Cataract Surgery with "Multi-focal" Lens

For many, many years I had put up with fuzzy, indistinct vision, (Your Bearded Blogger author is, um, "youth-impaired", at the age of 65.) I had over the years graduated to the highest strength reading glasses -- 3.5.

Last December I finally decided that I have had enough! So in January I set up an appointment with my eye doctor, and told him that I wanted to fix this. I have asked for several years about the possibility of the "lens implant" procedure, but, alas, I did not "qualify", since I did not have sufficent evidence of cataracts. This time I was ready to have the procedure even if I had to pay the full price myself.

So, when he says (not realizing how desperate I was), "Well, we can make an improvement over glasses if you are comfortable wearing contacts.", I replied:

"No, doc, No glasses. No contacts. I want to really fix it."

So here begins a little log of my experience with the "IOL implant" procedure, A.K.A, "cataract operation."

Some background:

Apparently the lens of the eye is just behind the cornea. This lens is one structure of the body in which the cells are not replaced with fresh cells. The old ones stack up on the lens and become hard and non-pliable. So the muscles of the eye can no longer bend the lens to achieve "accomodation" to different focus ranges. This is presbyobia. The older you get, stronger and stronger reading glasses are needed to see anything up close. Finally, the lack of focus stretches further and further out until you can't even see well at intermediate ranges and finally at distances.

Adding to the general loss of clear vision, cataracts build up in the lens and it becomes more and more cloudy.

The correction for this is to replace the lens with an artificial one. You need cataract surgery, or, as it is officially called, an "IOL (Intra-Ocular Lens) implant procedure".

Note that you really don't have to "qualify" (have cataracts) in order to get the operation. But you will have to bear the full price - about $10,000. With cataracts, medical insurance will pay about half of the price. This represents the cost of a fixed focus lens.

I decided on the "ReSTOR" lens. You can find more information about it at www.acrysofrestor.com

Here's what to expect:

You can expect another eye exam at the eye operation facility. Among other things, they apparently want to confirm that you really have cataracts. Also, measurements will be taken of the eye in order to determine the lens characteristics. Note that "eye insurance", if you have it, will usually pay for this exam. However, it is your medical insurance that pays for a portion of the operation. Usually this is half of the approximately $10,000 total. Believe me. If you have been putting up with the ongoing deterioration of your eyesight similiar to what I have described above, it's worth every cent.

TIP: They will dilate your eyes! This really exaggerates your poor vision, since the entire lens is now being used, not just the center part. So driving, particularly in today's typical heavy traffic, is really hair-raising! You might consider having someone drive you to this exam.

One day before the operation, you will likely be asked to start using eye drops. These may be an antibiotic and an NSAID.

TIP: I might suggest that you buy some 3x3 sterile gauze pads to pat the excess off your eyes. After all, it does not make any sense to apply an antibiotic and then blot it off with a kleenex or piece of toilet paper!

The operation: There is nothing unpleasant here. Why? You'll likely be nodded off! Although the facility's write-up described the anesthetic as "relaxing", I found that it put me completely to sleep. So I have absolutely no recollection of the operation itself - which took all of 10 minutes. (Note that only one eye is done at a time. The other will be corrected usually in two weeks.) My wife tells me that during the drive home, my head fell forward and I slept until we arrived.

I experienced no discomfort of any kind after the operation.

What does it look like?

Well, it wasn't instant visual nirvana. There was a sense (at least for me) of seeing through a frosted glass, which improved somewhat by the second day, but remained for over a week after the operation. Part of this, I learned in the short post-op exam, is due to temporary swelling of the eye.

Nonetheless, I could tell that text and other features were somehow sharper. Also I could see plenty well enough to drive by the middle of the day after the operation.

I found myself doing a lot of "cover one eye and then cover the other" to compare the results. Some findings: The overall tint when looking through the "old" eye seemed "warm", like a tungsten bulb. The view through the new "new" eye had a "cool" tint, as if illuminated by a flourescent or LED bulb. Also, things look brighter when viewed through the new eye. No more looking at the world through the clouded "original equipment" lens.

Over the next several days I started to notice some of the expected results. Two days after the operation I was accompanying my wife on some errands, I looked down at the instrument panel. "There's text!" Words like "cold", "warm", "fan", and the like. "How long has that been there?"

When applying the eye drops that day I could read the name of the drops without glasses, but not the fine print. Later, however, I found that I could read just about any size print - without glasses - in sufficiently bright light.

TIP: May I suggest removing the lens corresponding to the "new" eye from some of your glasses. (This will probably be suggested by the doctor or assistants anyway.) By doing so, you ensure that the brain's adjustment to the new vision from the treated eye is not skewed by eyeglass correction. Indeed, you will probably find that the eyeglass correction makes the new vision worse, like looking through somebody else's glasses.

I found that I could do computer work by using my weakest reading glasses with one lens removed. This seemed to result in less disparity between the unmagnified text seen by the treated eye and the magnified text seen by the other eye.

In summary, I would say that this will probably be experienced as a somewhat uncomfortable two weeks, since the treated vision is not yet optimum and the brain is trying to blend good vs really bad vision (with no glasses), or good vs magnified/corrected vision (with "single-lens" glasses).

Toward the end of the second week however, the improvement really became noticable. I was sitting in my Jeep and noticed fine white particles on the black dash. They looked like dandruff. "Dust! That's nasty!" I covered the good eye and looked at the same dash with the untreated eye (no glasses). "There, now it looks nice and clean."

One final note: SERIOUS SIDE EFFECT! Your doctor won't warn you about this!

You will be able to see yourself in the mirror clearly for the first time in perhaps 20 years! That's right - the gray hair which was previously fuzzy and indistinct, and the wrinkles and other irregularities which you have been blissfully unaware of for all those years!

After the second operation

Well, now both eyes had been "converted". There's no going back now. During the first two weeks after the first operation, I still had my choice of various strengths of reading glasses to use, depending on whether I wanted to read something, work on the computer, or see well at a distance (the distance glasses were actually prescription glasses).

Now I had no fallback. I had to take what my new ReSTOR lenses would give me.

And what they seemed to give me during the first week after the second operation was a mixture of good and bad points:

Distance: I could see well enough to drive, but it was like driving through a light fog. When walking in the hallways at work, I still could not make out the faces of distant people.

Computer work: I could use the computer, but it's fuzzy and indistinct. To see the screen clearly, I have to move the monitor closer. If I wanted to see some small detail I had to lean forward to the monitor. One thing: I did notice that I had to dim all the monitors that I use - they had suddenly become too bright.

Reading: I could read well without glasses, but only if the book was held upright and fairly close. I was struck by how small most print really is, without the magnification of reading glasses.

It's like: I could see well enough to do anything I want, and yet there was a lot of fuzziness and cloudiness.

There were two high points during that week:

I went to the home improvement store 4 days after the second operation (to get non-prescription safety glasses as a matter of fact), and I realized to my delight that I was shopping around in a store for the first time in 20+ years with no glasses. I could pick up items and read their description. I found myself looking around a couple of times to see if anybody was looking, and wanted to say: "Hey, you people! See the old man looking at stuff with no glasses!"

On the second weekend after the operation, I watched a movie at home with no squinting or straining to see. If I looked around the brighter parts of the room, they were still a bit foggy, but the TV screen seemed quite clear.

How quickly we forget simple facts: It took two weeks after the first operation to really begin to see well out of the corrected eye. In any case, during my one-week follow-up examination, my regular eye doctor told me what I wanted to hear:

The second operation was done on my "dominant" eye - the right eye. He said that when the vision in the dominant eye is degraded, it "takes down" the vision of the other eye. The lens brochure said something similiar: do not judge your vision until both eyes have been treated and have had time to recover. The brain simply cannot resolve two highly different inputs.

Some important notes about the obligatory eye drops:

4 months after the operations

My vision remains variable, and not at all as sharp as it was right after the first eye was done and the second (dominant) eye had reading glass correction.

I learned about a phenomenon called "secondary cataracts": I'm told that the original lens is not entirely removed during the operation. The back membrane is left intact, for the purpose of supporting the new lens until the surrounding tissues can take over. This membrane then often becomes cloudy. It then can be removed using a short laser procedure of a few seconds duration. However, it is necessary to wait for some period until it becomes cloudy enough to allow for accurate focusing of the laser beam.

Another cause of variable vision is persistent "dry eye". This is said to be common in older folks, although a couple of articles suggest that the incisions associated with the operation can damage the natural tearing mechanism of the eyes. I find that I must use eye drops from time to time during the day. Alcon's "Tears Naturale Free" seems to work well for this purpose, and, used regularly, help keep the vision clear..

The bottom line

While my vision is not spectacularly clear all the time, I would certainly do it all over again if I had to.

Overall, I am quite satisfied with the results of this multi-focal lens. The quality of vision conferred by this remarkable achievement of medical science is far superior to my prior years spent in out-of-focus, indistinct fuzziness.