Wednesday, March 15, 2017

ICL Day 7 / PRK Month 3: Follow-Up Appointment

Today I had a follow-up appointment with my surgeon, which is one week since my ICL surgery (left eye) and about 3 months since my PRK surgery (right eye).

My appointment was quick, my surgeon and her fellow looked inside my eyes and tested my vision on the Snellen chart. I could see most of the 20/20 line with my right eye and all of the 20/20 line with my left eye! Together, I could read the 20/15 line. I didn't use many lubricating drops today and my appointment was in the afternoon so maybe my eyes were drier than they were right after my surgery, who knows. They also tested my eye pressure which is normal.

PRK Update (3 months post-surgery)


My PRK eye is doing well. I still see starbursts around lights regardless of whether it's bright or dark in the environment. If I squint, they go away, so I don't know if it is due to residual astigmatism, higher-order aberrations, or what. It's gotten really sunny here in the past month or two and I also have really bad glare with in the bright sunlight, even with sunglasses on. This makes it really hard to read street signs because I'll have double or triple vision in my right eye. 

ICL Update (1 week post-surgery)


My ICL eye also seems to be doing well. The surgeon said that my vault was high and we would keep an eye on it. I don't know if this means I might have to get the lens exchanged, but I'm happy to wait and see how it looks next month. I see very large, prominent halos in dim and dark environments when looking just through my left eye. Interestingly, when I use both eyes, the halos diminish greatly and some completely disappear (and so do the starbursts from my PRK eye!). I'm also still seeing a white haze in my left eye, kind of like a glaze. I'm not sure if it's from the iridectomy or corneal swelling or something else, but it does not seem to be improving. It would be a bummer to permanently lose a lot of the contrast that I originally had in my left eye. In one of my first posts I noted that the contrast in my right eye has always been much worse due to the cataract I was born with; well, for the last week, my right eye has had much better contrast sensitivity than my left eye! 


I am happy I no longer need glasses or contacts to read, write, watch TV, drive, and everything else!! I'm hoping that some of these side effects resolve -or- my brain gets used to them quickly. I have another appointment in a month so I'll update again then. 

Sunday, March 12, 2017

ICL Days 1-3: I CAN SEE!

I had my ICL surgery four days ago. Just like I did for my PRK surgery in December, I'll provide a day-by-day retelling of what's happened.

Day 1: ICL Surgery 


My ICL surgery was scheduled for the afternoon, so I planned to sleep in as late as possible because I wasn't allowed to eat anything after midnight or drink after 7 AM. Well, I woke up at 8:00 AM of course and then watched mindless reality TV for a few hours until it was time to go. I was still feeling really nervous.

I got to the surgery center and was taken back to get my blood pressure reading and my eye dilation started. I had to change into a gown, put on a hair net thing, and got a bunch more drops to dilate and numb my eyes, along with antibiotic drops. They put in an IV for the "light sedation."

Then I was wheeled back to the surgery room and told to look at the bright light. I was conscious but because of the light sedation I was feeling pretty good. I was told to stare at the light, so I did. My surgeon didn't say much to me during the procedure but I did express that I was feeling some pain. I'm not sure if she did the iridectomy before the ICL insertion or after. Then my vision went out for about a minute and the surgeon said that the pressure in my eye was very high and they were trying to bring it back down. They put some more medicine in through my IV and my vision came back. Then it was done!

I was wheeled back into my area and the surgeon explained that everything went well. I could tell immediately that my vision was super clear, at least as clear as I could see with contact lenses! However, there was a fog or haze over my vision, kind of like a white veil. 

They said I could leave and get some lunch and to come back in two hours. I changed back into my clothes and left. I tried to eat lunch but wasn't very hungry. 

When I went back to the office, my surgeon again said everything went well and my eye pressure raised because of the gel they squirt inside the eye to help protect structures in the eye during ICL insertion. I got a prescription for one day of pressure-lowering pills and they said they would check my eye pressure again tomorrow. The surgeon checked my vision and seemed very surprised that I could read the 20/20 line perfectly! 

At the end of the day, my eye was very red and sore and it felt like something was in my eye. It felt most comfortable to keep it close. 

Day 2: Hazy


Last night I wore my eye shield, and today I woke up and my vision was still hazy/foggy. It's weird because everything is really sharp but it's like I'm not seeing as much contrast because everything is whiter and more washed out. My pupil is sill a bit dilated. I can't really tell where the iridectomy is. My eye still feels sore and is a little red, but feels much better than yesterday. 

Today I had a follow up appointment which I could have driven to myself but just to be safe I got a ride since this appointment location is about 30 minutes away. My appointment was quick. My eye pressure was normal, and I could read every letter on the 20/15 line! Amazing! I asked when the haze/fog would go away and was told in about a week. 

I'm noticing that when it's dark, I see some thin halos around lights. When it's dark inside and I watch TV, I also see some larger/fuzzier halos radiating from the bright spots on the TV. 

Day 3-4: Healing


Yesterday and today have been similar to day 2. I am still seeing white haze/fog but my vision is still very sharp. My eye feels better every day and it's no longer red. I think my pupil is back to the same size as my PRK eye. I definitely don't have any white line from the iridectomy/iridotomy, which I was concerned about because I have very round eyes and my lids don't always cover the top of my irises.

I have a follow-up appointment in just a couple of days, which will also serve as the 3-month follow-up for my PRK surgery, so I'm anxious to get an update about how both eyes are healing. 

Thursday, February 23, 2017

ICL in 14 Days: Complications Research

It's now 14 days, or two weeks, until my ICL surgery. I mentioned in a previous post that I have been more nervous about the ICL surgery in my left eye than I was about the PRK surgery in my right eye. I've been spending a lot of time reading blogs, reviews, and research about the ICL procedure and complications. Even though my left eye (-11 diopters) is almost twice as bad as my right eye (-6.5 diopters), my left eye has always been my dominant eye because (a) my left eye doesn't have a cataract which limits the amount of light that can enter my right eye, and (b) my left eye can be corrected to 20/15 while my right eye can only be corrected to 20//25. My left eye (when corrected) sees more contrast and has much better depth perception.

Therefore, having surgery in my left eye is somewhat scary because if something where to happen I would be stuck with worse vision in general.

I thought it might be useful to make a post about some of the potential complications of ICL surgery. Note that this post should not be used as medical advice and you should always do your own research and consult your own surgeon about potential complications.

Iridotomy/Iridectomy Side Effects

Although the Visian ICL V4c model is available in many countries and not require an iridotomy because it has a tiny hole in the middle of the lens, in the United States only the V4 model is available and does require an iridotomy. The purpose of the iridotomy is to allow fluid to move freely from the front to back of your eye. If this fluid cannot flow freely, eye pressure can increase causing glaucoma, which can in turn damage the optic nerve and lead to irreversible vision loss. 

While an iridotomy is a relatively common procedure, it has its own potential complications and side effects. Sometimes people see white lines of light or other light aberrations due to the iridotomy acting like a second pupil that lets light into the inside of the eye. 

Cataracts

Cataracts, or lens opacification, are probably the most common complication from the ICL implantation. According to the FDA study, which only followed patients for three years after implantation, cataracts formed in 14 eyes (2.7%) after three years, with only 2 (less than 1%) requiring surgery to remove the cataracts (the other 12 were not clinically significant). A more recent study found that 40.9% of eyes developed cataracts at year 5 and 54.8% at 10 years. However, only 4.9% required cataract surgery at 5 years and 18.3% at 10 years. This study might also overestimate the incidence of cataracts because they lost some patients (about 5% every year) who did not return to their clinic, and it may be that those who did not return had fewer complications.

Cataracts can be caused by different variables. According to this research study:
There are several theories in the literature to explain the development of anterior subcapsular cataracts that do not incidentally occur in the myopic population; these include perioperative trauma from the Nd:YAG laser during creation of peripheral iridotomies or accidental contact with the anterior capsule during pIOL implantation. Other proposed factors include intermittent microtrauma from accommodation, increased overall size of the natural crystalline lens throughout life, constant trauma from pIOL–anterior capsule contact, and subclinical inflammation from continuous disruption of the blood–aqueous barrier, causing metabolic and nutritional changes within the crystalline lens.
So in other words, cataracts can be caused by the ICL touching the natural lens during the implantation surgery, inadequate vaulting between the natural lens and ICL lens, the laser iridotomy procedure itself, and other factors.

Retinal Detachment

Retinal detachment and tears are scary. The retina is basically a layer in your eyeball that is essential to being able to see. When retinal detachment occurs, it can usually be repaired, but that eye might never have the same best corrected visual acuity again. In other words, if you had 20/20 vision before the detachment with glasses or contacts, glasses or contacts might only be able to correct you to 20/80 after the detachment. 

That said, being a high myope increases the chance of retinal detachment across a person's lifetime, but ICL surgery does not. However, an ICL may cause cataracts, which may require explantation of the ICL and extraction of the clouded natural lens, which is then replaced with an artificial intraocular lens (IOL) that can correct nearsightedness. This procedure can cause retinal detachment. 

So if, say in 10 years, I get cataracts in my left eye that obscure my vision enough to require surgery to remove the clouded natural lens, I will then have a higher chance of retinal detachment indirectly because of the ICL. 


There are other potential complications of the ICL, including infection, endothelial cell loss, pigment dispersion, and halos at night. So while complications are uncommon, they can happen and it's kind of terrifying!

I am now certain I'm going to go through with the surgery in two weeks. I will update again afterwards! 

Monday, February 13, 2017

PRK Day 60 (Two Months): Some Observations about my Changing Vision

Well, it's been 60 days--or about two months--since my PRK surgery in my right eye. My vision is still up and down, and I have good days and bad days. If I squint I can see very well, but I sometimes still having blurry distance vision and double-vision and always have starbursts.

Morning vs. Evening 

This biggest difference in my vision is still morning versus evening. When I wake up, my vision is very crisp and clear. I still have starbursts around lights regardless of how dark or bright the environment is but I don't have any ghosting or double/vision. When I first wake up my vision is as good, if not better, than it was with glasses or contacts pre-surgery.

As the day goes on, especially if I do a lot of computer work or reading (which is all day, 6 days a week for me due to my job), my vision deteriorates pretty rapidly (within the first hour or so of waking up. Even though I use eyedrops every 30-60 minutes when I'm on the computer, I develop ghosting or double/triple vision pretty quickly. I try to take breaks every 10-20 minutes to look out the window, which I think helps a little bit.

If I take a nap, my vision is crystal clear again when I wake up.

Light vs. Dark Environment

I also notice some differences between light and dark environments. When it's really bright outside, or there are a lot of lights on, my vision is much worse. Sunglasses help somewhat, but not completely. I notice that when I'm on the bus with my sunglasses on and looking out through the tinted (maybe polarized?) windows, everything looks super clear. But when I get off the bus and still have my sunglasses on, everything gets fuzzier. I'm going to purchase some sunglasses that are polarized and see if that helps.

In dark environments, like inside with the curtains closed and just one light on or outside on a really overcast day, my vision is much better. I think I actually see better at night than I did before with contacts or glasses, with the exception of starbursts coming from headlights and traffic lights. Halogen headlights are especially bothersome. 

Near Distance Vs. Far Distance

My near vision, within about 20-30 feet, is pretty good all the time. I don't notice it fluctuate very much depending on time of day or brightness. My reading vision out of just my right eye has never been great due to the cataract--I need more lights on to read printed things or more contrast on the computer. Pre-surgery, I could see about six inches in front of my face without contacts or glasses. Now I can see pretty clearly for 20-30 feet all the time.

However, when I've been awake and reading and/or it's really bright out, my vision past 20-30 feet will get blurred due to ghosting or double/triple vision and glare. I won't be able to read street signs or license plates from afar. I also notice that it takes a long time for me to refocus on objects that are far away after I've been looking at things close up for an extended amount of time. If I look at the window right now, for example, the tree in the distance looks somewhat blurry. But if I blink a bunch of times and stare at the tree, it comes into better focus in about five seconds. I'm not sure if this is due to dry eye or what. But then everything just starts over with a new day, with great vision in after I wake up!


A few days ago I started using the steroid drops just two times a day, which is down from 3 times a day. I'll take the drops for about one more month and then I'll be free! My next PRK follow-up appointment will be at three months after my PRK surgery, which will be the same appointment as my ICL one-day follow up.

Sunday, January 29, 2017

PRK Day 45: More Vision Ups and Downs

It's been 45 days--or over six weeks--since my PRK surgery in my right eye, and my vision still fluctuates a lot. I was surprised to hear at my last appointment that my eye was really dry, which is something I have never dealt with. I've been trying to stay hydrated and use lubricating eye drops often, but I'm not sure it's helping. I recently read about a research study that showed that 5% of eyes developed chronic dry eye after PRK, even though none had dry eye before the surgery! I hope that doesn't happen to me, but I also live in a dry climate now and spend a lot of time in front of my computer, so dry eye is a possible side effect.

What starbursts look like to me
I also reported in my last post that my ghosting/double-vision had resolved. Well, that doesn't actually seem to be true anymore. Sometimes I see ghosting and sometimes there's none, which again, is probably related to dry eye. Starbursts are still present during the day and night. My vision is still significantly better than weeks 2-4, which I'm very happy about, but it goes up and day throughout the day and between days. Some days I wake up with great vision and it stays pretty good throughout the day, other days I can't see very well for the entire day. The instructions from my surgeon say to use lubricating eye drops at least four times a day as needed, and the past few days I've been using them once every hour or two (while awake). 

I'm also looking forward to stopping steroid eye drops. I have to take them for three months and I'm about half way through. The first month I used prednisolone (tapered from four times a day for one week, to two times a day for three weeks), the second month I'm using fluorometholone 3 times a day, and the third month I'll use fluorometholone 2 times a day. They sting when I put them in my eye and leave a bad taste in my mouth. I think I had to use the drops for so long (3 months) because my prescription was so high (-6.5 diopters, +1.5 astigmatism). I've read that steroid drops reduce the risk of corneal haze, but they also slow down healing. 

PRK recovery is soooo slow, but I do think it's worth it to avoid additional complications that can come with LASIK. I wasn't a candidate for LASIK anyway, according to my surgeon, so it was PRK or nothing in my right eye. Still no regrets, and I'll keep updating with my progress. 

Monday, January 23, 2017

PRK Day 39: PRK Follow-Up and Visian ICL Measurements

Today I had an appointment that served two purposes: my one-month check-up for the PRK procedure I had in my right eye in December and repeat measurements for the Visian ICL to be implanted into my left eye in March.

PRK Update


My PRK update is pretty uneventful. I had my vision tested using the phoropter and Snellen chart, and I scored 20/30. This means I could see about the same number of letters at my 6 day follow-up appointment as I saw today, but my vision now is definitely crisper and I'm seeing more details. I should note, however, the my best corrected visual acuity (BCVA, so best vision I could get with glasses or contact lenses before PRK) was 20/25, so I'm pretty close! I couldn't get to 20/20 in that eye likely to due the cataract I was born with. I have a small amount of astigmatism left (formerly +1.5 now +0.5) which could potentially improve over the next few months. My eye pressure is great (sometimes the steroid drops can elevate eye pressure which can cause glaucoma). The tech said my eye was somewhat dry and to keep using the preservative-free eyedrops. I was then taken to a machine that mapped the shape of my corneas, and that was it for the PRK follow-up part of my appointment. 

In the last couple of days, the ghosting I was seeing has completely gone away. I'm still seeing some starbursts around bright lights both during the day and at night (like car headlights, TV light, etc.). My surgeon said this should improve over time as my cornea continues to heal. 

I am very happy I went through with PRK in my right eye and hope I see a bit more improvement in the next 3-6 months!

Visian ICL Update


I had a couple of measurements double-checked in my left eye for my upcoming Visian ICL surgery in March. The tech took me to another machine and said it takes "a bunch of measurements of your eye," like height and some other things I can't recall. Then the surgeon came in a took a white-to-white measurement to compare to the ultrasound measurement for sizing the ICL. 

I asked the surgeons some questions about potential complications, specifically from the iridotomy (small hole in the iris to prevent increased eye pressure and glaucoma) and from the ICL itself. She said that she hasn't encountered patients with the side effect of glare or white lines from the iridotomoy, but it's always a risk. I then asked about the risks of cataracts, which is the most common complication of posterior chamber ICL. At this point, it's a risk I'm willing to take. 

I'm nervous but looking forward to being able to see out of both eyes! For the last week, I've been wearing my glasses (with -11.00 in my left lens and non-prescription in my right eye) so they could get accurate measurements today of my eye that will have an ICL. Wearing my glasses has given me some terrible eye strain due to aniseikonia, where my left eye sees the world much smaller than my right eye. Even if I need glasses for driving after I get the ICL, today is the last day I'll ever have to wear my coke-bottle lens! There's no guarantee that the ICL will get me to 20/15, which is my current best corrected visual acuity in my left eye, but I should see a substantial improvement. 

My Visian ICL surgery is scheduled for the second week in March so I will post an update then. I'll probably also update about my PRK eye before then. 

Thursday, January 19, 2017

PRK Day 35 (One Month): Vision Fluctuations

My follow-up appointment with my surgeon isn't for a few more days, but I wanted to post today to give an update on my vision. It's been 35 days, or exactly five weeks, since my PRK surgery.

My vision during days 1-4 after PRK surgery was very clear during the daytime. I wasn't seeing a lot of detail (which was never as good compared to my left eye due to the congenital cataract in my right eye), but my vision was still good--so much better than before! My vision got a lot worse after the contact lens bandage was removed and stayed pretty consistent for the next three weeks! I saw huge starbursts and glare at night around any light source. I wasn't comfortable driving at night for the first three weeks, which wasn't an issue since I take the bus to work. I also couldn't read very well with just my right eye. I'm so happy that I only had PRK in one eye, since my left eye made up for the poor vision completely when I was wearing a contact or my glasses. I do a lot of reading and computer work, and can't imagine I would be able to function at work if I had PRK in both eyes at once.

Speaking of glasses, I went to Costco and bought non-prescription lenses for my glasses, so I could wear them for the next couple of months without having one missing lens and looking completely ridiculous before my left eye Visian ICL surgery. I still look ridiculous with my glasses on since my right lens is prescription-less and my left lens is -11 diopters and makes my left eye look tiny in comparison! I usually wear my contacts but my eyes get red and itchy so it's nice to take them out after work.

Even though I read a lot of blogs and knew that healing time was really variable, I will admit I was worried during the first three to four weeks. I ended up doing a lot of research to ease my mind. I learned about residual astigmatism, corneal haze, central island healing, and high-order aberrations, which can all be caused or intensified by PRK.

View of Trees Outside my Window
In the last week or so (from about day 28, or week 4) my vision has really began to improve, both during the day and at night. I look out my living room window at trees to compare my vision day to day. I'm seeing a lot more detail close up and mid-range, though things very far away are still blurry. During the day, I am still seeing starbursts around small lights (like the Wii or TV light), but they seem to be getting smaller. When I go outside during the day, I have ghosting (double vision) where I see one or two copies of the number on a street speed sign or icon on a walk sign. When I go outside at night, I can now tolerate looking at traffic lights and headlights. There's still some starbursts and glare, but they are much less intense than a few weeks ago. I have never experienced halos.

My vision is also best right when I wake up, and gets worse throughout the day, especially if I have to read or use the computer for extended amounts of time. I'm still using preservative-free lubricating drops every hour or two, so I don't think it's a dryness issue, but who knows. My next follow-up is just a few days away and I'm so curious what I will score on the Snellen chart, consider I wasn't able to read the big 'E' 35 days ago!