Wednesday, June 07, 2006

Laser surgery: a cure for blindness?

The Japanese pharmacist who filled my prescription for ophthalmic steroids, the keyword in his question being "butsu", to beat or to strike. I answered, in Japanese, very simply:

"No, laser."

I came away from the pharmacy with two small bottles, these to be used on the right eye, one drop four times a day until both bottles are finished. The Japanese ophthalmologist who prescribed these drops will review my condition in three months, in September, at which time I will undergo yet another visual field test.

The Japanese ophthalmologist, who works at the hospital which I now attend in Yokohama, and who I will call Dr Kanto, took a look at my eyes on Tuesday 6 June 2006.

When questioned, he was unable to say whether the radiation therapy which I underwent last year was or was not the cause of the deterioration in my eyesight. Certainly some people do suffer eyesight damage from radiotherapy. But he could not say what, exactly, had caused my present problems. It was quite simply impossible to tell.

That said, Dr Kanto told me that, in his view, the deterioration in my eyes was not "active". To make this statement, he used the English word "active"; he occasionally seeded his Japanese with a word or two of English.

The prognosis that he gave me was that I could expect that the condition of my eyes would remain stable, and that I should not expect to experience any further deterioration.

This was not a hard-and-fast promise to be relied upon as a picture of my future, but, rather, his take on the present situation. He does think that I should continue to be monitored and aims to see me every three months or so.

It was, he said, within the bounds of possibility that, in the long event of time, I might see some improvement in both eyes. But, when damaged eyes do recover, they do so with agonising slowness.

For the left eye, he had no treatment to offer. He showed me enlarged photos displayed on a computer screen and pointed out the patches that were clearly damaged. But he had some good news. The macula, the critically important light-sensitive portion of the left eye, was intact.

For the right eye, through which I see almost nothing whatsoever, he proposed laser treatment to punch a small hole in the eye, which, in some way, will help drain the eye. He predicted that the right eye would at least become brighter and that, possibly perhaps, I might experience some small improvement in my visual acuity in the right eye.

Whatever the result, I would see the result the following day. He characterised the treatment as risk-free and gave an assurance that it was entirely affordable.

Affordable? Yes. I went ahead and had the laser treatment, and, when I paid, my bill for my day at the hospital, a day on which I arrived at about 0830 and ended up leaving at about 1630, came to 5690 yen. That included the laser surgery. Computing this in American dollars at the approximate figure of 110 yen to the dollar, this works out at about US $52.

That was the cost to me under the terms of the Japanese national health insurance scheme, under which I, as the patient, pay only 30%, with the state footing the bill for the remaining 70%.

I was invited to take my time and think about the laser surgery, but, to me, it was a no brainer. Let's give it a shot.

The eye clinic was stacked up with waiting patients, so I left the hospital and went and had lunch, returning to keep a 2 pm appointment for the eye surgery. Naturally, the appointment did not run to time, so I sat around waiting.

Eventually, I was called to the laser treatment room.

A contact lens was placed in my right eye. This was unexpected and was considerably uncomfortable. I sat for what seemed like a very long time staring into the lens of a machine which made intermittent sharp brittle clicks, like the sound of a needle punching into something.

While Dr Kanto worked at the controls of the eye laser machine, a nurse held my face in position with both hands, so I would not move.

Finally, it was done.

"Umaku dekimashita," said Dr Kanto, which I think means "Well done".

Five minutes after the laser surgery, five minutes by the clock, Dr Kanto was looking eagerly into my right eye. Then he had his assistant had me do another eye chart test. But there was no sudden miraculous improvement, though I got the impression that Dr Kanto and his assistant had expected that perhaps there might be.

At that time, apart from anything else, my right eye was massively dilated by eyedrops in preparation for the laser surgery, so sharpness of vision could not be expected. In fact, as previously, in the center of my visual field all I saw was a smudged pool of darkness.

Picking up on the obvious anticipation of the doctor and his assistant, I was reminded, irresistibly, of the impatience of my two-year-old daughter, who must never be offered anything (icecream, or an orange, or whatever) unless it is immediately available, because she wants it right now.

And the desire, the anticipation, is understandable, because if they had rectified my eye by the simple procedure of punching a hole in it, then this would have been a miracle. But, as it was, I was still in the mundane world, the world of survival rather than cure, the world of, at best, incremental improvements.

Finally, having paid, I exited the hospital, feeling totally exhausted, as if at the end of a long and punishing siege of my body and soul.

But I walked out of the hospital with a future ahead of me, which was more than I had arrived with, since I had spent the previous weeks very much with the feeling that I was wrapping up my life, and that my life, as I had known it, was more or less over.

In the morning, in the dimness before dawn, I could see, mistily, the house, with my right eye. But this I could do before the laser surgery. The brightness of the sun, the brightness of daylight, totally washes out the field of vision in the right eye, but, in a twilight which is close to darkness but which is not darkness, I can see, vaguely, shapes: a doorway, for example, or a window on the stairway.

At 0551 I closed my left eye and looked at the world through the right. I could read nothing on my computer screen, but I could make out the rectangle of the illuminated screen, which appeared to be muddy gray, its grayness always in motion as patterns of meaningless interference played across the view.

Through the left eye, I could see the alarm clock sitting on the desk, and, next to it, a bowl containing two pairs of scissors and a bunch of pens. Through the right eye, I could see neither of these objects.

But, in my mind's eye, I could see the future I would make for myself, in the survival space which Dr Kanto had offered me. After long weeks of progressive hopelessness, he had offered me both treatment and a workable prognosis, a prognosis which I could live with, a future in which I could survive.

And, perhaps, prosper.

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