ICL Month 11 / PRK Month 11: Regression and Dry Eye Update

Well, I had my next follow up appointment and am still seeing 20/15 out of my left (ICL) eye. The vision in my right (PRK) eye has regressed from 20/25 to 20/40. I go in for another appointment in four months and if the 20/40 vision has stabilized, I can have a touch up if I want. I'm not sure if I do, I think it would be at full cost. Something to think about.

My dry eye in my right (PRK) eye has improved slightly, maybe. My surgeon said it looks better than at my last appointment, but I can't really tell. I'm not looking forward to allergy season starting in a couple of months, but I will just keep using the rewetting drops and hope for the best!

ICL Month 1 / PRK Month 4: Another Follow-Up Appointment

Last week I had another follow-up appointment. Everything was good. ICL vault was still high but not causing any inflammation and not blocking the iridotomy so the vault probably won't cause increased eye pressure (glaucoma). The white haze or fog I was experiencing in my left (ICL) eye is much, much better and I feel like my ability to see contrast is nearly back to "normal."

I could (barely, after staring for a while) read all of the letters on the 20/20 line with my right (PRK) eye and easily read all of the 20/15 letters with my left (ICL) eye. In practice, my vision out of my right eye definitely does not seem like 20/20. When it's bright/sunny, which is almost every day here, the glare makes everything in the distance blurry and I can't read even large street signs, even with sunglasses on. I don't know if this has really gotten better in the last few months so we'll see if it improves any more. Vision out of my ICL eye is incredible during the day. It's good at night too, but I do see halos around lights still.

Interestingly, my aniseikonia has switched, so now the picture out of my right eye is smaller than the vision out of my left eye! Not only is the right eye image smaller, but it's slightly shorter, like everything is slightly squished vertically. It's been difficult to get used to, and I notice it most when I'm reading. It's like my eyes aren't working together completely, which maybe they never were and I just never paid as much attention to my vision as I have in the past four months.

Allergy season for me has also started so I've started taking antihistamines everyday. This has made my eyes drier but it's not too bad. I'm trying to use less of the preservative free lubricating eye drops but sometimes I still need them. I'm going to try Systane gel drops to see if that relieves the dryness, especially over night.

I'll have another follow up appointment in two months!

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. 

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. 

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! 

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. 

Consultation Follow-Up Failure

So to recap, my right eye is very myopic (-6.50 sphere, +1.50 cylinder) and my left is is very, very myopic (-11.00 sphere, +.25 cylinder). I can see about 3 inches in front of my face, which means I need contacts or glasses to do anything, including reading books and computer work. At my last appointment my surgeon told me I am a candidate for PRK in my right eye and probably Visian ICL in my left eye.

Today I had my follow-up appointment to double-check my prescription and eye measurements for my right eye PRK surgery in December, and to have the chamber between my cornea and natural lens measured to make sure I'm a candidate for left eye Visian ICL which will be scheduled after the PRK surgery.

I went to work this morning before my appointment and wore my contact lenses. I took them out right before my appointment. When the assistant came into the room to check my prescription, I asked if wearing my contacts right before this appointment was okay since they make my eyes red and uncomfortable. To my surprise he said yes, I would have to reschedule my appointment! The surgeon then came in and said that soft contacts can sometimes change the shape of the cornea, and that someone (not sure who) should have told me not to wear my contacts for one week before this appointment and my original consultation in September! I swear, nobody ever told me that and now I feel silly for not knowing or asking before my first appointment.

The surgeon did say that I could still have my chamber measured for the ICL. I was taken to another room that had a reclining chair kind of like a dentist's chair. Another doctor explained that he was going to do an ultrasound to get very specific measurements of the inside of my eyeball. Apparently getting the correct size of the Visian ICL is incredibly important for accurate correction, avoiding endothelial cell loss, and avoiding cataracts caused by the ICL touching the natural lens, and the ultrasound is the most accurate way to determine your ICL size. I laid back in the chair and he numbed my eye and placed a silicone tube thing under my eyelids, which held my eye open and created a cup that he then poured cold liquid into. He asked me to look straight ahead and rubbed the ultrasound probe thingy all over the front of my eyeball. It was truly one of the strangest experiences I have ever had.

I rescheduled my follow-up appointment for two weeks from today, and won't wear my contact lenses at all between now and then.

Consultation Appointment: Approved for PRK and (probably) ICL

Today I had my consultation appointment for refractive surgery at my local university hospital, where I learned what my options are for correcting my terrible vision.

First the assistant tested my vision and asked if I needed a new glasses prescription at the appointment today. Since's it's been a year since my last exam, I said yes. The assistant said my prescription hadn't changed in the last year (he compared it to my old prescription I brought in)--yay! My current prescription is:

Right: -6.50 (sphere), +1.5 (cylinder)
Left: -11.00 (sphere), +.25 (cylinder)

My eyes have always had very different prescriptions, with the left being way worse, even though the cataract is in my right eye. I think that it's uncommon to have such different vision in both eyes, but I'm not sure.

At this appointment they did a bunch of tests in different rooms, where different people took measurements of my cornea and other parts of my eyes, dilated my eyes, rechecked my prescription after dilation, and then I met with the ophthalmologist who will be doing my surgeries. Our visit was short and sweet. She said I am a candidate for PRK (photorefractive keratectomy - like LASIK with without the flap) in my right eye and  probably Visian ICL (implantable collamer lens or sometimes called implantable contact lens) in my left eye. She said "probably" because they would need to do one more test to make sure the chamber between my cornea and natural lens was big enough for the Visian ICL to fit. I asked about clear lens exchange for my right eye, since that's what another ophthalmologist had recommended at my last consultation 7-8 years ago, but she said she would not perform that procedure on a 30 year old since I would lose my ability to "accommodate" and no longer be able to see close up. Everyone needs reading glasses by age 40-50, so I still have 10-20 years left to read without glasses and I would not want to lose that!

The ophthalmologist then told me that since the surgeries take place at different locations (Visian ICL at the hospital and PRK at the laser center), she would perform PRK first and then ICL a couple of months later. She then sent me to talk to the refractive counselor who could answer any other questions I had and discuss payment and scheduling.

The counselor was very knowledgeable and nice, and let me know that she had also had PRK at this center! Honestly, before this appointment I had researched lasik, CLE, and ICL but hadn't read much about PRK. I asked her a bunch of questions about possible complications, the healing process, etc. The counselor reassured me that the procedure was very conservative with a lower complication rate than lasik, and could be repeated if revisions were necessary. She also put my mind at ease when she said that this center (which is actually part of the local university hospital) and my surgeon are very conservative and only approve about half of the people who have consultations. I like that they seem driven by the latest research and helping people see, rather than making a lot of money by doing hundreds of procedures a day.

We scheduled a follow-up appointment for early November where they will double-check every measurement to make sure the laser is perfectly calibrated for PRK in my right eye, and measure the space in my left eye to make sure there is enough space for the ICL. We scheduled PRK for mid-December when I'll have a couple of weeks off work to heal, and will schedule the ICL surgery after I have PRK.

When I got home I spent some time reading about my ophthalmologist. She's an MD with over 10 years of experience, who specializes in corneal, cataract, and refractive surgeries. She completed a fellowship after her medical degree in these specializations, and has great reviews online. I have thought about having another consultation at another center to compare options and prices, but feel confident with this surgeon and center.

Refractive Surgery Consultation Scheduled!

My Polar Cataract
(see the white dot in the middle?)

I've scheduled a consultation for refractive (corrective) eye surgery, which is tomorrow! I've been searching and reading blogs about the process, and figured I would write about my own experience too.

Here's some background about my eye situation. I was born with a polar anterior cataract in my right eye. It's very small (but still visible if you look hard enough), completely opaque, and right in the center of my eye. The cataract hasn't ever changed shape or size. I had an eyepatch over my left eye when I was 3 or 4 since the eye doctor was worried that I might develop a lazy eye since not as much light can get into the cataract eye, making it much weaker.

Then, in sixth grade around age 12, my eyesight started to deteriorate in both eyes and I became myopic. I started wearing soft contacts around 13, which I wore everyday. I got my first pair of glasses at 16 or 17, to wear when I was too lazy to put in my contacts.

My Glasses

My vision continued to get worse throughout my 20s, and I'd have to get a new exam and prescription
every year. I had a consultation for refractive surgery when I was 22 or 23, before I went to grad school. I knew my vision was not stable but I wanted to see what my options were, since I was already completely blind without contacts or glasses. The ophthalmologist then told me that I could have clear lens exchange (cataract surgery) in my right eye, and an implantable contact lens (Visian ICL) in my left eye since the vision in my left eye was too poor for LASIK.

My vision continued to get worse every year until I was about 28. Now I'm 30, done with grad school, live in a city with fantastic health care, have a real job with a good salary and an FSA, and so I've scheduled a consultation to see what my options are! I'll update as I go through this process.