Last Tuesday I went into the ophthalmologists office for a YAG Laser Capsulotomy.  That’s the thing where, after cataract surgery, you develop another cataract on the rear surface of the lens capsule.  This happens about 80% of the time; I have no idea why proteins would decide to condense on a surface where they never did before but that’s what happens.  The YAG laser just burns a hole in the capsule so you can see through it.  This was quick and painless although I did have to actually go to the hospital to have it done.
The doctor told me earlier in the year that they had a laser in his office and would do this procedure there but apparently in the intervening months they were told that in order to work with Medicare, they had to do every procedure in a “real” hospital so I had to go there.  I don’t think the total experience was any different.  It literally took 30 seconds.  I could see better by the next day.
My follow-up was yesterday and I was told that although I had a slight astigmatism in my right eye, it was not really worth doing more surgery on.  All necessary procedures are included in the price that I’ve already paid so I can legitimately insist on it but my vision tests out at 20/20 and I’m not sure it’s worth it.  He is totally willing to go ahead with it but I’m going to let it ride for awhile and see what I think in six months when I have another follow-up.
So I guess that’s all over.  For awhile there, my vision was seemingly getting a bit worse but about a month before my last follow-up, I began to see noticeably better and that has remained.  After the YAG laser, I can see noticeably better still. I still don’t think it’s as good as I used to be able to see with glasses. Maybe it’s because I can only focus at two places – the doc says that this should improve with time.  Somehow (perhaps wishful thinking) I had the idea that my brain would figure out how to focus at all distances in about two weeks but the doc says it can take a long time.  As in a year or more.  Still, that makes me hopeful.  Last week while looking at displays in a museum I had to either get right up on a placard to read it or stand 10 feet away or so.  But I’m pretty much back in the saddle, optically speaking.

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I’m going to attempt to describe what it’s like to go through cataract surgery and be as detailed as possible.  Most people seem to just have the surgery and tell others “Yeah, I can see great!”  I’ve talked to some of these folks and when you dig hard, I’ve found that their vision was not so great at first and that it took about two weeks to return to normal.  So I have to conclude that most people try to put it all behind them and talk in vague generalities.
Well, I’m going to try and remember everything.  Plus, I read some personal testimonials at various websites and a large number of those are poorly written or obviously written by somebody who had a bad experience and was angry about it.  Lots of posts were written in all-caps; I always discount those.  Nothing was terribly useful to me so here is my experience.
I got an IOL called the “Tecnis Multifocal”.  There are several different models but I don’t know what the differences are.  I have a wallet card that I’m supposed to carry for some reason but it says that the prescription is about +20 diopters.  The diopter is the reciprocal of the focal length of the lens.  I’ve always wondered why optometrists use the term diopter rather than focal length like the rest of the optics world.  If one is the reciprocal of the other it seems that one would be as useful as the other. I’ve since learned that you can get contact lenses like this.
Right after the surgery, things were simply blurry – simply out of focus like what you see if you look through binoculars that aren’t focused yet.  After a few days, things were still blurry but seemed to be more focused.  At that point I could discern another aberration: around most images I could see six other images slightly offset from the real one.  They are faint but they are there.  These are mostly noticeable at night when looking at lights such as streetlights, traffic lights, oncoming cars, etc.  The aberrations aren’t all that distracting but they’re noticeable and generally contribute to the feeling that the eyes aren’t yet working right.  This effect has subsided with time.  I think this must be the “halo” that the literature describes.  I’m not sure If these ‘extra’ images are due to astigmatism or some other effect.  It will be interesting to see if they eventually go away.  I suspect they will not since one of the things I read somewhere mentioned that these IOLs are not recommended for truck drivers or anybody who drives a lot at night.  Another interesting aberration is that some lights (not sure which type – they almost always are bluish and I see them in parking lots) have many concentric rings around them.  More rings that my lenses have.
Up close is interesting.  There is a point at 12” away from my face (I measured it) where everything comes into sharp focus.  This was pretty blurry at first but was apparently due to the general blurriness I described above.  The image is pretty sharp but does seem to be a bit diffuse at the edges of sharply defined letters and numbers.  Photographs of things with lots of small things like leaves on trees seem to be never quite in sharp focus although I can definitely see what they are.  Printed text is easier to read than things like computer monitors that illuminate themselves.
The region in between 12 inches and about 10 feet is pretty blurry.  The surgeon says that with time, all this area will come into sharper focus and then the healing will be complete.  Or more like the brain training will be complete.
It’s interesting to try and study the images up close.  If I concentrate on a text document on the computer, some blurriness around the edges of things seems to come and go.  I don’t know if this sort of thing always occurs even in healthy eyes and you just don’t notice it or if this is my brain training itself to ignore things that are not known characters or to ignore a secondary image coming from the other focal point.  I think some of this may still be due to the other aberrations that are working themselves out because I can use a magnifying lens and get things into nice sharp focus.
I can at times see the rings in the lens or perhaps it is the shadow of the rings.  I notice that if there is a light source above my head, sometimes there will be a glint off my eyelashes and this point source that is very close to my eye will show me a pattern of rings which exactly matches that of the IOL.  I can reproduce this by sitting near an off=axis light source (such as sunlight through a window) and holding a length of ball-chain up very near to my eye (at about eyelash distance).  The glints from the little balls will each produce an image of rings that exactly match the diagram of the Tecnis that I downloaded from Abbot’s website.  Again, this is pretty rare and is not distracting but it is interesting.
Wednesday: Can read tail number perfectly on the left – can’t really make it out on the right.
Thursday: Tail number on A/C across taxiway is perfectly sharp on the left.  Can barely make it out on the right.
Friday 17 February 2012: Noticeably better as it is every day.  Again, left eye normal at infinity, right eye slightly blurry.  Traffic lights still with multiple ghost images but they seem closer to the real image today.  Merged with the real image so that I can only see half the ghost – unlike earlier in the week where I could see six individual ghost images around the center (real) image of the traffic light.  Today, streetlights have multiple faint halos – maybe three or four. Other lights do not. One porchlight in my neighborhood generates a nice ring pattern but only that one light.  Today, I can read the tail number off the plane across the taxiway perfectly with the left eye – I can easily make it out with the right but it isn’t sharp.  Also ocular migraine this morning – sometimes called a migraine aura or scintillating scotoma.  That brings the total to four altogether.  I can’t seem to correlate them to anything that might cause them.
Monday 5 March 2012: Just got back from two weeks in Greenville.  I had to just go on as normal and stop analyzing my own vision since I had to drive a lot and them work at a variety of distances.  While talking about it at work, I was accused of overthinking things and this may be a valid comment.  I should probably just get on with life and let my brain train itself.  Still, I’m back at it now.
Working in the optics lab, I went and got a pinhole.  It was the smallest I could find in the monochromator’s set (.25 mm).  I held this up to my eye until my eyelashes were touching it and put a flashlight right up to it.  This has the effect of allowing you to see things like floaters in your eye and, in my case, the lens implant itself and its concentric rings.  Pretty cool actually.  Nothing else of interest though.
At this point, I feel my left eye is back to normal at distances.  The right is still not in focus and I don’t think it will get there.  I downloaded an iPhone app that measures visual acuity and it still says I’m 20/20 in the left and 20/25 on the right.
Right before I left on my trip, I had a visit to the opthalmologist’s (the surgeon actually) and this is what he measured my acuity at.  Visual acuity is not everything though.  You can be tested at some value and still not think you can see as well as you used to.  I’m not sure how that translates into something you can test though.  The iPhone app seems to indicate that I have some astigmatism in my right eye.  This can be corrected and apparently is included in my treatment plan.  He also said I have the beginnings of a capsular cataract which is a common occurance after cataract surgery where some gunk condenses on the rear surface of the lens capsule.  This can be treated quickly with a laser and will be done – probably in May when my next appointment is.  He wants me to wait this long for everything to stabilize before deciding what to do next.  I can’t wait.
Finally, looking at computer monitors is still the hardest.  Oddly, when I first sit down, everything is blurry at the standard 18 inch distance but if I just look and try to read, the characters soon become focused.  If I move my head at all, the image goes blurry again and I have to concentrate awhile to make it focus again. I’m not sure why that happens except that the brain is most likely doing something cool.  At the last appointment, the surgeon again told me pointedly to just get on with life and not to give up and buy those “cheater” glasses at Walgreen’s.  I need to give the brain time to deal with its inputs.
Night driving is pretty annoying though.  Every light has either rings, a blur of blobs around it or it looks like a star with radiating lines coming from it.  Plus for lights that are off to the side, there is an annoying internal reflection or something that turns into a large diffuse blob of light.  But I don’t drive at night that much so I can deal with that.

Well, after a quick post-op today (at the 6 day point for the second eye), I’m 20/20 on the left and 20/25 on the right.  Pretty good.

I saw the surgeon briefly and he said I should read as much as possible and force my brain to learn how to see the images it’s getting.  The right eye is still blurry but should improve during the week and then it’s just a matter of practicing; kind of like how you have to flex a new knee joint after a replacement surgery. 

Things are pretty sharp at 12 inches but anything else is blurry.  He said that my zone of focus will enlarge with time.  Pretty crazy how the brain can figure all that out.

My eyesight has never been good for as long as I can remember but it’s always been correctable to perfection.  So I know what the world is supposed to look like – nice and sharp.

I guess that’s why I’m so impatient right now; I’ve made an investment in the sort of lens implants that allow me to focus at infinity and also up close at reading distances.  That’s something I haven’t been able to do without glasses in a very long time and even then not without the effort of carefully aiming the bifocals.  I’ve been very much looking forward to seeing well, particularly after having put up with a cataract on one side for quite awhile lately.

I realize it’s only been a bit over two days since my surgery but I want to see perfectly now.  On the left, I can see at infinity very well although perhaps not perfectly.  On the right, it’s still pretty blurry.  The left side can focus at about 12 inches but anything inside of that or outside of it out to about 15 feet is pretty blurry. 

I guess I just have to wait.  What’s annoying about my situation now is that there isn’t anything that will improve things.  I have no crutch like reading glasses – I just have to wait until the internal swelling or whatever it is settles down.

I’m still struck by how much more blue the world looks.  Everything that is white looks like something out of a Tide commercial.

Well that went just like the first.  I guess that was the idea.  I still have to say: it is indeed quick and painless but the recovery is always glossed over.  I was out of commission the entire day; thankfully, not due to nausea this time.  Living with my eye taped shut is very disorienting to me plus the eye muscles were sore as the anesthetic began to wear off. 

The next morning (Wednesday), my eye was still a bit dilated from the day before and so I was getting two different types of image inputs which again is kind of difficult to deal with.  I chose to stay home. 

When I got to the ophthalmologists office for my post-op, he told me that my intraocular pressure was “a tad high” in both eyes.  This worries me but he gave some eye drops with the instructions to use them twice a day and to come back on Monday (which I was going to do anyway).  I guess it isn’t all that big of a deal (yet) if it can be dealt with eye drops until Monday.

It’s still very difficult to read; the first eye will focus comfortably at about 12 inches but it’s hard for me to read with one in focus and one not so I still get tired of it after a few minutes and reading things on computer monitors and on my phone are especially irksome.  I certainly hope that will improve.  As far as driving goes, that is very good.  I was tested at 20/25 again but it seems better than that to me. 

Oddly enough, I can look through binoculars perfectly.  I can get both eyes to come into perfect focus so there’s hope that things will settle down to “normal”.

I have noticed that the world looks more blue to me.  The cataract is a natural yellow or brown color and this “colors” your perception of normal so today everything looks a lot more blueish than I’m used to.  I downloaded a spectral transmission chart for this lens (nerd stuff again) and it’s very flat over the visible spectrum so what I’m seeing now is obviously “normal”.

So that’s what life is like 8 days after the first one and 2 days after the second.  And I’ve used 4 days of PTO. 

I will never forgive the business world for getting rid of separate vacation and sick days and forcing us to “personal time off” for everything.  I can’t help thinking that I’m wasting vacation when I stay home sick or otherwise unable to work.  It was always a comfort to me to be able to put sick days into the bank and then know that if I was out for a significant length of time, I would be OK and would not have burned up all my vacation.  Bastards.

I had another post-op checkup this morning and my distance vision is 20/25 which is almost back to normal.  I don’t actually think my remaining “good” eye is any better than that without glasses so I’m doing pretty well.

I’m having trouble reading but the doctor says that once both eyes are the same, I will be able to read better.  As to focusing in close, that’s something that I have to work at for awhile (he didn’t say how long) and I should not use any reading glasses.  At least not yet. 

My brain will learn how to focus up close and in between so I just have to do a bit of therapy. That’s nothing official – that’s just my term for trying to read until my brain learns to interpret the new situation.

Next surgery is tomorrow morning – my head is already marked with the doctor’s initials.  I hope this one does not lead to the horrible nausea of last time.

Well, that was interesting.

I had my cataract removed from my left eye and the implant put in.  That all went perfectly according to the surgeon.  Then I got sick from the anesthetic and the day went downhill from there.

I think I may have contributed to this.  You’re not supposed to have anything to eat or drink from midnight on before a surgery.  In fact, I hadn’t really had anything to eat or drink since about 6:00 pm (dinner) so I was pretty hungry and thirsty to begin with.  Plus I had a pile-driving headache from the lack of coffee so there’s that.  I was also told back when they first scheduled this that since I am relatively young and in good health, I would probably be the last one to have the surgery since all the older people with diabetes and other issues are scheduled first so that they won’t have to go as long without their meals.  So it turned out; I was called in at about 10:30. I could tell who the other cataract patients were since we all had the surgeon’s initials scrawled on our heads with a marker.  Apparently this is standard practice to ensure they operate on the correct side.

Except for the headache though, everything went well.  I was a bit nervous but not excessively so.  I was taken into a pre-op area where a series of nurses got me ready.  I knew that anesthetic could make you forget things so I was extra vigilant about trying to remember things.  The nurses names were Arminda, Shondra, and Mai.  I have no idea if the spelling is correct but they seem right when you sound them out.  Arminda tried valiantly to get a needle into my vein for anesthesia but had a terrible time of it.  That was the first indication of my dehydration.  She managed it eventually and apologized profusely.  She warned of an impending bruise because of her efforts but there was none.  I’m not sure why they put you out for this but it was only for five minutes or so while they gave me a shot to numb the eye area (and about half my head besides).  After this I just waited for it to take effect and then it was off to the OR.

When I got into the OR, imagine my surprise to find somebody I knew.  I heard a voice: “Greg! I thought the name looked familiar!  It’s me, Julie!”  I couldn’t really tell since she was masked and had a cap – all I saw were eyes so she helped me out with some more info.  Turns out she’s in our small group at church and our daughters were BFFs in high school.  I was a bit of a comfort to know someone but I’m always a bit uneasy when I meet somebody I know in the context of health care.  I don’t fancy the notion of any of my friends seeing me unconscious or perhaps without my clothes on but in this case, you keep all your clothes on so it was a non – issue.

The surgeon came in and got straight to work.  He’s normally a friendly guy – much like a car salesman – but in surgery, he’s all business and quick besides.  His comments became intelligible mumblings to his nurse assistant but since you’re awake for these procedures I could see (sort of) what was going on.  I don’t know if it was because of the numbing or not but I could see light and dark but no real images.  I could see what looked like the outline of things but only if they were in motion.  Anytime anyone moved, I could see something like an impressionistic pencil drawing of them but as soon as they got still, they faded out.  Interesting how the brain works that way.  I recall the scene in “Jurassic Park” where the scientist said dinosaurs only saw motion.  Anyway…

I could see shadows of the instruments he was using as he wiped them back and forth and it was over in about 10 minutes.  He said that “that was a tough one” but in the end it came out “perfect”.  So that was that – Julie had me sit in a wheelchair and took me out to Melissa who was waiting.  On the way, we stopped at another OR to see her husband Jeff who I also know.  So it’s like old home week in the hospital.

We drove away from there to the nearest restaurant.  I wasn’t terribly hungry and was feeling a bit uneasy but ate anyway.  We went on home where Mel dropped me off and then went to the dentist for her scheduled cleaning.  While she was gone, I started feeling queasy and soon thereafter got totally sick.  I had to run to the bathroom and proceeded to puke my guts out.   At that point some coworkers called to see how I was doing.  Like an idiot, I answered the phone (I had heard them start to leave a message on the machine – yes, we still have an answering machine) and talked to them for a bit.  Then I hung up quickly and returned to the toilet for another session of worship at the porcelain altar.  This is bad news for people who have had eye surgery so I called the doctors number and told them.  They said come straight back.

Mel arrived back about that time so we headed back up to the doctor’s office.  I made the trip OK although I was feeling pretty poorly.  They measured my intraocular pressure and determined it to be OK (after having removed the tape on my eye).  They gave me some anti-nausea cream to rub on my wrists and sent me home with some more of it.  On the way home I got the nausea again and proceeded to puke into a sack I had brought along.  I was soon “out of ammo” but kept dry-heaving.  This was something new: nausea for the sake of nausea itself.  Before I had only thrown up when my body needed to get rid of something but this was something else.  Finally the medication kicked in.  It had the saving grace of making me sleepy so I went home for a nap.  From then on, I could not stand up without getting dizzy and nauseous again.  I used the rest of the medication and just stayed in bed. 

I think part of the problem was that I was still dehydrated (from all the puking) and hadn’t eaten anything in about 24 hours.  At least nothing that I had been able to keep down.  When I got up the next day I was dizzy and nauseous again but I think it was from lack of nutrition and water.  After drinking some juice, water, and simple food like toast, I started feeling better and spent the remainder of the morning just drinking water.  That was the ticket; I never got dizzy or sick again.  I called in to work and cancelled a business trip that I had scheduled since I was told that most people get on with their lives the day after.  I guess I would have if I had hydrated myself correctly although I still may have had that anti-anesthetic reaction.  I hope that good hydration will help me avoid this next week during my second procedure.

I went for my post-op the day after and was told that my eye is doing great.  It looks like I’ve been in a bar fight since my eyelids are swollen and my eyeball is bloodshot but they say it’s fine and my vision is now better than most people show up with the day after lens replacement.  I’m happy about that although I’m still getting used to it.  I popped out the left-hand lens of my glasses so that I can still use the portion of my glasses that I use to read.  While there, I asked the ophthalmologist if he could explain how this multi-focal lens implant works.  He said “No. I have no idea.”  I have to admire his honesty – I guess he just installs them, he doesn’t design them.

So, now I just wait for the swelling to subside and see how thing stabilize while I await the next procedure.