by Barbara Mende
Despite COVID-19, I believe that life keeps getting better. When people talk about the good old days, I ask them whether they’d have wanted to die of polio or measles or pneumonia. And whether they can imagine a pediatrician being forced to retire before she was 50 because of cataracts – as my mother did.
Cataract surgery in the 1950s hadn’t come far from what Jacques Daviel invented in 1748. At that time successful removal depended on the cataract being hardened enough to remove in one piece. Therefore patients were told to let it “ripen” or get hard, which could take years after the first symptoms. When they finally had surgery, they had to lie still in bed for several days with sandbags around their heads. There were numerous attendant risks.
My mother and six of her nine siblings developed cataracts in their 40s. While waiting for the ripening, she hid her condition for months, giving up her beloved needlepoint and novels, and asking me to read patients’ charts and lunch menus and magazine articles to her. But the worst part was what happened after the surgery. Intraocular lens implants were still lab experiments, and contact lenses as we know them were in their infancy. Most cataract survivors wore what people called “coke-bottle glasses” that magnified their eyes grotesquely. My mother managed to score a glass contact lens. But it was incredibly hard to manipulate, she couldn’t drive at night with it – a career-ender in itself when pediatricians made house calls – and she wondered whether she could trust herself to identify a rash or a throat infection. So she gave up her practice. So did her brother, a dentist, who never adjusted to contact lenses.
It was different in 1983 when I found I had the family’s early cataracts. I wasn’t worried, because I knew that Charles Kelman had invented a technique called phacoemulsification in 1967. The surgery was much less risky. You could have it at any time after the cataracts were discovered, and you only had to stay in the hospital overnight. Furthermore, implanting intraocular lenses at the time of surgery meant that you didn’t have to bother with contacts or strange-looking glasses.
At that time, though, I visited five doctors in Boston, and all of them were unwilling to perform the “experimental” procedure that was only 16 years old. (There were in fact a few who did, but I didn’t find them until later, and I looked pretty hard.) The fearful five all said I should wait six months to a year and then have the traditional procedure that my mother had undergone. “What will my eyesight be like by then?” I asked. One typical answer: “Oh, you won’t be able to see much at all. But try wearing a hat with a brim and sitting by a lamp when you’re watching TV.”
Since I had a career I loved and had to support myself, I didn’t think that was me. “Why wait?” I asked. “Frankly, we’re afraid of lawsuits,” I was told, “and we want to make sure the rewards outweigh the risks. But if you’re in such a hurry, go see Charlie Kelman in New York.”
I did, although I was warned against it. (One doctor said, “You realize how many lawyers and how many publicists he must have, to keep the lawsuits out of the papers?”) Although Dr. Kelman’s office occupied most of the 23d floor of the Empire State Building, he did his surgery in a small hospital near the end of Long Island which he’d bought into with help from his royal Middle Eastern patients because Manhattan hospitals didn’t want him to do “experimental” procedures on their turf. He flew patients back and forth in the helicopter he’d bought and learned to fly on a slow day.
My surgery was uneventful, and I was driving the next day, but I had trouble getting follow-up care back in Boston: “You want us to clean up after that charlatan operated on you?”
Fast-forward to 2015, when my son found that he had early cataracts. Phacoemulsification was now the established procedure, and by then it was day surgery. When he scheduled it, I asked him whether he needed a ride and he said no, he’d take a train. My second son, who had surgery last year, went back to work after the procedure.
Sometimes we think about where the cataract gene came from. My grandmother was never affected, so we figured it came from my grandfather. But we’ll never know because he died in 1913. In his forties. Of pneumonia.
We in the 21st century have a lot to be thankful for.