Vision in surgery

Within the last few months, I suddenly have become middle aged, or at least my eyes have. I’ve been using readers (“cheaters”) the past few years occasionally for reading, and had found them necessary during feline physical exams in order to age the little kittens by their tiny incisors, but it was only this spring that I found that I needed my glasses in surgery as well. Perhaps I could have held out longer if I used swaged-on suture, but threading the needle with my cassette suture was getting challenging.

So I put on my glasses for surgery and could immediately see nothing though the fog. That was an easy fix though– fog-free mask, fitted to the bridge of my nose. These masks have a foam strip along the bridge of the nose that has the added bonus of absorbing sweat on those 80+ degree surgery days.

But then came the next problem. When I put on my plastic $5 reading glasses and started surgery, I found that, in order to look through the lenses, I had to bend my neck downwards at a greater angle than usual. If I tried to look down with just my eyes, I ended up looking at the bottom of the plastic frame and the small space below it rather than through the lens.

The extra angulation really seemed to be uncomfortable for my neck and shoulders, so I tried sliding the glasses further down my nose, “geezer style.” That improved the angle of my neck, but it was a little uncomfortable across my ears and definitely insecure. The glasses would slide on the slick surface of the mask, and there was even one time when they slid off in the middle of surgery. Fortunately I was able to catch them in my hand before they landed in the middle of a cat.

So I did what all good modern humans do: I appealed to the internet for help. Or, specifically, to some spay-neuter and shelter veterinarian groups that I’m a part of. Suggestions ran the gamut from progressive lenses to loupes to better patient positioning.

Loupes

The idea of wearing loupes in surgery has intrigued me. Ergonomists often suggest them as a way to decrease neck angle, and it seemed that, if I was requiring corrective lenses anyway, I might as well use something that would further help with my neck angulation.

But the thing about loupes is that even if you find ones that you can adjust to a very steep declination angle, it’s still your eyes (or, your extraocular muscles) that are making the adjustment. There is no fancy prism or deflection in the lenses of the loupes– they just force you to turn your eyes downward in order to view through the magnifying lenses. So in that way, it seems that there is nothing that loupes can do regarding angulation that can’t be achieved with your eyeballs and a regular pair of glasses. It’s just a matter of getting those glasses low enough.

Of course, if you need the extra magnification, loupes can be great. Dr. Sandy let me try on a few pairs of hers and I found the magnification to be way more than what I wanted for spays, and the field of view to be much narrower than I would like. She also told me that there would be about a month’s learning curve in using them. So, I decided to avoid loupes for now.

Progressive Lenses

It turns out that it’s possible to get progressive lenses that have no correction on top, but that have a near-distance correction on the bottom. Since I don’t need glasses for distance vision, I hadn’t considered progressives.  But this would be a way to have lenses that allow close vision for surgery, and that have the clear glass on top so I could see the monitors or look at the other people in the room.

Generally progressive lenses would require a prescription, but a local eyeglass store suggested it may be possible to find them online without a prescription (since they are essentially drugstore readers with glass above).

Half Glasses

But it seemed to me that progressive lenses with no correction on top would  just be a way to avoid always looking over one’s glasses at people. So why not find some half glasses designed to fit as low on the bridge of my nose as possible?  That way when I look down I’m still looking through lens, and when I look up I’m looking over the glasses.

I like the light weight and thin metal construction of these glasses. The ear pieces are fine enough that they don’t get all mixed up with my surgery cap and mask ties and irritate the tops of my ears. And the bridge of the glasses sits right down on my nose so that they are as low as possible. Basically, they are like the bottom half of a progressive lens. This sort of glasses is available online, or, as luck would have it, at the South Station Terminal in Boston, where I found mine.

So for now I’ve solved my vision-in-surgery problem. Maybe once I reach the age where my vision stops changing, I’ll spring for a pair of progressives, but for now I’ll be looking over my glasses at you.