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 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. 

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!