were taken including blood sugar.

 

The nurse asked me to recite my name and date of birth, which I did. 

 

She then asked, “What eye was being worked on and please point to it.”

 

While pointing to my left eye, the letter L (I presume) was written on my forehead above my left eye with an erasable marker.

 

It was wiped off during post-surgery.

 

On to a second chair, I received more drops to dilate my eye.

 

Finally onto the surgical recliner which could morph into a surgical table based on my observations.

 

I was still sitting up and my eye was feeling “numb”.

 

The best way I can describe the feeling is the old toy fortune-telling eightball – watch the bottom when flipped over.

 

 

 

It was a little irritating too but tolerable and I was also expecting to get an oral feel-good drug to help “calm me down.”

 

The anesthesiologist came over and introduced herself as “Dr. Lee.”

 

She reminded me of Chandra Wilson who plays Dr. Maranda Bailey on Grey’s anatomy (a show we binge-watch during meals).

 

Listening to my chest with her stethoscope, she then had me sit up and listened to my back.

 

“I don’t like the sound of your cough.” Dr. Lee announced.

 

I replied, “It’s a side effect of Losartan which I just switched to because my pharmacist couldn’t acquire any Lisinopril.”

 

She said, “I don’t care, I’m calling the surgery off until you get a release from your doctor.”

 

She went to the nurse’s station and returned with a “doctor’s note” form that needed to be signed by a physician.

 

I’m an angry (kids get off my lawn) old man and was seething internally.

 

“How in God’s green earth do you prep me for surgery and then cancel it – your procedures are backward!” I said to myself having no medical degree.

 

I called Catherine who wasn’t too far away visiting nearby resale shops and then immediately called my doctors office.

 

Editors note: You are required to be driven to the Eye Institute.

 

If the driver wants to go elsewhere they must leave their contact number – which was asked for on the second but not the first visit.

 

Endnote

 

The staff at Swedish said they could get me in on Monday.

 

Because of the move to Indiana, I had postponed my last visit with seeing Dr. J. so I was due anyway.

 

Krister M. Johansson, M.D. Swedish Covenant Medical Group Family Medicine

Dr. Krister Johansson

 

It is unusual in this day and age to have the same doctor for 17 years.

 

We’ve gotten to know each other fairly well during that time especially since I was diagnosed with type II diabetes around 2009.

 

For the first three years after the diagnosis, I saw him quarterly.

 

We know each other pretty well, well enough to hear him say and I quote “What the fu*k are they talking about?” (or something like that) after listening to my chest through his stethoscope.

 

“As long you’re here we will take some blood and then you’ll go upstairs and get a set of chest x-rays”. Commanded the doctor.

 

“Show them the X-ray, that’s all they will need” continued the medical professional I’ve known and trusted for 17 years.

 

BTW you’ll hear Catherine and I talk about our Keto diet on occasion.

 

Both the good doc and I attribute my lowered A1c reading of 6.6 (as of that visit) mostly due to how I (we) eat.

 

Tuesday morning (8/20/19)

 

After a bit of Keto breakfast and a protein shake, I drove up to the Williams eye Institute Merrillville with my X-ray underarm, showing up unannounced.

 

I told the receptionist “I need to speak with a doctor or nurse about my lung issue, I have a chest X-ray that was taken 24 hours ago and I would like to share it with somebody on staff.”

 

Before I quote verbatim what she (the receptionist) said, it is important to understand the depth of the medical professional’s staff at William eye Insitute.

 

Douglas P. Williams, M.D.

Ann K. Williams, M.D.

Kent Kirk, M.D.

Efren Gomez, O.D.

Lisa Saks, O.D. Specialties: Medical Examinations, Contact Lenses, Post-Operative Care (remember this name for later)

 

The quote:

 

“We don’t have anyone that can read an x-ray here.”

 

via GIPHY

 

I kept silent and patiently waited until I could meet with a staff member.

 

A nurse called me into the small examination room across from the main reception desk where I pulled the X-ray from its manila sleeve.

 

“My doctor said my lungs are fine and I am cleared for surgery,” I spoke in an even voice.

 

front and side chest x-rays

 

The nurse replied, “We still need a written release.”

 

“So what you’re saying is you prefer to have a forgeable piece of paper than a documented X-ray?” I inquired, keeping the words ‘Show them the X-ray, that’s all they will need’ in mind while talking to a medical professional that has known me for 2 minutes.

 

Her retort: “Let me get Dr. Lee on the phone.”

 

Is anyone reading this old enough to remember? 

 

x-ray vision glasses ad

 

The nurse called Dr. Lee at the Hammond office and related our brief conversation.

 

Covering the mouthpiece with her hand, she turned to me and said, “We still need the written release.”

 

I said “Cancel the surgery” and started to walk away – I had had, enough!

 

“Making a trip to Chicago and returning with an X-ray taken at a large hospital was insufficient” were the words floating in my head.

 

The nurse said “just a moment” and handed me the phone.

 

Dr. Lee gave me the whole CYA (Cover Your Ass) speech to which I responded: “Your medical priorities are upside down” (or close to that).

 

BTW I’m a guy that argues with oncologists and board-certified veterinarians for a living.

 

Dr. Lee said, “Don’t worry I’ll talk to Dr. Johansson and get this whole thing cleared up.”

 

I left with an appointment for Friday 8/30/19 (Labor Day weekend) a month after my first visit to Williams.

 

The morning of Friday 8/30/19 (1 month since my first visit).

 

Williams Eye Insitute is a cataract repair factory.

 

Nothing like the Russian optical surgical assembly line but they do upwards of 20 cataract surgeries a day (at $1500 a pop minimum).

 

A tray full of eye drops while in the first chair (as before).

 

Vitals, questions, eye pointing and marking then more eyedrops in the second chair.

 

Dr. Lee came into the room and was quite cordial.

 

She listened to my chest and asked me to open my mouth.

 

Then with a syringe in her hand filled with purple goo, she injected the stuff into my mouth under my tongue.

 

This was the make me feel good stuff.

 

I kept the purple goo under my tongue for as long as possible.

 

They can’t put you completely out for cataract surgery because your eyes would roam wherever they want.

Responding to the surgeon while under the knife is essential.

The procedure is painless.

 

I was admonished one or two times by Dr. Doug to please “look” at the brightest (of three lights) shining directly into my eyeball.

 

I had warned him over a potential problem – my solar sneeze – it’s a thing.

 

 

Fortunately, it (the sneeze) happened before the cutting began and my face had already been covered with medical textile so nobody got wet.

 

In and out in about 15 minutes.

 

I learned from my research that there are three types of lens implants available for cataract surgery.

 

  • Aspheric IOLs
  • Toric IOLs
  • Accommodating IOLs

 

That would not have mattered much but I expected the doctor to tell me precisely what type of foreign object was being permanently installed into my body which turned out to be an Accommodating IOL, something I gleaned from a nurse.

 

Correct me if I’m wrong ladies.

 

If you had breast implants didn’t the doctor show you an actual implant, what it at least looked like up close and personal? (Please leave comments below).

 

Procedurally a cataract surgery patient will return the following day for a checkup.

 

Because it was Labor Day weekend they offered the check-up by their staff optometrist immediately following surgery.

 

I want to stop here and talk about another service they offer is which is “laser cataract surgery.”

According to the “menu”, they removed from my folder, I could’ve upgraded my surgery to laser surgery.

It was a mere $1500-$3000 per eye additional which was not covered by Medicare.

 

That bothered me.

 

I asked one of the nurses how long laser surgery lasted.

 

Turns out it’s a little quicker than conventional surgery, about 10 minutes.

 

Let’s do the math.

 

Conservatively, if laser surgery can be performed five times over an hour.

The laser machine produces $7500 to $15,000 per hour of revenue.

Let me put that in perspective for you folks.

I get the whole benefit/feature thing but I can charter a six-passenger Learjet for $5500 an hour

Just sayin.

 

After the checkup, I met with another nurse who sent me home with a new “drops” usage sheet.

 

Postoperatively I was required to drop (the same) 3 chemicals into my eye for a week and the following 2 weeks – 2 chemicals

leaving out the Polytrim and then Inveltys twice daily for 3 more weeks.

 

Why is left on the right and vice versa (top of page)?

 

The following Monday I ordered 1 bottle of Bromsite for $61.

 

3 days later the second bottle of Inveltys was ordered for $55.

 

I still have almost a full bottle of Polytrim so not taking the advice of the first agent at Well Future saved me $27.

 

Knowing about six weeks of postoperative eye drops would have been helpful when placing my first order with Well Future.

 

They (Williams) also gave me a pair of sunglasses to protect my eye(s) from harsh sunlight and dust.

 

The night of the surgery we migrated to our campground and on Saturday morning I tried to wear their sunglasses during a bright August morning.

 

I found sunlight to be harsh and while traveling the dust-laden gravel roads on our golf cart, filled my eyes with dust in spite of the doctor-approved glasses.

 

Not that I have an opinion about sunglasses.

 

 

desk drawer full of sunglasses

 

But owning two of the fastest motorcycles ever built has taught me something about protective eyewear.

I put on one of my dark (for riding into the sun) goggle/glasses which solved the light and dust problem.

They have foam rings pressing against your face that seal out air and contaminants providing decent vision at triple figure highway speeds.

 

Cataract surgery does not provide improved vision instantly.

 

It took about a week to see clearly through my left eye.

 

What I found extraordinary while blinking my eyes alternately was how apparent the “cloudiness” was in the (right) eye. 

 

 

 

Wednesday 9/18/19 (right eye surgery day)

 

The right eye went just as well as the left and the procedure doesn’t bear repeating.

 

Something I neglected to mention is that when you come for each visit they wanted you to bring your eyedrops apparently to determine if you were using them properly.

 

They are returned in a private label zipper bag and along with “special” sunglasses.

 

Upon receiving my second set of Williams private label sunglasses from the nurse I took my motorcycle glasses off from the back of my head and told her that I found their sunglasses to be not very effective against light nor dust protective.

 

foam motorcycle goggle glasses and cataract surgery sunglasses

You can decide on the efficacy of these sunglass choices

 

Her response was something like “these are the glasses we want you to wear” pointing to the ones that made me look like a 90-year-old man and did little to protect me from the elements.

 

So once again my feedback as a patient was ignored.

 

Please post your comments below.

 

Wednesday 9/25/19

 

I returned a week later for a follow-up.

 

This time Dr. Doug did the post-operative final exam.

 

Much like my conversation with Dr. Sak’s (follow-up exam after the first surgery).

 

I had to ask the same question.

 

How’s my new vision?

 

“My right is 20/40 which still may improve. My left eye is 20/30” Explained Dr. Doug.

 

A reminder, going into prior to surgeries both eyes were at 20/70.

 

I asked Dr. Doug “If both my eyes had the same vision why did I have contacts with two different prescriptions?”

 

His answer was and I can’t quote because it was difficult to follow so I state:

“That’s a good question.

 

The difference between the 110 in the 90 (my Toric contact lens prescriptions) is only 20° and there’s 30° at the one hour position on the clock so they were both pretty close.”

WTF?

I know having been a pilot – “There are twelve hours represented on a standard analog clock, and 360 degrees in a circle.

Because an analog clock is a circle, the number of degrees an hour hand will move in an hour is equivalent to the degrees in a circle divided by the hours represented on the clock face (12). This equals thirty exactly.”

But I’ll have to keep searching for an answer to the different lens prescriptions.

 

I also asked during the follow-up exam if “I’ll be needing corrective lenses specifically contacts not glasses (the motorcycle riding thing).”

 

He said “Time will tell” and then he asked me “Where would you get fitted, with Dr. Perez?” (Costco Merrillville).

 

“No” I replied, “I didn’t have the warm fuzzies with him, I’ll probably go to Moses eye care down the street.”

 

“They do a nice job there” Dr. Doug replied.

 

Which begged two questions in my mind that I left un-asked.

 

1) Williams has an eyeglass and contact lens store at the north end of the building on the first floor.

 

2) Lisa Saks, O.D. Specialties: Medical Examinations, Contact Lenses, Post-Operative Care (remember this for later – it’s later)

 

I know people and I have remarkable people skills so, in conclusion, I’ll say that Williams Eye Institute does a competent job surgically but as for their people skills, I felt I was left only with

 

Flipping the middle finger x-ray.

 

(I wonder if anyone there can read that?)

 

Without even a “thank you” for allowing his company to bill Medicare and United Healthcare $3,309.83 he shook my hand and parted company agreeing to meet in 3 weeks for a final post-op exam.

 

I left him with, “I like eye jokes, the cornea the better.”

 

He chuckled under his breath and walked away.

 

End review of Williams Eye Institute

 

Your zygodactyl footnote

 

This Post Has 5 Comments

  1. Tammi Ebbin

    Quite a detailed tale! I’m glad my experience with cataract surgery went much much smoother when I did it 6.5 years ago! I do love the way you tell a story Mitch!

  2. Virginia

    I don’t know why I kept reading but I just did. I like the way you write. Thanks for the entertainment. I’m glad it went well. Today is a great day for a ride in CT. VIrginia

  3. Eileen Piccoli

    Having recently had cataract surgery myself, I enjoyed your story. It made me chuckle and it’s good to know that I’m not the only one with lingering questions!

  4. Susan Shafer

    I wish your enjoyable (for the reader not you who had to go through all the ca ca) presentation of the abuse of the healthcare of us typical folks was atypical. I’ve been a nurse for 40 yrs and a human for 61 yrs and KNOW how we can and should be treated. I finally exhaled when you said things went OK. By the way, love your Flipping them the Bird X-ray! I may be going out on a limb here (hee, hee) but perhaps they’d be able to read it if they got their head out of the back of their front x6 three times a day.

  5. Ron Hilmes

    When I wore contacts (for a very short period of time) one was toric for astigmatism. Toric lenses are not like normal spherical lenses. You can have 20/70 in both eyes, but if one (or both) is astigmatic, the correction is completely different. What I remember from my toric experience is that the lens was ‘weighted’ to stay in proper orientation while vertical. Normally not an issue until you lay on your side to work on something at the floor and your lens rotates with gravity! Real strange sensation. I had lasik shortly thereafter.

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