Aa
Light Adjustable Lens Experience
I had started to discuss my experience with the Light Adjustable Lens in http://www.medhelp.org/posts/Eye-Care/adaptive-IOLs-outside-the-US/show/2076228 but found it was closed today. I've just had my second adjustment and wanted to give the many interested folks in the community an update on my experience.
I had the second adjustment yesterday afternoon. As with the first adjustment the appointment began with the optician working with me to look at where I was with my visual acuity and also getting an update on my intraocular pressures. After being dilated and waiting an hour or so, I went in with the ophthalmologist and had the UV irradiation. As before, they used topical anesthetic, a contact lens and eyepiece were applied, and the UV light turned on. This time I didn't find the experience as uncomfortable. It may be she used less irradiation this time or perhaps I still had part of the lingering washed out vision from the first adjustment still present. After, I was essentially unable to see out of the treated eye because of a large, intense red/pink distorted area covering most of my visual field. As the afternoon and evening went on it faded only slightly but I did seem to be able to have more sharpness with some distant objects than before, again, very hard to tell.
This morning still a lot of redness and pink hues especially noticeable when looking at white objects.Green LED lights look white. But my acuity is returning and I feel that there was definitely an improvement with the second treatment. The plan is for me to return in a few days for the first lock in and then the second lock in a couple days after that. It is hard to really know just how well the lens is working at this point as I haven't recovered from the UV irradiation and I'm wearing the dark UV blocking glasses. But I'm feeling optimistic that my intermediate vision is much better and reading vision also significantly better than my untreated presbyopic eye.
Unless they close this forum or the moderators delete this post I'll put a couple follow ups on and some observations as I get the lock ins done.
This discussion is related to adaptive IOLs outside the US.
I had the second adjustment yesterday afternoon. As with the first adjustment the appointment began with the optician working with me to look at where I was with my visual acuity and also getting an update on my intraocular pressures. After being dilated and waiting an hour or so, I went in with the ophthalmologist and had the UV irradiation. As before, they used topical anesthetic, a contact lens and eyepiece were applied, and the UV light turned on. This time I didn't find the experience as uncomfortable. It may be she used less irradiation this time or perhaps I still had part of the lingering washed out vision from the first adjustment still present. After, I was essentially unable to see out of the treated eye because of a large, intense red/pink distorted area covering most of my visual field. As the afternoon and evening went on it faded only slightly but I did seem to be able to have more sharpness with some distant objects than before, again, very hard to tell.
This morning still a lot of redness and pink hues especially noticeable when looking at white objects.Green LED lights look white. But my acuity is returning and I feel that there was definitely an improvement with the second treatment. The plan is for me to return in a few days for the first lock in and then the second lock in a couple days after that. It is hard to really know just how well the lens is working at this point as I haven't recovered from the UV irradiation and I'm wearing the dark UV blocking glasses. But I'm feeling optimistic that my intermediate vision is much better and reading vision also significantly better than my untreated presbyopic eye.
Unless they close this forum or the moderators delete this post I'll put a couple follow ups on and some observations as I get the lock ins done.
This discussion is related to adaptive IOLs outside the US.
Well here we are in 2015 so I thought I'd give a long term follow up. First the color vision issue. It has taken months and months for gradual improvement of the blue/green issue in the treated eye. I'm pretty sure the UV caused damage that has just taken a while to heal but there is also some color effect in my untreated eye from the cataract there which gives things a slight hue that I was unaware of until getting the lens replaced with the LAL. So for example, , when I look at the 'post a comment' button on my computer screen with the LAL eye the color is not so much green, more of a very pale blue unless I get very close to the image. The closer I am and the brighter the green, the less difficulty I have seeing the color.
Overall I'm pretty happy with the results, I have a sort of mini monovision with good overlap with the treated and untreated eye, particularly of intermediate vision. I don't normally wear glasses unless I'll be driving or going to the movies and this is significant because I'd been wearing progressive lens glasses over the last ten years. I still am getting used to the mini monovision even some months later but mostly I'm not aware of the discrepancy in focus between eyes and go about my business without problems. While I'm sure the results were as good as could have been possible I do have a slight bit of astigmatism on the treated side, correctable with glasses, that I wish would not have been there.
Another comment - there is an odd kind of focus I get from the LAL eye that seems to be related to depth of focus and is different from the normal accomodation I had before. If I look at a distant set of letters it can come into focus and it seems different than how I'd focus on things in the distance before (my LAL is set for near/intermediate). I think this helps make the monovision work better that it otherwise would become there is some sort of pseudoaccomodation at work.
Will I get an LAL for the right eye when the time comes? Well, first I'm in absolutely no rush to do so and will put it off until it is clear my vision is suffering. At 53 my hope is that additional options and experiences with the LAL will occur that will help guide my treatment. I definitely will try to get the treatment done in an English speaking clinic as working with the clinic in Berlin had some difficulty due to language and because my needs were different as a foreign patient. I liked the clinic where I had it done and would recommend it but be aware of the logistical difficulties. Hopes this helps.
Overall I'm pretty happy with the results, I have a sort of mini monovision with good overlap with the treated and untreated eye, particularly of intermediate vision. I don't normally wear glasses unless I'll be driving or going to the movies and this is significant because I'd been wearing progressive lens glasses over the last ten years. I still am getting used to the mini monovision even some months later but mostly I'm not aware of the discrepancy in focus between eyes and go about my business without problems. While I'm sure the results were as good as could have been possible I do have a slight bit of astigmatism on the treated side, correctable with glasses, that I wish would not have been there.
Another comment - there is an odd kind of focus I get from the LAL eye that seems to be related to depth of focus and is different from the normal accomodation I had before. If I look at a distant set of letters it can come into focus and it seems different than how I'd focus on things in the distance before (my LAL is set for near/intermediate). I think this helps make the monovision work better that it otherwise would become there is some sort of pseudoaccomodation at work.
Will I get an LAL for the right eye when the time comes? Well, first I'm in absolutely no rush to do so and will put it off until it is clear my vision is suffering. At 53 my hope is that additional options and experiences with the LAL will occur that will help guide my treatment. I definitely will try to get the treatment done in an English speaking clinic as working with the clinic in Berlin had some difficulty due to language and because my needs were different as a foreign patient. I liked the clinic where I had it done and would recommend it but be aware of the logistical difficulties. Hopes this helps.
So did you go to the Dr and confirmed that the lens was reshaped after lock-in? Bottom line: If you would decide once more, would you do with normal lens or the light adjustable one?
The good new is: I have no problems at all now (11/13/2014) with my color vision. I don't know at what point all pinkness was gone, but it was quite awhile ago.
The bad news is: The vision in my one treated eye has seemed to change abruptly. It seemed to shift about .5 diopters in a nearsighted direction during a 1-week beach vacation. (I could give a few more details, but the bottom line: my strong suspicion is the bright sunlight has reshaped the lens - which was not supposed to be possible, given that the lens was 'locked-in' as the final procedure.)
This theory of mine is unconfirmed, but as I say, it seems the likely reason from what I understand about the lens. (Not good). I am trying to contact the Dr. to attempt a correction and re-lock-in to verify and fix (or not) but have not heard back yet. Will attempt to keep you posted.
Also of some note: I have read absolutely zero reports of this on the web. However, I have met a second patient who is having similar problems with both eyes implanted with the lens. So in real life I only have knowledge of 3 eyes, and they all appear to be unstable after lock-in.
The bad news is: The vision in my one treated eye has seemed to change abruptly. It seemed to shift about .5 diopters in a nearsighted direction during a 1-week beach vacation. (I could give a few more details, but the bottom line: my strong suspicion is the bright sunlight has reshaped the lens - which was not supposed to be possible, given that the lens was 'locked-in' as the final procedure.)
This theory of mine is unconfirmed, but as I say, it seems the likely reason from what I understand about the lens. (Not good). I am trying to contact the Dr. to attempt a correction and re-lock-in to verify and fix (or not) but have not heard back yet. Will attempt to keep you posted.
Also of some note: I have read absolutely zero reports of this on the web. However, I have met a second patient who is having similar problems with both eyes implanted with the lens. So in real life I only have knowledge of 3 eyes, and they all appear to be unstable after lock-in.
2 Comments
Ken if this comes to you I'd be interested in an update. My wife had both eyes done in 2011 and has never received the major benefits this approach purports to give ?In particular she wears glasses and the vision in her distance eye has worsened such that she sees better long-distance with her with her near sighted eye which has also become her dominant eye !!
I just saw the forums and very impressed with your detailed updates.
I was wondering about the outcome of your color vision of the LAL eye now.
Has it recovered to almost 100%? And what is your score of it?
Can you give us more updates?
Thanks!
I was wondering about the outcome of your color vision of the LAL eye now.
Has it recovered to almost 100%? And what is your score of it?
Can you give us more updates?
Thanks!
Long version Part III
Saturday AM 5/24
I had the usual tests again, examinations and a final lock-in. This one took about 30-45 seconds of UV light.
I had a few final questions for Dr. Chayet. How long till I can exercise?
- 1 month from surgery to jog (Though I could use a stationary bike now)
- 2 months from surgery to lift weights.
We discuss experimenting with mini-monovision in anticipation of correction of the second eye at a later time, and Dr Chayet gives me some samples of contact lenses to try, with a prescription to purchase more. If I can tell that works for me, I would be more likely to try something like this with the second eye when that time comes.
My vision was very reddish in the right eye for several days. Even green traffic lights appeared as a reddish amber.
One slight unexpected effect: When I removed the goggles, I had a slight cross-eyed feeling, or something like seeing underwater. With reading glasses or sunglasses I don't notice it much, but when they come off it is very noticeable, especially for a minute or two. It seems to interfere with depth perception. I've tried to analyze it; at first I thought maybe it was just that my left eye had been better and I had been giving it priority, and now my brain was having trouble making sense of the reverse situation: After all, the difference in vision was greater between the eyes now than before, and in the opposite direction.
Later I thought maybe the lens is sitting in a slightly different position in my eye, so that the image is shifted on the retina slightly from what I am used to.
But I now think what it is most likely is, is that the image in the right eye is a little larger than the image in the left. For example, it seems that cars in the distance are 'shorter' with my left eye than my right. This is not something I have discussed with the doctor. It is a little annoying, but even if it does not go away, my overall vision is much improved and more useful - i.e., this is a second order effect/defect. I also notice that, with not needing to strain to see something, the left eye is also staying relaxed and unfocused most of the time; this may make the left/right difference even greater. I feel like I have something in my left eye now as though I need to rub it out.
I hope that the image size is the overall reason for the temporary cross-eyed feeling, and for the feeling of not great depth perception (like if the sidewalk is a little raised it is hard to notice, and I believe I have scuffed these with my shoes more than would normal). If that is true, then I would expect it to go away when the second eye is done later.
What else: 1 week later, I do not really notice a pink shift in the daytime unless I 'test' for it, but in the mornings especially I still interpret my clock radio green LEDs an digits as red.
6/19 2014
There has been no noticeable reddish/pinkish shift for some time; I didn't notice when that stopped, but probably a week or more ago.
I have noticed in this time that I can place a 1 diopter lens only over the left eye, and the cross-eyed feeling and depth perception problem seems lessened significantly. (for now, I tried popping out the right lens in a dollar store pair of reading glasses and wearing them sometimes). (This does not improve the vision in the left eye; but it somehow seems to make it 'match' the right eye better.) I have not tried with a contact lens in the left eye yet.
I suspect my vision may be sharper at distance again; I plan to visit an optometrist soon to find out. My close vision has I think moved out a little. The computer screen seems sharp at about 4.5 feet (I can read this Times New Roman 10 point font at that distance (24 inch 1920x1200 display), though just barely, as it is small at that distance)
----
Late notes: I see some excellent recent posts from psbpsbpsb in these forums from this year I had not noticed before. The only comments I would make are where we had some different experiences or concerns:
For me, the scheduling was not too difficult, given that Codet gives a 'canned' schedule out for consultations, surgerys, and post-op exams and you can schedule these for consecutive days to make that fit into one Airflight. After two weeks you must be there Monday through Saturday to allow for adjustments, so that can be fit into a second trip.
Codet issued me two pairs of goggles (LAL "Coolview" Post Op Spectacle"), one that was clear (to visible light; 100% opaque to UV of course) to wear indoors. The dark ones looked cool, but the clear ones looked a little goofy, and I endured some light teasing over them. :)
I did not wear the googles while sleeping or in the shower, but did at all other times. I kept my right (operating) eye closed while in the shower, so no problems here.
I had no pain or itching, except for a significant soreness if I grazed my eye while soaping up in the showers.
Sorry for filling up the forum! But I hope it is as useful for someone as previous posts were to me!.
Ken
Saturday AM 5/24
I had the usual tests again, examinations and a final lock-in. This one took about 30-45 seconds of UV light.
I had a few final questions for Dr. Chayet. How long till I can exercise?
- 1 month from surgery to jog (Though I could use a stationary bike now)
- 2 months from surgery to lift weights.
We discuss experimenting with mini-monovision in anticipation of correction of the second eye at a later time, and Dr Chayet gives me some samples of contact lenses to try, with a prescription to purchase more. If I can tell that works for me, I would be more likely to try something like this with the second eye when that time comes.
My vision was very reddish in the right eye for several days. Even green traffic lights appeared as a reddish amber.
One slight unexpected effect: When I removed the goggles, I had a slight cross-eyed feeling, or something like seeing underwater. With reading glasses or sunglasses I don't notice it much, but when they come off it is very noticeable, especially for a minute or two. It seems to interfere with depth perception. I've tried to analyze it; at first I thought maybe it was just that my left eye had been better and I had been giving it priority, and now my brain was having trouble making sense of the reverse situation: After all, the difference in vision was greater between the eyes now than before, and in the opposite direction.
Later I thought maybe the lens is sitting in a slightly different position in my eye, so that the image is shifted on the retina slightly from what I am used to.
But I now think what it is most likely is, is that the image in the right eye is a little larger than the image in the left. For example, it seems that cars in the distance are 'shorter' with my left eye than my right. This is not something I have discussed with the doctor. It is a little annoying, but even if it does not go away, my overall vision is much improved and more useful - i.e., this is a second order effect/defect. I also notice that, with not needing to strain to see something, the left eye is also staying relaxed and unfocused most of the time; this may make the left/right difference even greater. I feel like I have something in my left eye now as though I need to rub it out.
I hope that the image size is the overall reason for the temporary cross-eyed feeling, and for the feeling of not great depth perception (like if the sidewalk is a little raised it is hard to notice, and I believe I have scuffed these with my shoes more than would normal). If that is true, then I would expect it to go away when the second eye is done later.
What else: 1 week later, I do not really notice a pink shift in the daytime unless I 'test' for it, but in the mornings especially I still interpret my clock radio green LEDs an digits as red.
6/19 2014
There has been no noticeable reddish/pinkish shift for some time; I didn't notice when that stopped, but probably a week or more ago.
I have noticed in this time that I can place a 1 diopter lens only over the left eye, and the cross-eyed feeling and depth perception problem seems lessened significantly. (for now, I tried popping out the right lens in a dollar store pair of reading glasses and wearing them sometimes). (This does not improve the vision in the left eye; but it somehow seems to make it 'match' the right eye better.) I have not tried with a contact lens in the left eye yet.
I suspect my vision may be sharper at distance again; I plan to visit an optometrist soon to find out. My close vision has I think moved out a little. The computer screen seems sharp at about 4.5 feet (I can read this Times New Roman 10 point font at that distance (24 inch 1920x1200 display), though just barely, as it is small at that distance)
----
Late notes: I see some excellent recent posts from psbpsbpsb in these forums from this year I had not noticed before. The only comments I would make are where we had some different experiences or concerns:
For me, the scheduling was not too difficult, given that Codet gives a 'canned' schedule out for consultations, surgerys, and post-op exams and you can schedule these for consecutive days to make that fit into one Airflight. After two weeks you must be there Monday through Saturday to allow for adjustments, so that can be fit into a second trip.
Codet issued me two pairs of goggles (LAL "Coolview" Post Op Spectacle"), one that was clear (to visible light; 100% opaque to UV of course) to wear indoors. The dark ones looked cool, but the clear ones looked a little goofy, and I endured some light teasing over them. :)
I did not wear the googles while sleeping or in the shower, but did at all other times. I kept my right (operating) eye closed while in the shower, so no problems here.
I had no pain or itching, except for a significant soreness if I grazed my eye while soaping up in the showers.
Sorry for filling up the forum! But I hope it is as useful for someone as previous posts were to me!.
Ken
Long version Part II
Here's how that went:
CONSULTATION Saturday 5/3/2014 at 9:30 AM
After some measurements and examinations by others, Dr. Chayet examined and consulted with me.
He was very pleasant and patient and I felt much more at ease following our discussion.
We discussed dominant eyes, possible options of increasing the asphericity to increase depth of field.
After locking in the lens, would my eye stay stable? I asked.
Dr. Chayet said he had examined patients who had the lens implanted 4-5 years ago, and he had found typically there was a .25 diopter shift (always in the same direction); now he takes that into account and locks the lens in .25 diopters in the opposite direction, so that vision should get a little better, rather than worse, over time.
Could I have this lens explanted (removed) if a higher-tech option was available in the future?
No, probably not, it will be so tightly attached at that point, removal probably would not be an option.
How soon would I likely need some treatment for POC (Posterior Capsular Opacification.)
From his experience, this lens has a 15% POC rate per 5 years.
Crisp answers, no waffling. Very likable doctor.
Surgery was set up for Monday morning.
SURGERY Monday 5/5/2014 at 7:30 AM
Payment (credit card in my case) was made prior to surgery (denied by Visa at first, requiring some phone calls)
I leave all my belongings in an office (which is just my backpack - as I'm walking to and from here from my hotel just across the U.S. Mexico border). I'm led to a room to remove all my clothes except briefs and socks. I put on a hospital gown and am led to the waiting/prep room for surgery.
(Folks in this area of Codet don't speak much English, and I speak no Spanish, but we get by. They all seem to be sweet people.)
A pill goes under my tongue, an IV gets started. Shortly I am led into the surgery room where I lay down.
The anesthesiologist places some plastic tubing around my neck so two tubes slightly enter my nostrils to give me oxygen(?).
("keep your eyes open, don't talk, don't move" they said)
My right eye is propped open, and the rest of my face is draped. I am awake and reasonably alert. I try to watch what is going on inside my eye.
But I only see two bright objects near the center of my field of view that don't seem to move. I had expected to see some movement of instruments inside my eye, but didn't. (or at least, I don't recall it).
Maybe 10 minute pass? The doctor says everything looks good, and they wheel me back out to the prep room.
Soon I am ok to be transferred back to an easy chair. Then I get some juice. Shortly I am myself again (maybe a little slower and not so coordinated), and I am led back to the closet where I change back into my street clothes. I have a hard plastic eye patch taped to my face; it is to remain on for 3 hours, when it is time for eye drops again. At that point I am to switch to a pair of UV-blocking goggles. (which must be worn until final lock-in 2 weeks later, except for sleeping and showering).
They say eat something, take it easy, don't put your head down, don't do anything strenuous.
I am free to go when I have something to eat and feel ok. I stop in the cafe across the hall and take care of that and then start walking back to my hotel across the border to come back the next day for a post-op check. I need to put drops in every 3 hours and with the typical wait at the Mexico-US border, I'm a little concerned I will still be in bright daylight beyond that time and unable to remove the goggles to do that. Codet personnel arrange a ride across the border for me.
Already, I can see my distance vision is very sharp. It must be at least 20/20. Black is black instead of gray; I have nice contrast again in my right eye. Now I feel I could drive safely... and am amazed how bad my left eye is (which was the better of the 2 eyes just that morning). There is no fog anymore. Bright lights at an angle don't obliterate my vision as it did before. No multiple images.
However, my close vision is not so good. It is worse than before, and worse than my left eye.
POST-OP Tuesday 5/6/2014 at 9:00 AM
Again I am examined, and the doctor says it all looks good, the lens is centered, etc. I get some more eye drops and am free to go, to return 2 weeks later..
2 WEEKS LATER
I am back for Monday - Saturday adjustments. (The plan was for an adjustment Monday, Wednesday, Thursday, and final lock-in Saturday)
I feel my distance vision is not quite as sharp at distance as it was earlier. However, I may be able to focus fairly well from distance to arms length, where immediately after surgery it seemed I could tell I was losing sharpness at about 6-7 feet. But this is all pretty subtle stuff and hard to measure given differing variables of brightness, text size and so on.
Monday AM 5/19
After the usual eye tests,( visual acuity, pressure, and so on) Dr Chayet examined me and discussed the results. The lens seemed centered; everything looked good. He said normally the adjustments were a roller coaster with overcorrection first in one direction, and then in the other until final lock-in. That last lock-in also will shift the lens .25 diopters (in the 'nearsighted' direction), which is what he wanted, so he normally planned to be at 'perfect' before the last Saturday final lock-in. For some reason, I was already close to that and he said I had left him a 'narrow window'. He told me I had a small astigmatism which surprised me. He said that was not uncommon following cataract surgery (as though it might be a result of surgery), but with the LAL, it wasn't a problem since it would be 'adjusted out'. My eyes were dilated, and I believe some desensitizing drops were used. Then I sat down at the LAL machine.
Due to the ultraviolet light intensity, they covered my non-operating eye with a patch, and I was to keep the other eye shut as much as possible to keep a good dilation - so I didn't observe much. Dr. Chayet manually placed and held an object (perhaps a glass lens?) directly and firmly against my eye which was very "uncomfortable" to say the least. I tried to avoid a blink reflex for what was maybe 45-60 seconds of treatment. Initially as I sat down there had been 8 golden light sources places around the perimeter of my view (I'm guessing for the machine to use for alignment of some sort?). They remained on for the duration.
When the procedure actually began, a very bright light appeared between those golden light sources, and with that and the object being firmly pressed onto my eye it was a challenge to hold still. An assistant actually applied some pressure to the back of my head so I would stay forward and pressed into the head fixture of the machine during this time. Then it was over, and the object was removed from contact with my eye. My eye felt more than a little abused. I was free to go immediately (wearing my protective goggles again, of course).
I don't recall noticing much difference in the 'color' perception of my right eye in the bright monday light; only a small pink shift.
Wednesday AM 5/21
After the usual tests and examinations by others, Dr Chayet tested my acuity as better than 20/20 (perhaps 20/16?), which is where he planned to be, but he planned to be there 'later'. He consulted 'with the machine' and decided we would go ahead and do a first lock-in today, and then have a final one on Saturday. (i.e. no need for a Thursday treatment). We repeat the earlier procedure, but this time the light seemed more intense. The 8 golden lights appeared cherry red afterwards when viewed with the right eye.
My right eye vision was noticeably darker and redder than the left. Nighttime was especially dramatic. Light sources like headlights on cars were deep red, the sky is deep red, and so on, as though a red filter was placed over my eye.
Here's how that went:
CONSULTATION Saturday 5/3/2014 at 9:30 AM
After some measurements and examinations by others, Dr. Chayet examined and consulted with me.
He was very pleasant and patient and I felt much more at ease following our discussion.
We discussed dominant eyes, possible options of increasing the asphericity to increase depth of field.
After locking in the lens, would my eye stay stable? I asked.
Dr. Chayet said he had examined patients who had the lens implanted 4-5 years ago, and he had found typically there was a .25 diopter shift (always in the same direction); now he takes that into account and locks the lens in .25 diopters in the opposite direction, so that vision should get a little better, rather than worse, over time.
Could I have this lens explanted (removed) if a higher-tech option was available in the future?
No, probably not, it will be so tightly attached at that point, removal probably would not be an option.
How soon would I likely need some treatment for POC (Posterior Capsular Opacification.)
From his experience, this lens has a 15% POC rate per 5 years.
Crisp answers, no waffling. Very likable doctor.
Surgery was set up for Monday morning.
SURGERY Monday 5/5/2014 at 7:30 AM
Payment (credit card in my case) was made prior to surgery (denied by Visa at first, requiring some phone calls)
I leave all my belongings in an office (which is just my backpack - as I'm walking to and from here from my hotel just across the U.S. Mexico border). I'm led to a room to remove all my clothes except briefs and socks. I put on a hospital gown and am led to the waiting/prep room for surgery.
(Folks in this area of Codet don't speak much English, and I speak no Spanish, but we get by. They all seem to be sweet people.)
A pill goes under my tongue, an IV gets started. Shortly I am led into the surgery room where I lay down.
The anesthesiologist places some plastic tubing around my neck so two tubes slightly enter my nostrils to give me oxygen(?).
("keep your eyes open, don't talk, don't move" they said)
My right eye is propped open, and the rest of my face is draped. I am awake and reasonably alert. I try to watch what is going on inside my eye.
But I only see two bright objects near the center of my field of view that don't seem to move. I had expected to see some movement of instruments inside my eye, but didn't. (or at least, I don't recall it).
Maybe 10 minute pass? The doctor says everything looks good, and they wheel me back out to the prep room.
Soon I am ok to be transferred back to an easy chair. Then I get some juice. Shortly I am myself again (maybe a little slower and not so coordinated), and I am led back to the closet where I change back into my street clothes. I have a hard plastic eye patch taped to my face; it is to remain on for 3 hours, when it is time for eye drops again. At that point I am to switch to a pair of UV-blocking goggles. (which must be worn until final lock-in 2 weeks later, except for sleeping and showering).
They say eat something, take it easy, don't put your head down, don't do anything strenuous.
I am free to go when I have something to eat and feel ok. I stop in the cafe across the hall and take care of that and then start walking back to my hotel across the border to come back the next day for a post-op check. I need to put drops in every 3 hours and with the typical wait at the Mexico-US border, I'm a little concerned I will still be in bright daylight beyond that time and unable to remove the goggles to do that. Codet personnel arrange a ride across the border for me.
Already, I can see my distance vision is very sharp. It must be at least 20/20. Black is black instead of gray; I have nice contrast again in my right eye. Now I feel I could drive safely... and am amazed how bad my left eye is (which was the better of the 2 eyes just that morning). There is no fog anymore. Bright lights at an angle don't obliterate my vision as it did before. No multiple images.
However, my close vision is not so good. It is worse than before, and worse than my left eye.
POST-OP Tuesday 5/6/2014 at 9:00 AM
Again I am examined, and the doctor says it all looks good, the lens is centered, etc. I get some more eye drops and am free to go, to return 2 weeks later..
2 WEEKS LATER
I am back for Monday - Saturday adjustments. (The plan was for an adjustment Monday, Wednesday, Thursday, and final lock-in Saturday)
I feel my distance vision is not quite as sharp at distance as it was earlier. However, I may be able to focus fairly well from distance to arms length, where immediately after surgery it seemed I could tell I was losing sharpness at about 6-7 feet. But this is all pretty subtle stuff and hard to measure given differing variables of brightness, text size and so on.
Monday AM 5/19
After the usual eye tests,( visual acuity, pressure, and so on) Dr Chayet examined me and discussed the results. The lens seemed centered; everything looked good. He said normally the adjustments were a roller coaster with overcorrection first in one direction, and then in the other until final lock-in. That last lock-in also will shift the lens .25 diopters (in the 'nearsighted' direction), which is what he wanted, so he normally planned to be at 'perfect' before the last Saturday final lock-in. For some reason, I was already close to that and he said I had left him a 'narrow window'. He told me I had a small astigmatism which surprised me. He said that was not uncommon following cataract surgery (as though it might be a result of surgery), but with the LAL, it wasn't a problem since it would be 'adjusted out'. My eyes were dilated, and I believe some desensitizing drops were used. Then I sat down at the LAL machine.
Due to the ultraviolet light intensity, they covered my non-operating eye with a patch, and I was to keep the other eye shut as much as possible to keep a good dilation - so I didn't observe much. Dr. Chayet manually placed and held an object (perhaps a glass lens?) directly and firmly against my eye which was very "uncomfortable" to say the least. I tried to avoid a blink reflex for what was maybe 45-60 seconds of treatment. Initially as I sat down there had been 8 golden light sources places around the perimeter of my view (I'm guessing for the machine to use for alignment of some sort?). They remained on for the duration.
When the procedure actually began, a very bright light appeared between those golden light sources, and with that and the object being firmly pressed onto my eye it was a challenge to hold still. An assistant actually applied some pressure to the back of my head so I would stay forward and pressed into the head fixture of the machine during this time. Then it was over, and the object was removed from contact with my eye. My eye felt more than a little abused. I was free to go immediately (wearing my protective goggles again, of course).
I don't recall noticing much difference in the 'color' perception of my right eye in the bright monday light; only a small pink shift.
Wednesday AM 5/21
After the usual tests and examinations by others, Dr Chayet tested my acuity as better than 20/20 (perhaps 20/16?), which is where he planned to be, but he planned to be there 'later'. He consulted 'with the machine' and decided we would go ahead and do a first lock-in today, and then have a final one on Saturday. (i.e. no need for a Thursday treatment). We repeat the earlier procedure, but this time the light seemed more intense. The 8 golden lights appeared cherry red afterwards when viewed with the right eye.
My right eye vision was noticeably darker and redder than the left. Nighttime was especially dramatic. Light sources like headlights on cars were deep red, the sky is deep red, and so on, as though a red filter was placed over my eye.
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