In the very early stages of establishing my private practice, around 1975, patients started to ask about IOLs. A few innovators and early adaptors were doing the procedure in Kansas City, Mo., where I established my clinic. I signed up for several training courses and learned about ways to size anterior chamber IOLs, avoid pupillary block, obtain the necessary Institutional Review Board approval, how to have patients sign five pages of “I’m being experimented on” consents and, especially, how to pick IOL power to avoid the dreaded “3-diopter surprise.”

Lastly, we were told to “pick easy patients” for the first several cases — meaning ones who had an easy disposition, no other eye pathology and were not extremely farsighted, nearsighted or astigmatic.

SELECTING JIM

After considering a number of individuals in my practice, I chose “Jim” as my first IOL patient. Jim was a 73-year-old retired carpenter and an expert woodsman. He was very depressed about his progressive nuclear cataracts that had kept him from using lathes, saws and carving knives safely for several years.

Given his goal of seeing well and returning to his shop, I believed he would not be happy with aphakic glasses, nor would he be able to manage contact lenses. Jim was a kind and optimistic man, with a faith in me that, in retrospect, may have exceeded my own.

The surgery went extremely well; he ended up with little astigmatism, which was pure luck as his against-the-rule astigmatism was neutralized by the massive, six-stitch superior limbus incision. He was 20/20 or J1 at near without glasses and could once again see clearly. He pressed me to do his second eye as soon as possible. That also went well. He was ecstatic with his corrected and uncorrected vision and raved about what a glorious change it had made in his life. In a personal epiphany, I began to do IOLs on all patients following Jim’s success.

AN UNEXPECTED GIFT

About three months later, my staff said Jim was in the office and wanted to give me something. He gifted me two beautiful canes that he had made completely by hand using saws, lathes and glue. He then hand-carved, polished and painted them. Canes were a specialty of his and something he regularly made for his friends.

Jim had tears of gratitude in his eyes as he gave these gifts to me; I did as well, as I understood what a profound gift and joy it is to restore sight.

I have seen hundreds of thousands of patients in the 47 years I’ve been an ophthalmologist. Out of all of them, Jim’s level of gratitude makes him the most memorable. The two decorative canes he carved have been proudly displayed in our living room for almost all my career. The way my hips feel some mornings, I’m tempted to take them with me to work. OM