Six and a Half Years Later

It's been in the back of my head to update this blog for a long time. I remember how frightening the whole experience was and how hard it was to find people with updates any further than a year or so after the surgery. The problem is I didn't really have anything to report, because I honestly haven't been to an eye doctor since a second eye exam about a month after the surgery in 2013. Today I changed that and finally went to see an eye doctor, the biggest reason for that was because my family has a history of glaucoma and I really just wanted to make sure that wasn't creeping up on me. The other reason was that I know I'm not at exactly perfect vision (and I wasn't right after the surgery) and it's been long enough that the idea of occasionally wearing glasses to see better at night doesn't really bother me. Plus I assumed the prescription would be low enough that the lenses wouldn't be an inch thick like they once were. I moved since I got the eye surgery done, So I walked into the new eye doctor today thinking that I had gotten the rarest eye surgery in the world and they wouldn't have a clue what they were looking at. Turns out in the last couple years this surgery has gotten a lot more common for people who can't get lasik, because this doctor was not only familiar with it, but had referred multiple patients to get it done. That kind of surprised me because it feels like doing a google search on the surgery today still only turns up articles as recent as 2015 or so. The end result is that everything appears fine, after looking at my eyes normal and then dilated, I was told that the lenses are looking good and still in place. My eyes are still extremely healthy, and it all looks normal. I mentioned to the doctor that I feel like I get dry eye in my left eye as a result of the surgery, and she said it was actually impossible for ICL to affect that. I admit that my surgeon told me the same thing after the surgery, but I always sort of had my doubts that he was waving my complaint off because he didn't want the liability. It was a lot of money to pay to then come out of it with a affliction they claimed ICL couldn't cause. I believe this doctor, because she has no reason to tell me otherwise, that what's more likely is my eyes are just more sensitive to that now. I'll get into it more in a bit, but it's truly rarely an issue. As of today, I still don't NEED glasses, but I have a mild astigmatism in both eyes, so I can wear them just to make things a bit sharper. The prescription is something like -1 in the left eye and -.75 in the right, which is basically nothing as far as I'm concerned. I'm still going to get the glasses, because there are times when I'm in a meeting, or driving somewhere that I'd prefer to have the best vision possible, but I don't consider it a failure of the surgery. My astigmatism was there right after the surgery and I can still read at 20/20 if I'm using both eyes together. So that's the update from today, but while I'm here I'll share some general thoughts looking back at the whole process. First of all, I absolutely would go back and do it again if given the chance. Going on a trip and not having to worry about bringing your contacts, solution, contact case, and glasses, is a great feeling. I do think they are a little generous on the whole "wake up and be fully healed and able to see" thing. Not only did it take a day or two for me to see completely (some of that being the awful pressure issue that happened.) There was also quite a bit of time where I would wake up in the morning and not be able to see out of the left eye, it would look a little fuzzy like I had slept with my contacts in or something, but it would go away after a few blinks. That said, I haven't woken up with that issue for at least two or three years now. That last issue I would bring up, that I remember really freaking me out for the first couple weeks is the glare lines. As much as they say that laser iridotomy (the holes they punch in the tops of the iris on both eyes) doesn't have any effect, it definitely created a line of glare in certain situations. It's when you're looking at a bright light and blink your eyes for a brief second there's this line that goes bottom to top across your vision. As scary as that sounds I promise your brain correct it super fast and the second you're able to stop thinking about it, you'll never notice it again. Also since this involves holes in the iris I have to imagine it's drastically different depending on your eye color. I have light blue eyes for reference, but based on some (extremely) light research, it sounds like darker eye colors behave different. All in all I would say this isn't something you should be afraid to do if you're considering the surgery. Well over 6 years later my eyes are completely fine and have no real side effects. I hope this helps someone out there make a better informed decision, and I'm sorry it took me so darn long to write an update.

Surgery

Surgery Day

The day of surgery I woke up more than a little nervous, but ready to go. I definitely wasn't quite ready for how long of a day it was really going to be. The first thing they did when I got there was test my pressure, which they noted was higher than it had been the week before. They didn't seem all that concerned about it however, and just gave me a new eye drop, which brought my total up to four. They told me it was nothing to be concerned about because the steroid drops I had been on since the iridotomy tended to have the effect of raising the pressure some.

After that they took me back to a room next to the OR where they took my vitals and put in my IV. Most places that do the ICL need to meet you at a hospital somewhere since they require an actual OR, but one of the nice things about the place I had it done was that they have an OR connected to their normal office. They put multiple sets of dilating drops into my eyes, and a couple numbing drops. From there they took off my glasses and led me into the OR. I remember sitting down onto the table, having a bit of a conversation with the anesthesiologist nurse, and then my memory cuts out. I wasn't completely asleep, but was essentially doing anything someone asked me to do, all though apparently not for very long as I would find out later. Of all the things I was told going into this procedure, I would say the thing that turned out to be the least true was how quickly my vision would be perfect. I should stress that this is not always the case, and I read many accounts of people waking up from surgery and being able to read the clock right away. I was definitely not able to do that.

I can sort of remember being helped into the car, and coming home to just lay down on the couch and pass out. Two hours later my mom woke me up to tell me it was time to go back, and I noticed right when I woke up that things were not really as they should be. I could see a little better than I had without my glasses on, but it wasn't a huge difference, and I had a pounding headache in my temples. I also felt like I had a grain of sand in my right eye every time I blinked. As we were driving back to the doctor's office, but mom explained to me how while under anesthesia I was told to look down, which I did, then I immediately looked back up, which caused the doctor to scratch my left cornea. After surgery they had then put a contact on the eye to act as a band-aid and help the eye to heal faster. That didn't really explain what was bugging my right eye though...

My first post-op check-up revealed two things going wrong with my eyes. First the right eye also had an abrasion on it, but this one was more like a burn across the cornea that was causing it to sag off my eye a little bit. Or at least that's how it's been described to me. Like I mentioned, it really just felt like blinking with a grain of sand in my eye. So to fix that, they just put a second contact into that eye, to also act as a band-aid. This isn't as big of a problem as it sounds, cornea abrasions can heal relatively quickly. The second problem they noticed was that the pressure in both my eyes was way too high and needed to be relieved, which is not quite as comfortable of a fix.

This has been known to happen in ICL procedures, but apparently not often, because we were first told by my doctor that he had had to relieve the pressure five times before, but he later revised it to only three. Before the collamer lens is implanted into the eye, they release a sort of organic gel into the incision, which acts as a buffer between the implant and the rest of the eye. While this protects it very well, and keeps many problems from happening, it can also create a few. Once the surgery is finished, they attempt to flush out as much of that gel as possible, but occasionally too much of it can stay in, and block the eye's natural "drainage" system. The gel will naturally dissolve within 24 hours, but until it does, if the eye is blocked, the only solution is to release some of the water/gel that is building up and causing the pressure. The way they do this is to press on the eye with a needle (from the side) and squirt the fluid out through one of the smaller incisions made in the eye from the surgery. They numbed my eye before doing this, so it wasn't nearly as painful as it sounds when I'm describing it. The relief is also immediate, the pounding headache and fuzzy vision go away, and you feel like a million bucks. I still couldn't see of course, but at this point I figured I'm a little behind on recovery due to the abrasions. As I was leaving, they mentioned that it was possible that my pressure would go back up, and I would need to call them and come in right away if that was the case.

Turns out they were right, I woke up around 3pm, in more pain than I had been the first time. The pressure can't as much be felt in your eyes as it can your temples, or eyebrows. I could tell that the pressure in my left was higher than my right because it was pounding so much more in that eye. I could also see a spot in my vision right in the center looked similar to the spot you see after rubbing your eyes really hard. It seemed like I was seeing a reflection of the back of eye, but I can't say for certain that's what it was. So we went back up the eye doctor and went through the same process as before. They had to put dye in my eyes to better monitor the pressure, next they took out the contacts, and pressed on them to relieve the pressure.

I went back home hopeful that I could make it through the night and be fine the next day, but sadly this wasn't the case. I had to go back a third time, we called the doctor from the emergency number we were given and met him up at his office at around 8pm. Since I was on a schedule of needing the pressure to be relieved about every four hours, it really seemed likely that I would need to do this again around midnight. No one involved really wanted to have to do that, so the last time he relieved the pressure it was actually a little painful because he was trying to get out as much of the pressure as possible so I could make it through the night.

After all of that, I was in fact able to make it through the night, and woke up with my eyes feeling fine. Not exactly fantastic, but they weren't giving me a migraine anymore. I had an appointment scheduled that morning, that was supposed to be my 24 hours check-up, but of course they had just seen me at 8 the night before. The abrasion in my left eye (the small scratch) had healed completely, and I read at about 20/50 in that eye, which they were able to get down to 20/25 by having me read the chart through a small hole in an otherwise covered black screen. I had never seen something like that before, but apparently looking through a much smaller hole enables you to test the vision without any of the light bouncing off the swelling in your eye. The right eye was still healing, so it only read at about 20/70. I was a little irritated that my vision was not nearly as recovered on the second day was everyone had told me it would be. That said, it wasn't exactly terrible considering I had my pressure spike three times the day before, and had abrasions on both eyes. This would be my biggest complaint with the whole process, I just don't feel like anyone was ever honest with me on the recovery time required. When I asked, they told me that after the post-op the next morning I would be completely fine going to work. Walking out of the appointment  I knew they was no way that I could drive, let alone work on a computer for the rest of the day. So I went home and just sat on a couch with my eyes closed for the remainder of the day.

I went back to work two days after the surgery, and oddly enough, my eyes have switched in strength from the vision test I took. I can see perfect out of my right eye, which barely read at 20/70 a day before, but my left eye seems to be on a slower recovery.

Writing this, five days after the surgery, my left eye is still fuzzier than the right, but seems to improve a little each day. I feel like it's just more swollen because the pressure was always higher in that eye, thus it had to be pressed on a little harder to relieve, but it's hard to say for sure.

If the left eye does not completely get to 20/20, I am able to get lasik performed on it at no additional charge, but I'm definitely hopeful that it doesn't come to that. So far I'm certainly not at the point of wishing I hadn't done the surgery, but I definitely wish my eyes were healing faster.

I have another check-up in a few days to mark a week since the surgery, and will write another post then.

YAG laser iridotomy

The first thing they did to me today after bringing me back into the examination room was to place drops into my eyes that constrict my pupils, so they have a larger space in the iris to work with, where they're punching the holes. I've gotten tons of drops in my eyes over the years, but man, those suckers felt like you were getting lemon juice squirted into your eyes.

It takes about 30 minutes for the drops to wear in, so they kept me busy by signing a ton of forms about all the risks I was taking, and some other general medical stuff that you need to sign before having surgery. I noticed as I went on that lights started to became blurry from my pupils constricting. The effect is very hard to describe, because it's the opposite of getting your eyes dilated, where lights are also blurry. It's really just a different kind of blurry where you get the feeling that light is hanging out around a light source when it shouldn't be.

When they was all finished they took back to their laser room, where they perform their lasik operations as well. At first I was a little worried seeing the chair all the way back with a laser above it the size of a small car, but that's what they use to do the lasik. The laser they were using on me was kept in the corner, and was about the size of the regular equipment in an eye exam room.The laser itself is called YAG, which stands for yttrium aluminium garnet. It's called this because it uses a synthetic gemstone to create the specific wavelength of light.  Basically you sit at a table, and put your chin and forehead up against a frame like you would for many of the other measurement machines you go through on a regular eye exam. I was completely calm until they pointed out the grip handles on the table on either side of the table and asked me to hold on to those. It really gave off the impression of a soldier telling you to bite a bullet while they sawed your leg off.

They put some drops in to numb my eyes and then stuck a lens over my right eye to keep it open as they lined up the laser. It hurt about as much as I expected, basically like having someone flick you in the eye. The first time it happens it sort of catches you off guard, but after it's done a few more times you don't really notice. I was under the impression that since they are punching two holes into each iris, there would be two laser zaps and it would be over. That wasn't really how it worked. The first or second "zap" of the laser opens the hole, but the remaining tissue around it will seal back up if it isn't carved away as well. I joked with my doctor that it's almost as if the eye doesn't want you to punch holes into it. Depending on where the initial hole is punched, there may be lot more laser zaps because that particular area has more to take out, or they may be less needed. 

My right eye was done relatively quickly, the highest level of discomfort I experienced was when I forgot to blink with my left eye and things got blurry which makes you woozy. Since both eyes are numb it's easy to forget that you haven't blinked in a while. 

The left eye took a little bit longer because the second spot he choose to make the hole was apparently very near a vein in my eye, which caused lots of pigment and other stuff to float through the hole and get in the way. I'm told it bled a little, but if he presses the lens down a little tighter on my eye it stops quickly. It wasn't anything I could feel though, beyond that occasional sensation of getting flicked in the eye.

Once everything was done they went over the drops that I have for inflammation and gave me a couple reminders about the surgery next week and sent my on my way. I could see right afterwards, but it was like seeing through a really dirty windshield. That feeling went away after about three hours, and I was able to put my contacts back in. I've looked into my eyes with a mirror for a bit, and there's definitely no way of knowing they've got some new holes. 

Since then I have noticed one side effect from the procedure. I can tell the holes are at the bottom of my eyes, and letting in light. If I'm staring at a larger computer screen and reading something at the top of it, there's a faint glare in my vision, sort of like a shimmering around the edges. If I move my eyes further down, that glare goes away. When I blink there's a faint white line that moves from the bottom of my vision and settles at the middle. The best way I could describe it is like having an eyelash across your vision.

I decided to wait to post this to see if the this feeling has gone away and so far it hasn't. It's been 6 days since the iridotomy. My eyes still feel kind of scratchy, but are otherwise completely fine. The white line doesn't bother me as much as it did the day after the procedure, but it's definitely still there, and I think once everything else is done, I'd like to explore any options about getting rid of it.

The ICL surgery is tomorrow morning.

The ICL Decision

I found blogs like this extremely helpful when doing my research on the procedure, so I'd like to share my own perspective as I go through the process. I'm a little behind on starting this, so I apologize that this first post is so long. My hope is that someone may stumble onto it and find it helpful.

Background

I have high myopia, or extreme nearsightedness at -11 and -10.75, so basically I'm blind. The best way I can describe it, is you know that very large big "E" that's usually at the top of the eye chart? I can't even tell there's a letter there if it's the one brought up on the screen. That's 20/400, and there's no real measurement past that, but I've been told that my vision is somewhere around 20/1000. I've been in glasses since I was about 5 or 6, and made the jump to contacts when I was 13 years old. I was probably legally blind by about that time as well. 

Ever since my dad got lasik it was naturally something I was asking about as well. The first time I asked, they told me I couldn't be a candidate until I was 18. When I turned 18, they told me with my eyes I would have to at least be 21. Then of course, when I got close to 21, I was told that I would only have one shot at lasik, and it would be best to wait until I was 25. Eye correction is something that's been on my mind for a long time. It's not that I have dry eyes, or an astigmatism to a level where it makes wearing contacts uncomfortable, I can wear them fine. I can't stand wearing my glasses, but that's mostly because it limits my range of vision, and makes every light glare to where driving at night is very uncomfortable. I've always slept with a digital watch on, because I wouldn't be able to read an alarm clock that was two feet away from me in the middle of the night. I have to place the watch about an inch from my face just to read that.  The real reason I want vision correction is that my day doesn't start when I wake up. It doesn't even start when I put my glasses on because I can't see great through them,so it's really not until I've taken a shower and put my contacts in afterwards that my day actually starts. I've decided that I want my day to start when I open my eyes.

Consultation

I'm a little behind on writing this, so this happened a few weeks back, but it was only about a week after turning 25 that I scheduled a consultation appointment to find out about lasik. My eye doctor had recommended a specific place a couple months before, but with a very specific warning. I was told that with my level of high myopia, they might refuse to do lasik on me, and that I shouldn't argue with them. I could probably find a discount laser eye center that would be willing to do the procedure just to make some cash, but it wasn't ever going to be worth winding up with vision worse than what it was with contacts. It was tough to hear that after all my years of waiting lasik might not be possible.

The day of the consultation I did my best to "steel" myself to the possibility of staying stuck in contacts, which all things considered, really isn't the end of the world. I went through about 30 minutes of different tests, some of which where part of a standard eye exam, and some where things I had never done, like how thick my cornea was. After all of that the doctor came in and told me that if I were his son there is no way he would recommend lasik (well, not a big surprise.) They would have to alter so much from the surface of my eye that it would leave it almost flat, and at night the light would halo so far out that driving would be very uncomfortable. As much as hearing that sucked, he told me there was another option called Visian ICL, or implantable collamer lens, also sometimes called implantable contact lenses. This is basically what it sounds like, they take a contact made from a material called collamer, and insert it into your eye between your iris and your eye's natural lens. The effect is like wearing a contact lens at all times, and almost always produces better vision than lasik. On top of that, the recovery time was only about a day, and I could be back at work the day after. 

Here's where me being a dumb 25 year kid comes in, he went through the various risks, and I listened to them, but all I could really hear in my mind was "you're going to get perfect vision!" What I do remember from that first appointment was that infection is the greatest risk involved, since it's much more of a surgery than lasik and involves something foreign being permanently lodged inside your eye. If that sounds unsettling, that's probably good. The real catch to me, was that it costs about two to three times as much as lasik. I wouldn't say it's unfairly expensive though. The price is high because the lenses themselves aren't cheap, and you need an OR for the procedure, as well as 5 RNs. All of that adds up, which as I would find out, is the main reason people aren't lining up  to get this done instead of lasik. 

The whole thing takes place in three steps. First you have an examination where they determine the prescription for the implants, and make sure that your eyes are healthy enough. Next a week before the actual surgery they perform an iridotomy which is the process of punching holes in your iris with a laser to help your eyes drain better once you get the lens in. Last is the actual procedure where you're under anesthesia, and a little loopy, but you otherwise know what's going on. A couple hours after that I'll come back to have them check the pressure in my eyes to make sure every thing's ok, and I'll be back the following morning to do the same. All said in done, it's only one full day off from work, and a couple other half-days, which I liked. 

Like I said, I went home having already made up my mind that I wanted to do it. The only real decision I had to make, was how many kidneys I had to sell to pay for the procedure. My mom was initially on board with it as well, but became concerned after talking to our eye doctor about ICL. What worried her was that they had never seen anyone who had gotten this done. This procedure has only been done on about 300,000 people, despite being approved by the FDA since 2005, which is more than a little unnerving. Initially I was a little upset that my mom had suddenly become worried about this, but now I'm extremely grateful that she brought it up because it led to a long week of research on my part.  

I found out that the biggest long-term risk of ICL was that it could cause cataracts from the lens rubbing up against your natural lens. I also found out that even with this more obscure procedure there are other options. The FDA also approved a different lens in 2004 called the Verisyse (which I still have no idea how to pronounce) which goes in the anterior chamber, or in front of the iris, and has less of a risk of cataracts because it's further away from the lens. It's also been shown to produce less accurate results, and greater halos at night. The other important factor that kept me from pursuing this option was that it requires a much larger incision. The Visian ICL is rolled up and inserted through a pretty small hole, and the Verisyse can't be made any smaller so the incision must be the size of the lens. I would strongly encourage anyone considering this procedure, or anything like it, to do as much research as possible. I trust my doctor, and I don't think he would ever lie to me, but I do think that he answered my questions in a way that always made it sound like strolling through the park. Sure, you might get mugged, but what are the odds of that happening? There are two things I found extremely useful when researching, the first being blogs, like I mentioned at the start of this post. They really help illustrate the experience from someone's point of view who isn't giving a testimony for the company making the lenses (you can find tons of those.) The second was medical case studies, for this I recommend a site like PubMed, which will list most of the studies that have been done, and what side effects they saw. I'm a numbers guy, so I wasn't ever truly happy with these studies, because at most the sample size was 50 people. That said, I wasn't able to find anything that made me super concerned to do the surgery. They all found the potential risks to be no greater than lasik. There is indeed a risk of cataracts, but I couldn't find a case where someone my age developed it within a few years of getting the ICLs. The worst thing I read about was the ghosting, and halo effect at night people were seeing. The blogs all made it clear though, even with the halos at night, everyone said they would do it again in a heart beat.  

Everyone approaches major decisions differently, I usually make a scale in my mind of pros and cons, and see which one outweighs the other. The reason I tend not to write them down is that some factors "weigh" more than others, and if you make a list, all the potential risks would list out a mile long, and on paper the decision would seem obvious. To me, however, the risks are all out-weighed by one simple pro: I am blind, and I would be able to see.

Initial Examination

Every place does this process differently, but I was told to be out of contacts for a week before the next appointment where they would do all the size measurements on my eyes and determine what strength to make the ICLs themselves. That week in my glasses only served to strengthen my resolve for getting the procedure. My mother wasn't with me for my consultation appointment so for the next one I decided to bring her along and drill the doctor with as many questions as she could come up with. I went through mostly the same set of tests as before, but this time it was a more accurate reading because even your soft contacts alter the shape of your eye slightly, and your prescription can change some when you're in glasses for a week. They also measured how many endothelial cells I have in my eyes, since there's a slight risk to them when inserting the lenses, and I'm fine there. The most interesting thing I learned in my second sit-down with the doctor was that this particular eye doctor took part in the clinical FDA study back in 2005 that gave the Visian ICLs their approval. This means that they've been doing this procedure as long as any other place in America has been doing it. Even with that, they admitted to only doing about 2-3 of them a month. Like I said, they aren't really common. One of the listed benefits of the ICLs over Lasik is that if anything goes wrong, they can remove them, where as lasik is irreversible. So we also asked if they had ever done that, and they said that there was one instance where a lady had signs of cataracts before getting the ICLs, and when it worsened she had to get the ICLs removed when they removed her natural lens to perform cataracts surgery. He also mentioned that the worst thing that ever happened was that they had to take a patient back into the OR after the procedure to "burp" the wound, because the gel they use to protect your eyes can sometimes cause blockage before it dissolves naturally. This doesn't sound all together pleasant, but if he felt that the worst thing that happened was having to go back into the OR so they can re-open the wound for a moment, I'd say they are way worse things. We left that appointment with even my mother being satisfied.

The next step is for me to get the iridotomy, which is about an hour long appointment and involves holes poked in my eyes by lasers. I've read a couple different accounts of this process ranging anywhere from the worst pain imaginable to a small pricking sensation, so I really have no idea what to expect...