Doctor My Eyes (Part II)

Part I is here.

By Christopher Lane

At the end of April I met with my surgeon, Dr. Elizabeth Davis, to discuss my upcoming cataract surgery. Dr. Davis is an ophthalmologist associated with Minnesota Eye Consultants [there is music at the link—just in case you're somewhere where you shouldn't be surfing —Ed.] and is a graduate of Cornell, Johns Hopkins and Harvard. Her sub-specialty is corneal, cataract, and refractive surgery. After our interview, I felt very comfortable with her training and experience. After conducting a series of tests to confirm that I did indeed have cataracts, Dr. Davis advised me that the surgery was required, the sooner the better. We scheduled my right eye for the end of May.

During the procedure, which takes about ten minutes, my natural lens was replaced with a plastic one. My doctor has chosen a TECNIS Aspheric Intraocular Lens (IOL) manufactured by Abbot. The TECNIS IOL is an acrylic wavefront lens with an aspheric design. Wavefront analysis involves beaming light into the eye and then "mapping" how light waves travel after they are reflected off the inner back of the eye (the retina). Wavefront analysis allows lens manufacturers to design lenses that are able to correct common refractive errors (nearsightedness, farsightedness and astigmatism). According to Abbot, the TECNIS IOL can improve functional and night-driving vision. Also according to Dr. Davis, the TECNIS IOL is the equivalent of a Leica or Zeiss camera lens.

On May 24th, I was admitted to have my right eye done. I was amazed at how pain-free the entire process was from the insertion of the IV right through recovery. At no time was a bothered by any pain at all. In addition, all of the medical personnel that I encountered tried to put my mind at ease, recognizing that this can be a nerve-wracking experience.

Once I was prepped, an IV was inserted to administer some sedative during the process. No general anesthetic is used, but local anesthesia is administered directly to the eye. A Zeiss microscope, which uses a brilliant white light for illumination, is lowered on to the eye. I then experienced what I can only describe as a helluva psychedelic light show, swirls of color—red, purple, blue, orange and some without names. Apparently this is very common and it sure takes your mind off what’s going on, which, incidentally, you are well aware of since the team is communicating with you. The entire procedure took eight minutes from beginning to end. Before I knew it I was whisked away to the recovery room for some juice and pretzels.

I had the second surgery on June 14th and the experience was much the same. I wondered about the lack of any pain and the optometrist informed me that there are no nerve endings in that particular area hence no pain. Total recovery will take about 40 days for each eye.

The only thing that I can criticize about the whole experience is the underestimation of the recovery period. Immediately after the surgery I was effectively blind in that eye so I couldn’t drive. Although I could see light and shape it was like looking through a very thick fog bank. It was two days before I could see well enough to return to work and over a week before everything was back to normal.

Well, not exactly normal. My vision is vastly improved. Everything is extremely sharp and colors are much more vivid and true. I am really seeing again. Unfortunately, the surgery did not improve my near vision so, at some point, I will have to use reading glasses. Although no one likes to go through surgery, cataracts are no longer the life sentence they once were. Just find a good doctor and get them taken care of. You won’t regret it—and I bet your photography improves as well as your vision.

Chris

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Original contents copyright 2010 by Michael C. Johnston and/or the bylined author. All Rights Reserved.

Comments

[Leigh Youdale]

Although I opted for both eyes to be fitted with long-distance lenses because of flying, and I'm more than happy with the result. Some of my acquaintance have had different lenses inserted in each eye, effectively covering the close/distance needs. Apparently the brain doesn't really differentiate unless only one eye is open.
The only 'pain' is having to pop spectacles on and off to look at the settings on my RF cameras.
I guess I was more fortunate than you post-op though. I presented at my surgeon's the next morning for examination and removal of the protective pad left on after the operation. I was pronounced fit to drive that morning!

[David]

Told you it would be okay. However, I am surprised that it took so long for you to be able to see properly again. I was not allowed to drive home, (of course!), but I could efeectively see quite well as soon as I "woke up". My surgery was slightly different in that apparently I was awake during the procedure, as you were, but the drug I was given put me to sleep straight afterwards and I don't remember anything about the procedure at all. Anyway, I am sure you will agree it was worth it. I was also told it would take up to a year for my vision to settle down completely, which means you will probably be up for two sets of spectacles in that time.

[John Brewton]

I had laser surgery eight years ago. Changed my life. My photography life, that is. I still need reading glasses, but not for picture taking. Of course, when I hand off my camera to someone else for a look-see they bitch about the diopter adjustment being off!

[Joe Dasbach]

Where did they put the red dot?
On the left? or the right?

[RawheaD]

I just got wavefront LASIK around 3 years ago, curing nearsightedness (and slight astigmatism) I'd had for 22 years. Different world indeed. And finally, being able to peep into a viewfinder the way it was designed (with your eye pressed against it) :-)

[MikeW]

Thanks for writing about your experience. My wife has to have this surgery soon; I know she will find it helpful.

[Seth Glassman]

I had cataract surgery in my right eye, the experience was pretty much as you described. In the recovery room I felt as if the eye that had been operated on was pointing in a strange direction and I wondered if that was how Marty Feldman saw the world.

[Bill Mitchell]

I'm glad that it worked out perfect for you, as it nearly always does, but it must always be remembered that as with any surgery real disaster is a possibility and should not be taken lightly.
Wm. Mitchell, MD

[Ari]

Every once in awhile I hear something and realize we have reached 'the future.' I was just reading through Neuromancer, the original cyber punk novel. In it actresses showed off their wealth and fashion sense by getting Zeiss lens and iris implants.

[robert e]

Congratulations! I hope you enjoy good vision for a long time to come. That an eight minute pain-free procedure can relieve cataracts and correct for aberrations is miraculous.

[Nick]

Two totally naive questions that have been bothering me for some time: 1) Can you see the tools (scalpel,etc) that the doctors are using in any way? 2) How to the docs ensure that your eye is steady?

These sorts of eye surgeries seem like wonderfully useful procedures, and I am very glad that they are so capable of restoring clear vision to those with out it. They just squick me right the heck out, though.

[Rdkeir]

For those who read this because they're going to get cataract surgery, my experience was more like David's and John Brewton's. I was in the recovery room with my glasses off when I realized that I could read the clock in the room across the hall, after a lifetime of needing glasses for anything more than a few feet away. Now I wear reading glasses, which is an easy trade for improved vision everywhere else.

[gene lowinger]

Nice that it was so easy for you. I couldn't have the same type of lens you did because I needed corneal transplants in both eyes. I had corneal dystrophy. Now I wear RGP contact lenses and my distance vision is 20/15. After my last checkup with the eye surgeon he told me about a new lens replacement that will effectively give me x-ray vision ...... ooooh goody!

[Joe Cartwright]

I had both of my eyes done two years ago. Remarkable improvement in vision. I opted for the "Crystal Lens" inserts which attach to the focusing muscles of the eye for normal short to long distance correction and am free from eyeglasses except for very small print and dim light. Colors took on a new life and I found I was shooting color film more. Thank god for modern medicine!

[Isaac Crawford]

The question is, can this procedure be done for folks that just have lousy vision without cataracts? My mom (who has terrible vision) was a little bitter when she found out that she wasn't a candidate for Lasik surgery. She has a friend that had cataract surgery and can see fine now. There have been several times mom has joked that she hopes she gets cataracts so she can get her vision corrected. Can she just skip to the surgery without the cataracts?

[Blake Shaw]

Hello Isaac,

Yes, as a matter of fact your mother could have what is called clear lens extraction, that is, replacing the natural lens of the eye with an intraocular lens. With the right equipment and the right surgeon, the power of the intraocular lens can be calculated to eliminate the need for glasses. (correcting for the need for reading glasses, or presbyopia, can be corrected as well, but involves trade-offs, which I won't get into).

This surgery should only be done by an excellent surgeon who has experience in the procedure, and can take the time to explain all of the choices of lens implants to match the visual needs of the patient. There is little margin for error in the lens calculations and you are operating in an otherwise healthy eye.

Regarding Chris's recovery, it sounds like he may have had some corneal swelling after the surgery, a not uncommon occurence, especially if the cataract is more advanced. As in his case, it usually resolves with no consequence.

And regarding the term "wavefront" used to market this lens. It's actually more of a marketing term to designate a lens which has been designed to minimize spherical aberration when implanted in most eyes. It is not correcting for the individual wavefront aberrations in each individual patient's eye, the way wavefront lasik is advertised to do.

I am an ophthalmologist, and trained in cataract surgery, but I now leave cataract surgery to a colleague of mine who is a superb surgeon.

Nevertheless, I agree with Dr.Mitchell, to not take surgery lightly, there is always a chance of a complication, even if surgery goes perfectly. However, if your cataracts are causing vision loss which is limiting your lifestyle (like your photography!), and you have an excellent surgeon, then you should not hesitate to proceed with cataract surgery.

I am pleased Chris had an excellent result and wish him the best.

[Isaac Crawford]

Thanks for the info, I'll pass it along. I think my mother would disagree on what a "healthy" eye means:-) Her vision is bad enough that she might consider this...

[Dan]

that IOL design is quite an old design. newer designs AND materials are available which are much better in reducing the risk of secondary cataract: areas between the IOL and the lens capsule which become again opaque, affecting vision. They are treated with laser, but it's much better if you don't get them. You should also be aware that your doctor is probably getting some sort of reward from the manufacturer for each IOL they sell, so be sure you research the matter thoroughly before talking to your doctor and you challenge their suggestions all the time.
These newer IOL's I am talking about can also correct for both near-vision and far-vision; they may not be suitable to everyone but you should definitely ask your doctor about them. I won't mention brand names, because they are manufactured by the company I used to work for, but you can find them easily on google.
I used to sell IOL's and machines for cataract surgery for a living, so I know what I'm talking about.

[Zaan]

I had the same question as Isaac above, and have been waiting for this update since I read the last entry. I'm quite farsighted (around +8 diopter in both eyes), and would be delighted to do without glasses that give me a somewhat disabled appearance and contact lenses that dry my eyes out. As far as I've gathered, laser surgery is only just now starting to work for eyes as bad as mine, if at all. The other option would then indeed be to just throw out what I have and reboot.

It's interesting to read here that there are now lens replacements that can actually adjust for near/far in connection with the eye muscle. I'd love to get some more information on this entire issue.