Cataract Operation at Dr. Solomatina Eye Rehabilitation and Vision Correction Centre

It has come about that I have been a witness and companion to three different vision correction operations performed at Dr. Solomatina Eye Rehabilitation and Vision Correction Centre [1]. Several years ago we already wrote about the LASIK vision correction operation [2], last year a glaucoma operation was performed on a close relative, and this year I accompanied another close relative who underwent a cataract operation on both eyes. The last case, I must admit, did not go without its curiosities, which also served as the reason for writing this article. The good news is that all three eye operations were successful and the patients have recovered the ability to see the world in its accustomed colours and quality.

Cataract

A cataract can be described as a dreadful business where, as time passes, the eye's lens gradually becomes less and less transparent to light. One might compare it to a pane of glass that has become dirty and, over time, becomes dirtier and dirtier. As a result, the visible image begins to become blurred and dimmer, until it becomes so unclear that the person can only distinguish between light and dark. Strangely, in the early stages of a cataract one can at least partially restore visual acuity by wearing glasses.

The only effective treatment is replacement of the eye's lens with an artificial one. There is also the less effective method of ultrasound phacoemulsification, which evidently is not widely practised due to possible complications. As the doctor explained, the medicines advertised on TV that will restore vision in a couple of days, as well as various herbal infusions and decoctions, are even less effective - unless miraculous self-healing occurs or you belong to the placebo group. The most troubling aspect is that alongside a cataract there may also be other conditions (glaucoma, retinal damage, etc.), many of which cannot be diagnosed while the eye's lens is opaque. I had the opportunity to look into the eye through a microscope-like device - through a completely clouded lens you truly cannot see anything through it. I must admit that even in the eye partially affected by cataract I could not make out anything in particular. :)

Cataract is encountered in people over 50 and due to the slow progression of the disease, patients often do not pay particular attention to the fact that their vision is deteriorating. Cataract most often develops from heredity (if a grandmother in the family has had a cataract, you can start mildly worrying :)); UV radiation also has an unfavourable effect on it. A cataract also tends not to develop in both eyes simultaneously, which stretches the process out further. However, people close to the patient can notice it. For example, an always tidy housewife starts not noticing dust on the furniture, dirt or crumbs on the table, and so on. These are of course not unambiguous signs of cataract, yet if possible, attention should be paid to these factors.

The Cataract Operation

Cataract operations are performed in several places, including Stradiņš Hospital (it has been heard that also at Daugavpils Hospital, but this has not been verified). One can qualify for a state-funded operation, though it is true that you will have to wait in the queue (a couple of years). The operation can also be performed at Stradiņš for a fee. At Stradiņš one should expect to remain in the ward after the operation, which may even be convenient for people from the regions, as they can then go home and come back for a follow-up after a few weeks. Positive feedback has also been heard about the Lūkina Clinic. In our case, given the previous positive experience with the Solomatina Vision Centre, we did not bother looking for anything else and stayed with this one.
It is worth noting that all three "companions" agreed that it is better to have the operation in autumn, as the sun does not shine as intensively, the days are shorter and there is no temptation to spend more time outside (you can, but must wear sunglasses).

The Course of the Cataract Operation

1.    Book a general eye examination (LVL 25). Must be booked a month (or two) in advance. Not necessarily with Solomatina himself. In our case there was a very pleasant young doctor whose name I forgot, but who walked us through various devices, examined everything thoroughly, was quite talkative and explained everything in fine detail, delicately pointing out the need for the operation, which would cost such and such (just over LVL 400 for one eye). Insurance does not apply (WTF?).

Although the appointment takes place by booking, we still had to wait about an hour. Going to such an examination alone would not be wise, as during the examination and under the effect of the drops the pupil is dilated. If you are the companion, allow for an hour to an hour and a half.

2.    Agree on a date for the operation (at least another month ahead).

During this time, a whole bunch of tests must be done and a whole bunch of medical certificates obtained regarding the state of health (a list of approximately 10 items). The final certificate is given by the family doctor, but among the less expected doctors, a certificate from the dentist is also required. If your teeth are in order, such a certificate can be obtained within a few days at a local or district health clinic. You do not need to bring the certificate yourself to the Solomatina centre - anyone can deliver it.

3.    Two weeks before the operation an advance payment must be made. Payment can be made in cash or by invoice. Cards are not accepted. The receipt can be used for tax declaration. Some tablets and instructions on how to prepare for the operation are provided. Nothing particularly special - on the day of the operation, best not to eat.

4.    The operation takes place in the middle of the day (around 13:00), at the appointed time. Formalities must be completed and a contract signed (which stipulates that in the event of an unfavourable outcome, you agreed to it yourself). Preparation then follows (approximately one hour), during which some drops are administered. Before the operation itself, the patient is taken to another room where they must wait again, and then the operation itself. The operation lasts approximately 15 minutes (only!). After the operation, the patient - with the operated eye covered with a patch - needs to be helped to dress, clothe themselves and gather their things (they cannot do this themselves as they must not bend down). Anaesthesia is local. Tablets, eye drops and a prescription for medicines to be purchased by the patient (approx. LVL 4) are issued. Eye patches must also be purchased by the patient (at least 14, to apply overnight). If you are the companion, allow at least 2 hours.

Here I would like to pause for a moment. Usually the left eye is operated on first and then the right. In our case the right was the critical one and we were hoping for a state-funded operation for the left. It was quite a curiosity to see the patient after the operation with the left (!) eye patched. To the question - how is that, the nurse replied that it had not been possible to operate on the right eye because mucus had developed. It was difficult to truly believe this, and later when posing this question to Solomatina, he remained silent as a partisan or deflected with general phrases. The only rational explanation is that when ordering lenses, there was a mix-up as to which eye and a lens was ordered for the left. Fortunately, the operation and rehabilitation proceeded successfully, though I must admit the stress was considerable, as in the event of failure the patient would have been left blind (and would presumably have been difficult to motivate to undergo the operation on the right eye).

Contrary to what was said before the operation - that afterwards one could immediately resume a full life - that was not quite the case. After the operation (for at least two weeks), the operated eye must be patched overnight and when going outside. Heavy objects must not be lifted. Even after bringing in just slightly more than half a bucket of water from the well, the patient complained the next day that the eye was somewhat more painful. Going to the sauna or bath is not permitted, and hair must be washed with cautious care. Therefore, if a person lives in the country and alone, it should be planned so that someone is available to help with heavier tasks during at least these two weeks.

5.    The next day after the operation (around 10:00) - a check-up. This is the moment when you will see Solomatina himself and will be able to ask the questions that interest you. Solomatina is not very talkative, although when in a good mood he does sometimes volunteer information of his own accord. The next check-up time is agreed upon and you can head home (even if you live further away).

6.    Then follow two tedious weeks. You can watch TV, but still must avoid straining the eyes. Around the house the eye need not be patched, so you can enjoy watching how the eye recovers. :) Depending on individual vision characteristics, it is possible that by the third day one can already read something (i.e., clearly see larger letters).

7.    After two weeks, the next check-up (LVL 10), after which it will most likely no longer be necessary to patch the eye shut, but it is recommended to use sunglasses (in winter too). The next check-up time is agreed upon.

Complete eye rehabilitation occurs after 3 months, although thereafter it is still advisable not to overexert the eyes. Overexerting the eyes means: watching TV in the dark, reading in poor light, weeding the garden bent over, lifting heavy objects and doing so intensively.

A Few Rumours I Overheard in the Waiting Room

These are only rumours, so if they seem important, it would be best to ask the doctor directly.
1.    Aspirin must not be taken before the operation. This may be important if you are a heart patient.
2.    Both the examining doctor and the operating doctor must be informed if you have elevated blood pressure.
3.    There tend to be two types of lenses: ones that allow you to see close-up without glasses, and others for distance vision. Which means you will need glasses either way. If not asked, they will fit the ones that allow you to see well at a distance.
4.    A "gift" is not necessary. If you really want to, this can be done the next day after the operation.
5.    There tend to be discounts (mainly for vision correction, i.e., not cataract), which can be followed on the website.
6.    The operations are not performed by Solomatina himself, but he is always somewhere nearby.

[1] http://www.acucentrs.lv/index.htm
[2] http://www.iinuu.lv/en/dziveszinai/der-zinat/redzes-korekcija-ar-lasik