Post Op Progress

[NeLso]

Just had my cataract surgery today.  I will detail my experience (may not be typical) with continued posting to this thread.

The lens I selected was the Tecnis Asphyerical set for near (target -2.0)

Time:  -1 hour:
Signed in, paid the customary insurance fees, and was eventually led to a nice big first class seat.  No movies or peanuts, but they did give me a "huge" swig of water and a valium pill.  IV was started after all the customary questions: name, date, type of surgery, which eye,etc. Then a nurse wheeled me into another room.  I got attacked by a 3 more nurses, one of whom might have been my doctor but.... I got complete memory loss from that point on.

Time 0:  
Surgery.  Don't know what happened.  Don't even know if I was awake!

Time: +1/2 hr:
Surgery complete.
Nurse apparently explained something to me about eye drops, etc with my wife present.
She remembers the details.  I don't remember a thing!  Operated eye was not patched and still fully dilated.
Vision was very hazy.  Not able to focus sharply at any distance.  But going from totally blind to being able, even with the low acquity was amazing.  But I was too drugged up to appreciate it.  I was more hungry than excited.

Time:  +1 hr:
When out for some grub.  Noticed that all light sources (red tail lights, reflections off of shiny objects) had a distinct circle around it.  It wasn't a halo, but a dense dotted line circle with a radius of about 1/10th my visual field.  Very interesting.  Hmmm.... I wonder where that came from?  Colors are every so slightly off.  Cement, which normally looks white/grey, has a purple hue to it.  


Time:  +2 hr:
Got home with a full stomach and the first thing I did was look into my eye with "the contraption" that I made that allows me to see inside my eye.  First thing I saw was a circular ring on the outter edge.  I'm not sure what that is... perhaps the edge of the Tecnis lens?  But it's not a thin ring... actually looks quite thick.  There's a lot of "stained glass window" type panels all across the rest of the field. 3 very slight, almost transparent parallel "scratches" appear across the entire lens.  Not sure what that is either.  I also see a very thin, almost hair like curve "thingy" just inside the ring on one edge.  The outter edge is almost perfectly circular, but with a slight steepening at one end.  (capsulorrhexis? If so, wow!  Almost a perfect circle!)   All this is fascinating!

Time +6 hrs
Vision is still blurred at all distances, but experimenting with different spectacles, seems to indicate that the lens was indeed set for about 2.0.  So I imagine the blurriness is not due to an incorrect IOL calculaton.   I don't see the dense dotted line circles coming off brightly lit objects anymore.  Eye dilation is subsiding somewhat.  The thick ring that I saw inside my eye is now partially obscured by the edge of the iris.... can't tell that there was a ring anymore.  (what was that ring?!)

More to follow...

[Ray T Oyakawa, MD]

Sounds normal.

Dr. O.

[NeLso]

Some more observations:

Since my operated eye was "ripe", I think my brain totally shut it off.  Post surgery, my living/dining room is noticibly brighter.  Both eyes are now taking in light and although my operated eye is still blurry, I can see much better using both eyes together.  (even when one eye is blurry!)  Colors are more vivid.  I can't explain it, but it is truely amazing.  (somebody with a crystalens implant posted similar results)

30min post surgery msg to a friend:  "Sugery dine. Feel froggy, ught eye sees more. Blied rhan lef but qwite brury dizzy bu to wasted.

What a killer!  Make sure don't have anything planned post surgery and definitely don't drive, don't walk home, don't do anything without a companion!  

[LynneAV]

For my cataract surgery,I was sedated only for the brief time it took to do the "eye block," mercifully. Otherwise I was wide awake before, during, and after and suffered no sleepiness or other after effects. There seems to be a lot of variation in procedures. My sister in law was not given any sedation whatsoever, and she reported that the anesthesia injections were a bit unpleasant. I have other friends who reported "twilight" sleep and don't remember much if anything. I remember wondering if the surgeon would ever get the IOL centered correctly, and thinking maybe I should say something, ha. It was a big "whew" when she got it centered and then we were finished.  

[JodieJ]

I had no sedation (my request) and no injections--just the eye drops.  The colored light show was quite spectacular.  I could feel pressure but no pain.  My vision in my affected eye was somewhat blurry, but I could see fine with my other eye.  I could have gone to work after leaving the surgery center--but why would I want to do that?  So I caught a matinee at the local multiplex.    

[farmerjon101]

read your post..very informative.. What lenes did you have? and keep me posted on progress. I know that I am stalling for time because of the unknown, so I find your post interesing. Thanks

[NeLso]

Dr. O.
Thank you for your reassuring words!

farmerjon101
My lens is a Tencis ZA9003 set to a "near" target (-2.0).
Don't wait to get your A-scan.  If your cataract gets too dense, your odds of an incorrect lens power goes up.

JodieJ
You are one brave cookie!  I was deathly scared of the IV, but not the surgery.  (because I knew I would be high as a kite!)

-------------------------
More observations:
Time:  +36 hr:

I made an interesting observation today.
My operated eye is still a bit blurry but the colors are vivid.  It is not vivid because of the removal of the cataract though.  It is more vivid because my natural eye still has the yellow tinted filter muddying up the colors.

The amazing thing is that the brain is combining the slightly blurry but vivid colors with the sharp focus coming from my natural eye.  The result is stunning clarity!  (a patient with Crystalens implants mentioned the same results several months back)  Separately, each individual eye is just so-so.  One is blurry, the other muddy.  (note:  the "muddy" color is normal... everyone's eye has a natural yellow tint)

Another observation:  Although my eye was set for -2.0, near.  I can see both close and far.  My distance vision was measured 20/25, with near as "very good".  Come on.... what's up with that?!!  I can't explain it.  It's not physically possible unless the lens is moving (accomodating) inside my eye.  I imagine as fibrosis sets in, my focal distance will eventually lock in at a specific distance?  Don't know whats going on... but this is weird.  I do know one thing.  

If my eye is accomodating, the only possible way is through vitreous pressure and maybe iris contraction.  But seriously... to go from 10" to infinity?  That's just not possible!  (but that's what I'm experiencing at the moment, although slightly blurry throughout the entire range)  I expect to lose this fantastic accomodation ability over the next few days.  That would be a real bummer...  

[NeLso]

Post Op
Time:  +24 hrs.

At the post op appointment, they measured my eye pressure and did the standard eye chart exam.  Both near and far.  Apparently, I can see fairly well (after much straining/blinking) at both distances.  

Strange as it may seem, the Dr didn't dilate my eye and look into it.  Perhaps it wasn't necessary?  I wanted to ask about the ring I saw, but didn't get a chance.

Big thing I noticed in the morning was the light dimming, on/off/on/off, but not off completely, just dimming.  In bright light, the yellow/orange of the _natural lens_ is quite evident.  Feels like a haze over the eye... a sensation similar to the onset of another cataract!  The operated eye is definitely filling in for the color clarity, while my natural eye is doing the focusing.... and looks like the brain is putting it together to form a crystal clear picture.

[farmerjon101]

Hi NeLso
Still reading your comments..thanks.
Have an appointment with specialist next friday. I saw the top of the range specialist 6 weeks ago and came out with so many unanswered questions, that's why I went looking for this forum and another opinion. There are just too many people who need further info, makes me wonder if the questions are being asked or the info not given by the specialists as in my case.
I hope the new doctor will tell me when the cataract needs to be removed, because I haven't got a clue when it's the right time. My sight seems to be okay and the optician said the cataracts were mild.
It's good that you are progressing well and seem happy with the result. I have got the name of your lens written down and will find out if it is suitable for my eyes. Thanks again

[NeLso]

Prior to doing research on lens models, call your surgeon and ask where he performs his surgery.  The IOL specialist at that surgery center will know who uses what lenses.  This will help narrow down the lens that you might want to research, otherwise you may spend hours researching different lenses only to find that no doctor in your area specializes in that lens.  You definitely want to choose a lens that your doctor is comfortable with.

Medicare rules allow a reimbursement of only $150~200 for approved lenses.  If the surgeon accepts medicare, other patients can not be charged more for the same lens.  Crystalens, Restore, Rezoom and other "premium" lens are not approved by medicare, therefore it becomes a free-for-all.  The going rate varies widely, anywhere from $1000 to $3000 or more.  Ask about the pricing because your insurance won't cover it.  These are good lenses, but not for everyone.  

My cataract progressed slowly until dilating eyedrops were administered.  The effect was immediate each time.  After I noticed this, I was able to hold out for nearly 2 years without any further dilation.  When I finally decided it was time, the next dilation turned my pupil white.  Not everyone will share my experience, but if your cataract is not bothersome, let it be.... just don't wait too long to get your A-scan.  

A-scan is where they measure the length of your eye.  Once your lens clouds up, measurement gets difficult.  Your eye has about 60 diopters of refractive power.  40 of it comes from your cornea and the remaining 20 comes from your natural lens.  Obviously, it varies from person to person and if your A-scan is not accurate, your IOL may not be of the correct power.  (the doctor will do a B-scan, but I am told this is not as accurate?)

The hardest part is to look in the mirror and ask yourself what is most important for you.  I had the most difficultly here.  You need to ask yourself what setting you really want for your new vision.  I chose near vision with a monofocal lens.  

[JodieJ]

I'd suggest avoiding a surgeon who uses A-scan if you're concerned about getting very close to your targeted vision.  It's older technology, and it's less accurate than an IOL Master.  I've read that an IOL Master sometimes can't be used with a very dense cataract.  This is one reason for not postponing your surgery for too long.

Your best bet for a problem-free outcome is an aspheric monofocal IOL, like the Tecnis, AcrySof IQ, or SofPort.  If your surgeon is very experienced with a particular brand of aspheric lens, s/he can factor this into your IOL power predictions and make them a little more accurate.

I was a high myope who developed a cataract in one eye only due to retinal surgery, but I chose to have cataract surgery on both of my eyes.  My post-surgery vision with my "good" eye was every bit as good as my best-corrected vision before surgery.  My night vision with aspheric IOLs seems to be slightly improved.  

[NeLso]

I mispoke!!  JodieJ is right.  I keep "associating" A-scan with IOL Master.  Make ABSOLUTELY sure that your doctor has the IOL Master.  (you'll see the logo on the side of the machine)  The IOL Master can measure your eye at something like a 5 fold increase in accuracy!!  Thanks JodieJ for correcting my oversight!  After months of near constant research, I now have a tremendous amount of knowledge to share, but so very hesitant to post it here due to concerns that I might steer someone wrong.  


Post Op
Time:  +3 days.

Yesterday was my first experience at night driving.  The clarity is awesome, but every light comes with a free diagonal starburst.  But wait, if you order now, we'll add a little bit of haze as well.  It's "only" one fuzzy line, but it streaks across my entire field of vision, particularly for the brighter lights.  I'm a bit bummed about this.  The angle is +45 degrees of horizonal.  

This morning I looked inside my eye again and of the 3 parallel scratches that I orignally saw, one is crossing right through the middle at a -45 degree angle.  Hmmm... same angle as my starburst!!  It scratch streaks across the entire visible part of the lens.  (much of the IOL is hidden behind my non-dilated iris)  I am now wondering if the diagonal single line "starburst" is from this scratch?  No sense in sulking about it, but posting it here for everyone's future benefit.

Anyways, I'm pondering whether it is a scratch on the IOL or fold marks?  The scratch gets deeper in the middle, then thins out again.  This leads me to believe that it might be marks left from folding?  (since scratches typically get deeper, then abruptly stop)  

Maybe it's not the IOL?  A scratch on the posterior part of the capsular bag?  I guess I'll never know...  

One good thing is that my brain is taking the non streaking image from my other eye and "removing" the starburst I see from my operated eye!  Night time driving is crystal clear, way better than I have ever seen at night!

By the way, my cornea/IOL combo has the very same amount of slight halo-hazing around lights that I see with my natural eye.  Seems like slight haloing is normal.

Finally, I am typing this on my NBPC with no glasses.  Looking across the room (15ft). I can read my wall clock as well, although slightly blurry.  I am having a slight issue with my new mini-mono vision though.  I am sure I will neuro-adapt.

[farmerjon101]

thank you both for your important imput. I have taken it all on board. NeLso..am I allowed to asked what the final costs were. Dont answer if you find it too personal. Although I  probably live on  the other side of the world to you I am curious.
Do you have any pain at all? I have taken on board Dr Hagens recommendations as well and it it the same lens you mention JodieJ..so it looks like a winner. I will check with my doctors clinic to see what lenes he uses. The other specialist gave me a quote of $11.000 for both eyes. that was with crystalen, which I see now are not necessarily the best, Insurance will cover part of it though. Nelso have you had any more starbursts of light? It would be a miracle to be able to drive at night as I haven't been able to for many years, we live on a rural block and it's isolating not being able to see to go anywhere at night, day time is fine though.....so far.
Appreciate your posts as it is important for me to know what I might expect.
Thank you again

[JodieJ]

Given your strong desire to be able to drive at night, you sound to me like a perfect candidate for aspheric monofocal IOLs.  These IOLs are covered in full by Medicare/Blue Cross.

My cataract surgery with AcrySof IQs was paid for in full by my Blue Cross insurance.  (That's right, it was entirely free!  I had already met my limit for out-of-pocket expenses for the year with my retinal surgery.)  I had limbal relaxing incisions for astigmatism, but my surgeon did not charge extra for them.  It all turned out to be a wonderful yet unanticipated gift.

[farmerjon101]

I phone the doctor's rooms and was told they used the Acrysoft IQ lenses. so that's all good. they also use other lenes as well but majority of patients use the IQ. which the medical insurance  will cover. so that's extra  good. Sounds like you had a positive experience. Thank you.

[NeLso]

> NeLso..am I allowed to asked what the final costs were.
Insurance covered most of it so far.  But I don't know what the charge will be for the surgery.  I will let you know the total figure once the numbers are in.  

>  Dont answer if you find it too personal.
Nothing's too personal with me.  Yesterday, I took a shower for the first time post-surgery.  My eye sees so well now, that I was shocked/amazed to see my own xxxx in stunningly clarity!  (uh oh... did I just open myself up for a crewd joke?! )

> Do you have any pain at all?
Never had any pain whatsoever. The ***** from the IV was the only pain I felt.

> ... crystalen, which I see now are not necessarily the best
The best solution is to objectively analyze your OWN priorities.  For example, if you spend all your life inside a 5 foot box, setting your vision to distance would be a disaster.  Everything is about trade-off's.  If you have slight cataracts that doesn't bother you, just leave it be.  Let it get to the point where it bugs the heck out of you.  Just don't let it get "ripe".  Crystalens has it's benefits, but the risks seemed just too excessive for me.  Gambling is not my forte.

> Nelso have you had any more starbursts of light?
Last night I went out to grab a movie and saw no starbursts at all!

[farmerjon101]

thanks again..go to specialist on Friday..to get the verdict..as for seeing xxxx in clarity that might give me a huge fright!! have my mind wide open now and thanks to this fantastic sight have more knowledge than before.

[NeLso]

Post Op
Time:  +5 days.

Really bummed out to find that my newly restored accomodation (see my post at +36hrs) ability is now gone.  (which I kinda expected)  For the first few days, I was able to focus near and far without any training, adjusting, or anything to even suggest that "something was different".  The focusing just happened... as natural as can be.  How was this possible?  I wish I knew!  (but it's largely gone now.... and might get worse)  Strange thing is that I lost it within a span of 12 hours.  In the moring it was fine, gone in the evening.  I'm wondering if I lost my distance vision because I was focusing on tiny objects for a long period of time?

Although the wall clock that I was able to see clearly just 24hrs ago is now blurry, visual accuity with glasses is still excellent.  I do notice some astigmatism.  I don't know if this is due to eye swelling or if it will subside with time.  

The "starburst" type diagonal streak of light (when looking at bright lights at night) is no longer there and looking into my eye, the scratch/fold mark appears more transparent with less of a dark shadow to it.  Night vision continues to be excellent.

Very happy; but what a tease!  I feel like a cowboy who got a chance to test drive a Lexus... and then they took it away and threw me back on a horse!.  I'm left wondering how things might have been with an accomodating IOL.  

The study of cataracts and it's treatment is FASCINATING!  

[NeLso]

Post Op
Time:  +6 days.

Starting from day 4, my far vision started to deteriorate.  I guess this is normal as I have mono-focal lens and see distance clearly was not part of the orginal plan.  I'm still perplexed at how I was able to accommodate so easily and effortlessly.  Near vision/intermediate vision is still sharp.

An annoyance that I forgot to mention is the arcs of light that I see at night.  Any light that hits the lens at a certain angle not only creates an arc, but also a shimmering of light inside the arc.  It is easy to tell that the arc of light corresponds to the edge of the lens and that the shimmering of light inside the arc is the rest of the lens.

Anyone who has been reading the medhelp board knows that the arc of light is normal during the healing process.  I hope it goes away!

Oh.. and one other thing.... night time contrast and therefore vision is actually BETTER than a person with natural eyes.  I can read license plates numbers (with glasses) where others have difficulty..

Finally, the UV bug zapper does not appear blackened out with the Tecnis lens which is in stark contrast to what was reported by a previous poster with a Crystalens HD.  (color is the same as my natural eye) The Cyrstalens-HD must be filtering more of the "blue" content?

[farmerjon101]

Still following your thread.. I might go for the distance or blended vision..wlll find out tomorrow if it's good for me. I had my eyes lasered 10years ago and it was fantastic. didn't have to wear glasses in the rain any more but lost my ability to thread a needle without several goes at it and  needed glasses for close up work. Now the cataracts.
I want what I had 40 years ago!! but it's not going to happen.
Thanks NeLso

[NeLso]

Post Op
Time:  +3 weeks (21 days).

Target vision was set for -2.0D.  (just inside arms distance)  The more time elapses, the more my "depth of field" dimishes.  The incredible effortless accomodation ability (far, very near, everwhere!) that I initially had is now gone.  It looks like I got what I asked for... monofocal at arms length.  

It seems I have astigmatism.  I can see verticle double vision.  This is probably due to pre-existing astigmatism.  The axis was always 170 degrees for as long as I can remember, so the direction of astigmatism seems to make sense.  (ie. not induced by surgery)

Night vision is still incredible.  No halo's, no streaking, nothing out of the ordinary.  

Only one thing that still has not gone away.  The arc and glistening/sparkling of the lens is still there.  It appears suddenly when overhead lights (only at night) hits at a certain angle.

Overall, an excellent lens.

farmerjon101, total cost billed to my insurance was $9750.  Surgery was $5k, with the rest being pre-op measurements, office visits, and physical.  Out of pocket came out to something like $500.  ($250 of it was for deductible)

[farmerjon101]

still interested in your progress, Im going for the chop on the 3rd Nov, Im nearly ready for it. It will be nice to see again. Thank you for your valid information and help. It helped me decide to stop being a whimp and get on with it.
Farmerjon 101