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 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.

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 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. 

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!

PRK Day 6: Bandage Contact Lens Removal

It's been six days since my PRK surgery and today I had my first follow-up appointment at the laser eye center.

A fellow (I think? I didn't catch his name or title) came in and examined my eye, tested my vision, and removed the contact lens bandage. He used some scary looking tweezer instrument to grab the edge of the contact and then kind of slid it off my eye. Ouch! That hurt and it felt like there was something in my eye for the rest of the day.

My surgeon then came in and said everything looked great and I was seeing 20/30! It seems like my vision is way worse than that, but I'm having some pretty significant sensitivity and starbursts around lights which makes it hard to see especially when I'm outside.

I'm to stop the antibiotic in Friday and decrease the steroid drops to two times per day until I run out, at which point I need to continue a lower-level steroid for two more months. My next follow-up appointment is in about a month, at which point we'll hopefully schedule the Visian ICL surgery for my left eye!

PRK Days 1-4: Surgery, Healing, Sleeping, and So Many Eye Drops

I have been trying to stay away from screens for the last few days to let my eye heal, so this post will include information about my surgery day and the 3 days following.

Day 1: PRK Surgery Day

In the past few weeks, I filled my eye drop prescriptions (which were sent directly to the laser center) and talked to the nurse at the laser eye center who walked me through the entire procedure. On surgery day, I woke up around 5:30 AM, showered, and had my partner drive me 30 minutes to the surgery center. He dropped me off and I walked into the center for my 6:30 appointment. I paid for the surgery ($1700) with my credit card for the cash back, and will submit my receipt later to my FSA for reimbursement--yay for pre-tax health expenses!

I was the only one in the lobby at 6:30 AM, and was quickly taken back to a room where a nurse took my blood pressure. Then I was asked if I was ready, I said yes. I was given a hairnet and booties to cover my shoes and taken to an other room where I was given several rounds of numbing drops a few minutes apart each. After I was completely numbed, the nurse spread iodine on my right eye and patched my left eye. I only had surgery on my right eye today, since my left eye will get a Visian ICL implant in a few months.

My surgeon greeted me in scrubs and I was then led into the laser surgery room. I was laid down with a pillow under the laser machine. My head was positioned directly under it and my numbed eye was held open by some contraption. The surgeon then told me to look directly into the green light, which was centered between a circle of white lights. It's hard to remember exactly what happened next, since my eye was covered with liquid at times and my surgeon didn't explain what was going on, just kept telling me to keep looking at the green light. At one point I smelled burning hair and within a few minutes, it was over!

She applied the bandage contact lens and I was led to another room, left eye un-patched, removed my hairnet and booties, and the surgeon examined my eye. I could see! My vision wasn't perfect, and everything seemed very bright, but already I could tell my vision was going to be so, so much better than it had been for most of my life.

Eye Drops

I was taken to another room to rest before my afternoon follow up appointment. I drank some water, ate some snacks, and the nurse explained my aftercare regime for the first week:

• antibiotic drops four times per day
• steroid drops four times per day
• NSAID two times per day (for just 3 days) 
• preservative-free lubricant eye drops every hour when awake
• Ibuprofen four times per day 
• vitamin C once a day 

After taking my first round of eye drops, I fell asleep. When my surgeon returned for my afternoon follow-up, she said everything looked great. She warned me that my vision would almost certainly get worse before it got better, and healing time was very variable, so I could be seeing very well in two weeks or two months. The rest of day 1 was uneventful, I ate dinner then went to sleep early with an eye shield taped over my eye.

Day 2: Ouch! 

I woke up and tried really hard to avoid screens. I started listening to Serial podcast so I could close my eyes and avoid any strain. My vision was still pretty good, but as the day went on, my eye started to burn and feel like it had sand in it. My eye was watering a lot by the evening, and I was regretting not filling the prescription painkiller the doctor prescribed! I kept taking ibuprofen and and lubricant eye drops. I would get some relief, then nap, then wake up with painful watery eyes. I went to sleep early again.

Swollen Eyelid

Day 3: Feeling Great

Today I woke up feeling much better, I had no pain but my eyelids were super swollen! They weren't swollen shut, just really puffy. This was a Sunday and the laser center was closed so I decided to call the hospital to speak to the ophthalmologist on call. I got through right away and explained that my eyelids were puffy, but my eye had no pain, no redness, and my vision was the same as yesterday. She said it could be a reaction to the procedure or the a preservative in one of the prescription eye drops, and unless my vision was worse or I had pain it wasn't urgent. I stayed home for the rest of the day listening to podcasts, napped a lot, and went to bed early again. I think I've slept an average of 15-18 hours a day for these past three days!

Day 4: Still Feeling Great

Today I woke up and the puffy eyelid had completely cleared up--yay! You know when you lay down or fall asleep after you've been crying and your eyelids puff up? I think that's what happened to me two nights ago. My eyes were watering non-stop from the pain, and then I went to sleep and they kept watering. I haven't had puffy eyes since so I don't think it has to do with eye drop preservatives.

I have my next follow-up appointment in a couple of days, where the surgeon will remove my contact lens bandage.