Tales of train travel and another trip to the optometrist’s

I recently had a few days of annual leave to go and visit my family. As driving is becoming more challenging due to the sodding cataracts in my good eye, I decided to simply remove that particular stress from the equation and catch the train instead. Now, getting the train is a bit of a palarver, because I don’t live within walking distance of the train station, which means I either have to rely on the bus service and put up with a longer journey whilst also feeling slightly queasy throughout, or grit my teeth and shell out for a taxi. As well as that, the train fare is considerably more expensive than the cost in petrol. But anyway, I decided I’d just have to hang the expense for the benefit of avoiding the stress and visual exhaustion of a long drive.

I contemplated the bus, but eventually caved in and got a taxi to the station. Weirdly, the taxi driver was the same one who had driven me there about a year ago, when I was going to Moorfields for an appointment due to my cataracts first becoming bothersome. “How are your eyes – have they managed to stabalise them?”, he asked me cheerily. “No”, I replied gloomily, “they’re getting worse”. He sympathised, and I moved on to other topics of conversation before I managed to depress him as well as myself.

Arriving at the station and wandering down the platform, I suddenly spotted a woman with long brown hair being led towards me by a guide dog. “Oh!”, I exclaimed to myself. It was the friend of one of my old uni friends, whom I’d actually exchanged Facebook messages with about visual impairment, but had never actually met. I bit the bullet and called out her name before rapidly following up with: “It’s Emma – Vicky’s friend!” “Oooh!”, she replied, “Hello – how are you?!” We proceeded to have a chat about where we were both heading, cataracts, silicone oil (she also had a detached retina in the past and has had silicone oil in place ever since), the futility of visual field tests for patients who can’t see to count fingers, the variability of the sight loss journey for those born blind versus those who experience sight loss later in life, and losing a parent in the supermarket. After a while, she explained that she needed to move further down the platform as her guide dog was accustomed to being further along, and I continued along the platform the other way to check my train times.

As I walked along, I heard, “BEEP BEEP BEEP” and realised that there was a lady on an electric mobility scooter, seemingly stuck half in and half out of the disabled toilet with the door wedged against her. There were plenty of people on the platform but no-one seemed to have noticed that she was having trouble. I pulled the door open and asked her, “Can I help you? Are you trying to get in or out?” “I’m trying to get out!”, she said, before thanking me for holding the door as she did a spot of nifty moving back and forth so that she was able to reverse safely out.

“Well”, I thought to myself as my train arrived and I settled myself down in a window seat, “that was an eventful start!”. The next hour passed fairly quietly, although I wasn’t too chuffed that the train gradually became more and more full. Eventually there were people standing all the way down the aisle and the guard kept asking people to please keep any seats free of luggage to enable passengers to sit down, as he apologised for the busy service. Not long after a stop at which even more people crammed themselves onto the heaving train and it set off again, there was suddenly an urgent exclamation: “Can someone spare a seat please – there’s someone who’s not well here!” Before I really knew what was happening, the chap sitting next to me tapping away at his laptop had vacated his seat and a young woman was hustled into his place. My first thought was, “Oh bloody hell, I know hardly anything about first aid!” Fortunately, there was another call from the further down the train, “It’s okay – can I get through please, I’m a doctor!”, and a man appeared at her side, asking medical questions and checking her pulse. Fortunately, she was with someone whom I presumed to be her dad, who explained that she had meniere’s disease and they were on their way up to London for a hospital appointment. After a few minutes, she fortunately started to look a little better, had a drink of water, and began to talk a bit. She turned to me and apologised (I told her not to worry about it), explaining that she’d been feeling rough for the past few days and had been unable to go out or do very much. She told me that people just take their health for granted until something goes wrong and expressed her frustration that she just wanted to feel well again, and be able to do the things she used to. I nodded in sympathetic agreement, thinking, “Yep, I can absolutely relate to those feelings”. It wasn’t the time to launch into precisely why I could relate so much to her words though, so instead I attempted to make her feel a bit better by telling her about my uncle who had meniere’s disease, which was controlled pretty well for most of his life. When I reached my destination, I wished her all the best before squeezing past everyone and disembarking. I sometimes think how odd life is in those moments when you’re party to a tiny snippet of someone else’s story and you never get to hear how it worked out. I hope she was okay and that the hospital managed to improve things for her.

Fortunately, there were no other medical emergencies for the remainder of the journey, unless you count my realisation that I really should have made space in my backpack for some lunch as I suddenly found myself ravenously hungry with only two emergency cereal bars to resort to as sustenance. Luckily, there were no issues on my journey home a few days later, either. However, my time away had meant that I hadn’t driven for a few days and unfortunately my next drive into work was on a particularly ghastly day. It had been pouring with rain so the road was scattered with puddles, the early morning sun was low and bright, meaning there was glare from both the sun and from the wet road. Despite having recently had my visual acuity checked at Moorfields and doing the 20 metre number plate test a few days previously (and passing both), the horrible drive made me question my vision all over again. I sighed with frustration as I rang my optometrist and managed to get a cancellation appointment for another check.

A couple of days later, I was once more updating my friendly optometrist with the latest on my sodding eyes as I set out my intentions for the appointment as follows: a) to check that I still met eyesight requirements for driving, and b) to determine whether it might be possible to improve my vision with yet another new left lens. He seemed to think this was all perfectly sensible, although when I asked, “Am I your most paranoid patient?”, he confirmed, “Yes!”, without a second’s hesitation. Ask a silly question, I suppose…

In giving him an account of my most recent Moorfields appointment, I bewailed the fact that my consultant and other ophthalmologists I’ve seen have refused to advise me on when the best time would be for me to undergo cataract surgery, telling me that it’s my decision. “What would you do?”, I asked him, “Tell me what you think – don’t be like the ophthalmologists!” And he did. He said that he has great faith in modern medicine and that successful cataract surgery would vastly improve my quality of life – it should enable me to return to very good visual acuity in my left eye and eradicate the ghosting and blurriness, as well as the glare from lights. His advice was to continue trying to correct my vision with glasses, but once it can no longer be corrected to meet eyesight requirements for driving, then to get a referral back to the cataract department at Moorfields. I agreed that this seemed to be a sensible approach. It was also oddly reassuring that he talked about quality of life, as I do often question myself as to whether I’m being a drama queen over all this eyesight crap. It would appear that I’m not.

The upshot of the appointment was that I still meet eyesight requirements for driving, but I’m only just within the limit (which I already knew, to be fair). The good news is that he was able to improve it slightly with a prescription for a new left lens. The bad news is that the new left lens is eye-wateringly expensive. Well, maybe I’m being a drama queen there. It could be worse, I guess. I told him that I’d just go for it and not think about the expense, because fortunately I have savings and that’s what savings are for. “Savings are for holidays!”, he corrected me, clearly horrified at the prospect of spending them on anything else. “Oh, I haven’t had a holiday since my retina detached whilst I was on holiday in Berlin back in 2014!”, I replied. So that settles it – I’m not going to feel guilty about shelling out for another new lens.

The cost has got me thinking though. I might suggest that my optometrist’s practice might like to consider introducing some kind of loyalty scheme. You know, like Sainsbury’s nectar points, perhaps. They could call them “winks”. For every £10 people spend on eye tests or glasses/contact lenses, they could be awarded one wink. Then, once they’ve accumulated, say, 40 winks, they could be redeemed as part payment for a subsequent eye test or new lens. Perhaps 40% off, for example, to effectively “snooze” part of the payment. I’m definitely going to suggest this when I go in to pick my specs up…

Acuity anxiety

I’m not really one for statistical analysis because, despite our Prime Minister’s declarations about the delights of mathematics, my detestation of anything numerical almost matches my disdain for the Tory party. However, if I were to plot a graph with the passing of time since my last eye check at my somewhat frustrating cataract assessment appointment at Moorfields back in April and my increasing anxiety regarding my vision, there would be no doubt of the correlation between the two. Before anyone accuses me of catastrophising, I should point out that between November 2022 and March 2023, the visual acuity in my left eye plummeted from an entirely reasonable 6/7 to a disastrous 6/18, rendering me unable to drive for a couple of weeks until I’d managed to get it corrected with a new lens in my glasses. As I’d been warned by both my consultant and optometrist that the posterior sub-capsular cataract causing this deterioration was likely to continue to get worse quickly, it was therefore entirely logical and reasonable for me to assume that things were on a fairly swift downward trajectory – hence my nervousness as time passed.

When I occasionally voiced my increasing concern about this, more than a couple of people cheerfully told me, “Well, if Moorfields have told you that you can drive, then don’t worry about it – just carry on until your next appointment”. (My next appointment, dear Reader, isn’t until September, and if past experience is anything to go by then it will most likely be postponed at the last minute.) These same possibly well-meaning but entirely unhelpful people went on to blithely tell me, “Anyway, there must be loads of people who shouldn’t be driving”, occasionally peppered with anecdotes of Great Uncle Cedric, who was driving at the grand old age of 95 and backed into a lamp post / hit the neighbour’s motorhome / killed the cat / ran over the local lollipop lady, etc. etc.

Naturally, I was neither reassured nor amused by these responses. Anyone with an ounce of sense will understand that just because there are undoubtedly a huge number of people on the roads who shouldn’t be driving, this doesn’t make it okay. Similarly, we should all have sufficient sense of personal responsibility to get checked out if there’s any doubt as to our fitness to drive. And so I made an appointment with my optometrist for a visual acuity check to make sure I still met the legal requirements. By this point, I was sufficiently worried that I waited until my sister was staying with me for a long weekend so that she could come with me and drive home if the optometrist gave me bad news. I don’t quite know where I’d stand if I drove to an eye appointment and was told that I no longer met eyesight requirements for driving.

The day before the appointment, we played a number of rounds of “Read that numberplate”, with varying results. Fortunately, we didn’t bother to keep score. At one point, looking at a car out of an upstairs window in my house, my sister was adamant that the car was white and became increasingly concerned when I said it looked blue to me. Happily, it turned out that we were each looking at a different car. Even more happily for me, the blue car was at a considerable distance away from the white car – hence why neither of us could actually read the numberplate of the blue car! “I think we should stop this now and just wait until my appointment tomorrow”, I told her. She nodded sagely in agreement.

The next day, my sister insisted on driving to the optometrist’s. I tried not to view this superstitiously as a Bad Sign, and instead sat back and made the most of not having to concentrate on the road. As a consequence, my navigational instructions were somewhat lacking. I felt a bit guilty that my sister had come down for a nice break by the sea and instead of relaxing, was chauffeuring me to the optometrist’s and then having to wait outside with the dog. “I shouldn’t be long”, I told her, after instructing her where to go to find a bench to sit and wait in the shade and then disappearing for my appointment.

Instead of the quick five-minute visual acuity check, my optometrist ended up doing a full eye test, which meant that I was actually quite a while. Fortunately, we swiftly discovered that my visual acuity was still 6/7.5, albeit with some effort, meaning that I still meet driving requirements. When he told me the good news, I goggled at him in disbelief. Upon recovering from my amazement, I asked him, “Then why has it felt as if my vision’s been getting worse? D’you think it’s just paranoia?” “Maybe a bit of paranoia”, he answered (he knows me well by now), before going on to explain that it will also be because cataracts mean that it’s more difficult to discern things without sufficient contrast.

Somewhat worryingly, he told me that DVLA don’t take contrast into account – they’re only interested in visual acuity and visual fields. I asked him what he’d advise in terms of driving with this in mind, and he said carry on as I meet the legal requirements, but try not to drive in low light. I told him that I never drive at night any more, and that I usually wear sunglasses when driving in daylight because of the glare, but sometimes it’s difficult now as it’s a bit too dark with sunglasses on but it’s too bright without them. He nodded, telling me “You’re stuck between a rock and a hard place”, before advising me to try and avoid wearing sunglasses in lower light as this will enable more light to get into my eye which will help my vision. In doing a full eye test, he ascertained that a change in prescription wouldn’t help. I asked him if anything could be done to improve the ghosting or lack of contrast, and he shook his head regretfully. Damn those bloody cataracts!

After pumping him with more questions about cataracts, cataract surgery, risks of surgery, driving, etc., the appointment came to an end and he advised me to return in six months for a visual acuity check if I was worried. Fortunately, he always seems more than happy to answer questions and explain things, which I’m always grateful for. Upon paying for the eye test, the receptionist was very apologetic for having to charge me, as I thought I’d just be nipping in for a quick visual acuity test. “Oh, don’t worry about it”, I told her, “I was afraid I might be needing a new lens again, which would be about £250!”. I headed out to find my sister who had been patiently waiting with the not-so-patient dog, and we headed home to celebrate with ice-cream.

Back behind the wheel… for now

After my upsetting Moorfields appointment described in my last blog post, “It’s worse“, in which I received the news that the vision in my good eye had deteriorated due to the extent that I no longer met the eyesight requirements for driving, I lost no time in following up the glimmer of hope offered to me by the ophthalmologist – that updated lenses might help. Sitting on the train back to my mum’s, shivering in a state of shock which even a takeaway cup of steaming, strong tea and a warm almond croissant couldn’t soothe, my sister rang her local optician’s practice in Surrey. She managed to get me an appointment for that Saturday – a mere five days away, although it felt as if I was in for a month’s wait. Fortunately, they rang the following day with a cancellation appointment, which I accepted with alacrity.

Seeing a different optometrist is always something of an experience – for them, rather than for me – as I explain my history. This appointment began with confusion over my prescription glasses: a single vision lens for long sight in my bad eye (for all the good it does) and a varifocal lens for short sight in my good eye. “Is that right?”, I was asked in a puzzled manner. I assured them that it was. Then an OCT scan, where the silicone oil in my right eye apparently looked “pretty”, and difficulties were encountered getting a clear image of my left eye because of the cataract. The optometrist proceeded to ask me if I had a letter from Moorfields explaining my situation. “All my paperwork’s at home in Kent”, I told her, “but I can give you a history.” Her slightly dubious look faded, as I launched into a brief but concise account of my ocular troubles, and she scribbled somewhat frantically to keep up.

We eventually got onto the, “And which is clearer… this… or this…?” part of the eye test. It seemed to take a long time, and she occasionally urged me not to overthink it (clearly she doesn’t know me). I was delighted and astonished in equal measure when she told me: “We can correct your vision to 6/9+3 with new lenses”. As my chin hit my knees, she smilingly observed, “You weren’t expecting that, were you?!” She emphasised that the new lenses probably won’t help for very long, as the posterior sub-capsular cataract is progressing rapidly but, as always, I’ll take any improvement I can possibly get as far as my eyes are concerned. We talked about the cheapest method of obtaining the most improvement possible in terms of what lenses to get (Moorfields had already advised me not to spend too much on new glasses). The verdict was to have a new varifocal left lens fitted in my spare pair of glasses, and use a pair of over-the-top sunglasses or clip-on lenses when needed. It became clear that it would be best for me to order these at my local opticians back in Kent, so the next puzzle to solve was how to get back there and what to do with my car.

Fortunately, this was solved relatively quickly. My sister extended her job title from Eye Secretary Extraordinaire to Personal Chauffeur (Nigel Mansell style), and drove me home. Then it was off for another optician’s visit, to sort out a new lens. As we were waiting to see the optician, my own optometrist sauntered down the stairs, saw me, and said, chirpily: “Hello! How are you?” “Not great”, I answered truthfully, before feeling instantly guilty for not smiling and fibbing, “Fine, thanks; how are you?”, as is generally customary. He proceeded to get on with his task before hot-footing it back upstairs and quite possibly hiding until I was safely out of the door.

My glasses were ready within just a few days, which was far faster than I’d hoped, after being warned that they could take up to two weeks. I think the optician took pity on me. Even so, I spent those few days carrying out repeated visual checks within ridiculously short intervals, paranoid that my cataracts would continue to worsen so quickly that my new lens would be of no help by the time it was ready. I was so worried about this prospect when I went to collect the glasses, that I asked if the optometrist could do a quick test to ensure that I still met DVLA standards for driving, with the new lens.

After a bit of a wait, I was called into the consulting room, where I settled into the chair with a pounding heart. “Hello, I don’t think I’ve seen you before – usually I see your colleague”, I told the optometrist, as I attempted to calm myself. This was made easier as he consulted his notes and declared that he’d seen me in 2018, professing himself to be greatly offended that I didn’t remember him. He then let me off, pointing out that he looked different in a mask. (Optometrists, you see, are aware that the pandemic is not over.)

“Can you read these letters?”, he asked, indicating the screen. I reeled them off with ease. “How about these?”, he continued. Again, I read them without effort. “Good”, he said, “You meet driving standards”. I suppressed a whoop and asked, “Is that line 6/12 then?” “It is”, he confirmed, “You know your stuff!” He then moved onto another set of letters, and again I was able to read them without any problems. “Excellent!”, he declared, “Now you can drive a heavy goods vehicle.” “Really?!”, I spluttered, “Even with no useful vision in my other eye?!” “Oh yes – you only need good vision in one eye”, he confirmed. “Well although I’d quite like a career change, that seems a bit drastic so I think I’ll steer clear of heavy goods vehicles”, I responded. “Yes, fair enough”, he agreed. After quizzing him a little on the various visual effects of cataracts, I thanked him and the receptionist before metaphorically holding my nose and gulping as I paid the bill for my new lens. I then emerged onto the high street, feeling somewhat lighter in spirits.

A slightly scary trip to the optometrist

I went for my yearly optometrist appointment recently. I’d been worrying about it for at least the preceding month; partly because worrying is clearly what I do best, but also because I’d noticed that my distance vision appeared to be worse than it had been. (The distance vision in my left eye, that is, as the right RD eye has no useful vision.) I alternated between manically trying to read different numberplates and other road signs as well as general text at various distances; and reminding myself that I had experienced similar panic before my previous annual eye test at which everything had been fine (or as fine as it could be, for my eyes). I attempted to calm myself further by holding up a hand in front of my eye and peering through my fingers to mimic the pinhole effect, and also tried out reading my car numberplate through my opera glasses. In both cases, the image I saw was much clearer and sharper. Therefore, I reasoned with myself, the issue wasn’t a retinal one, but rather refractive error which could be corrected with new lenses. But still I worried, and worried… until the day of the appointment dawned and I spent the morning feeling positively queasy with nerves.

I managed to make it to the optometrist’s without dissolving into a quivering heap, and the usual friendly chap greeted me with, “Oh hello! How are you?”. “I’m okay”, I fibbed, feeling my nose grow an inch or two as I sat down. He began shuffling things around whilst telling me that his last two patients hadn’t turned up and so he’d gone into lazy mode. “Lazy mode?! …Don’t tell me that just before you’re about to examine my eyes!”, I berated him. He chuckled, somewhat shame-facedly, before demonstrating on his computer screen that he had done some useful work. After voicing my opinion of people who don’t turn up for their eye appointments (he probably wished he hadn’t made that casual comment), we got down to business.

I explained my worries about my distance vision, and he was reassuringly relaxed about it. After laughing about my opera glasses experiment, he agreed that the results of the pinhole experiment sounded as if I needed updated lenses, telling me sternly, “You always worry too much.” “I know”, I replied somewhat miserably, “but the question is: how do I stop?”. As there was no immediate answer forthcoming, I added: “That was a serious question!”. I bet he just loves appointments with me…

After the initial Snellen chart and reading tests, he ascertained that my visual acuity had got worse – but only slightly in the grand scheme of things. It doesn’t feel slight to me, so I can only surmise that I must be noticing it far more because a) I’m hyper-aware of any changes in my vision; and b) having useful vision in only one eye means that any issues can’t be compensated by the other. Pressures were fine in both eyes, which was a relief. Then came the scary slit-lamp examination: “Look up… look down… look right…” yeh, fellow eye buddies, we all know the drill by now, as well as the almost heart-stopping moment of panic when we think something concerning has been spotted. Thankfully, all was well – or as well as it can be for me.

Next came the task of trying different lenses, but I was perplexed that we couldn’t seem to achieve the sharp focus I was hoping for, and which I can see by using the pinhole effect. Eventually, he came to the conclusion that this was due to my cataracts. He explained that I have two different types. I already knew this, as he’d told me at previous appointments, but I hadn’t known what they were. One is a nuclear cataract, which is the common type that people often get as they age. I actually had these diagnosed in both eyes years ago – well before my serious eye problems began. It caused some confusion at the time, as I was apparently very young to have them. The second type is a posterior sub-capsular cataract, located on the back of the lens capsule, as the name implies. That one, he told me, usually occurs due to trauma or laser surgery. So I’m assuming that’s developed as a result of the laser for my last three tears, or maybe even the cryotherapy for the first two tears? The laser was two years ago and the cryotherapy was eight years ago though, so I’m not sure why it’s only now that I’m noticing the effects of the cataract.

He explained that nuclear cataracts tend to be more opaque, allowing light to travel through (presumably until they get much worse); but the posterior sub-capsular ones are far more dense, meaning that the light can’t travel through them. He did also say that, once formed, this type tends to remain fairly static rather than getting worse, so I’m clinging onto that small ray of hope (no optical pun intended). He then illustrated his quick lesson in posterior sub-capsular cataracts by popping that fetching contraption back on my nose, slotting in a few lenses, and asking me to read the screen. I looked across and exclaimed, “Oh, what’s that black bit in the middle?”. “That’s your cataract”, he told me. “Bloody hell!”, I burst out, before I could restrain myself, “That’s my cataract?” “Yes”, he nodded. “But it’s right in the middle!”, I wailed. “Well, it’s not really right in the middle, it’s a bit below”, he explained. I then realised that I was actually seeing it slightly above, which of course makes sense because of the way our eyes work. His conclusion was that this couldn’t be corrected with new lenses, although I might see a very slight improvement if I wanted to shell out for a very slightly updated prescription with an anti-reflective coating on the lenses. Needless to say, I’m going to shell out.

I came away with a mix of emotions. On the one hand, I was relieved that the dreaded Moorfields dash wasn’t required, that my pressures were fine, that things are as stable as they can be, and by his assurances that I’m still well within the eyesight requirements for driving. On the other hand, I continue to feel utterly bereft by the news that my vision can’t be improved by new lenses, as well as somewhat freaked out and depressed about this wretched cataract. And, of course, no sooner was I out of the door than I began to think of more questions I wish I’d asked. For example: how the hell did that contraption enable me to see my own cataract? And: how do they remove a posterior sub-capsular cataract? For the usual type (nuclear, I now know), they make a cut in the cornea, remove the natural lens, and replace it with a plastic one. But if this other catatact is on the back of the lens capsule – how on earth is that dealt with?

Once I’ve fully processed this latest piece of crap in my ongoing eye saga, I shall have to heave myself out of the doldrums and do some research. In the meantime… if anyone knows anything useful about all this, please let me know. Oh, as well as tips on how not to worry, if you don’t mind.