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Lens Replacement Theory: Part Five

Posted on June 7th, 2024

Dave!All this week I've been talking about the cataract surgeries I've had (if you missed it, you can start with Monday's entry here). My review of the process has been positively glowing, and I have never been so happy to have done something so simple which has improved my life so much. But there are down-sides...

THE COST: As I mentioned, my insurance wouldn't pay for any multifocal lens options (most don't). If I wanted multifocal (and I did) I would be paying for the lenses out of my own pocket (though they would co-pay the actual surgery costs after my deductible had been met). Only monofocal lenses were covered. At the clinic I went with, the lenses are $2,900 each, $5,800 for the pair. I'm telling you right now that it would be a bargain at twice the price. But it's a fuck-ton of money at the regular price, and that's going to be a barrier for a lot of people. It was almost a barrier for me. But ultimately I couldn't put a price on my vision, which is used every waking moment of every day, so I bit the bullet. First I paid $188.91 for the exam and consultation after insurance. Then I wiped out my Health Savings Account to the tune of $3,935.14 for the first lens and surgery after insurance. Then $3,542.15 went on my credit card for the second lens and surgery after insurance. That's $7,666.20 and counting (I don't have the amount for the follow-up exam, as that hasn't gone through insurance yet). Having to care for your health is a real bitch in this fucked-up country. Even if I went with monofocal lenses, I'd still would have had to come up with $1,800. Maybe people have better insurance than I do. Maybe MediCare will have paid for all of it if I waited. I dunno. All I do know is that I'm going to be approaching an $8,000 medical bill so I can see.
UPDATE: Boy was I off. Turns out that my grand total for everything (at least I hope this is the end!) is $9472.63. Yikes.

ABRASION: I hesitate to talk about this because I seriously don't want to dissuade anybody from getting cataract surgery if they need it. My second surgery was flawless. After four hours or so, I felt the anesthesia wearing off. They tape your top eyelid over your lower lid so your eye doesn't dry out. That stings a bit, but is seriously no big deal. Once I could feel my eye moving again, I took off the tape, put medicine drops in my eye and... milky vision! But by the end of the day I was already seeing. In the morning I woke up and had perfect vision. Wonderful. This is the typical experience. My first surgery, however, was not typical. When the anesthesia started wearing off I was in horrible pain. Like I had been stabbed in the eye. I took the tape off and my eye was stuck looking up and to the right. Very disconcerting. The pain eventually lessened, but I was not comfortable. The next morning everything was blurry. I couldn't see out of that eye at all. In the morning when I went to my post-surgery checkup, I was told that my eye had somehow gotten an abrasion and three layers of my eyeball were scraped off in front of my pupil. Of course I never felt it happen during surgery since the side of my face was deadened. I was told that the eye has rapid healing, and I would 3 or 4 days. It took 7 days. After that I've had days where my eye goes a bit blurry. As of right now, I am still suffering from "Recurrent Corneal Erosion" because the new cells forming to heal my eye sometimes get stuck to my eyelid at night as my cornea swells, but that's being treated and I should eventually be just fine. UPDATE: I was prescribed some gel of some kind which reduced the swelling of my eye at night so my cornea could have a break and fully heal. That's all it took! Now everything is back to normal and I'm seeing perfectly. Amazing!

FLOATERS: I've had loads of floaters for decades. It doesn't generally bother me... until it does sometimes. I was told that the presence of floaters wouldn't change from what I had been experiencing except they would likely be more in focus. I can't really say for sure if that's true or not. It feels like it could be true... but since absolutely everything is more clear now, it could just be more of the same. What I can say is that because my vision is more clear, any disruption to that clarity is very noticeable once I see it. Floaters. A smudge on sunglasses. Something in my eyelashes. I can't unsee it. I have to take care of it ASAP or go crazy. But short of replacing your eye fluid via surgery, you can't "take care" of floaters. I am guessing that eventually it won't drive me as crazy on those occasions that I notice them. In the meanwhile? It's worst when working on my computer and that's kinda problem. I have a hard enough time concentrating... especially when working.

THE STUPID! This last one is all on me. Reaching up to take off my glasses before hopping in the shower or going to bed. Coming very close to poking myself in the eye because I think I have contacts in. And here's the thing: you really, really don't want to be poking yourself in the eye for a week or two after surgery. It takes your eye a while to heal, and doing damage by rubbing or poking it is something you definitely don't want to do. I have no idea how seriously you can cause problems, but I honestly didn't want to find out. My constant worrying was ultimately enough to stop me from doing damage, but it's hard to fight against instincts you've built for decades.

And thus ends my accounting of my cataract surgeries. Hope it was as fun for you as it was for me.

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Lens Replacement Theory: Part Four

Posted on June 6th, 2024

Dave!I'm talking about my cataract surgeries! If you missed Part One, you can find that here. And if you missed Part Two, you can find that here. And you definitely need to have seen Part Three, which is all about the surgery, which you can find here.

But today we're talking about after the surgery (Spoiler Alert: I could not be more thrilled with the results).

That first day you wake up after your second surgery when both of your eyes have had their lenses replaced, prepare to be in shock if you had a heavy eyeglasses prescription like I did. You open your eyes and... the world is in focus! You can see! It's definitely weird. But even weirder? It's kinda been messing with my head when I'm trying to fall asleep. Since I had been taking my glasses off before my head hits the pillow for decades, I think my brain uses that as a clue that it's time to start falling asleep. But now that everything is in focus when my head hits the pillow, my brain is still thinking that I'm not ready to sleep because I can see. No idea how long it will be before my brain understands that this is not how it works any more, but hopefully it's not too long.

But the strangest thing by far post-surgery is how I'm perceiving things around me. I thought that cataracts were only affecting my night-vision. Not being able to drive at night was what pushed me to get things fixed, after all. But I had no idea whatsoever that my day vision had been compromised. Badly. This was most obvious when I had only one eye's lens replaced. This is an (exaggerated) simulation of what I was seeing when I switched from one eye to the other...

Yellow-ish vision vs. Blue-ish vision!

My cataract eye looked dingy and yellow. My fixed eye looked cool, crisp, and blue-toned.

And then it hit me... my progression to dingy yellow vision happened over a long period of time. And my brain just kept remapping colors so that white still appeared white in my head, even though it was no longer very white at all. So once one eye got fixed, all of a sudden I was seeing white as being truly white in that eye. And since my brain had remapped color, it appeared blue-toned because it was no longer yellow-tinted.

Once my second eye got fixed, I had no way to compare what I had been seeing to what I was seeing after surgery. But the re-re-mapping must have already begun, because I wasn't seeing everything as if it had been blue-shifted. I did, however, see white as being very, very white. My toilet was frickin' gleaming!

Right now I'm kinda in-between. In another week once I've forgotten what my dingy eyes used to see, and my brain has finished re-re-mapping colors, I'm guessing that everything will settle down and my normal will be back to... well, normal... again.

One thing that I hope won't be going away any time soon is the clarity of what I'm seeing. My glasses were very thick, so there was a distortion to what I saw. And because there was refraction and grime and dust accumulation going on, I never saw things with any real clarity (though it was better than what I got out of multifocal contacts, because they weren't sliding around with every blink). I watch television now and, day or night, a 4K picture makes a big difference. It's so noticeable that when I look at SD (standard definition) content, it just doesn't look crisp to me any more (even though my television upscales and sharpens it). Never used to bother me, now it does.

And now a bit about my lens choice...

As you may remember in Part Two, I had to make a choice as to which lenses I'd get implanted. I opted for the Multifocal 2-Zone lenses because I didn't want to rely on glasses like I would have to with a monofocal lens, and was concerned with losing contrast which was more likely with a 3-Zone lens.

NEAR-VISION: I used to wear progressive bifocals to see near-to-far. I was told that with Multifocal 2-Zone lenses my clarity of sight would begin at 24-28 inches. I figured this would cover most of what I'm trying to see... 95% minimum. For that remaining 5% I'd just buy some reading glasses. So long as I could glance between working on my laptop and looking at my television without issue, I'd be fine. I was concerned about using my mobile phone since I do that a lot and I generally hold the phone fairly close. Turns out I had nothing to worry about. I can see my mobile perfectly if I hold it just a little bit further out (but not comically far away). To make it even less of an issue, I switched my iPhone to large-sized, bold dynamic text and turned on "Display Zoom." Anything closer than 18 inches is too blurry to be much use but, for me, that zone of 18-to-26 inches is okay, 26 inches to infinity is flawless. The only time it's been an issue is when I got a sliver in my finger and couldn't see to pull it out because I didn't have any readers handy. Guess I need to start stashing them everywhere like I do with tape measures.

BRIGHT LIGHT: Interesting to note that the lights in my house seem much brighter to me when it's dark out. It's like replacing a 75-watt bulb with a 100-watt bulb. At least it would be if my lights weren't all LED now. That will take some getting used to because not all my lights have dimmers on them.

CONTRAST: I am thrilled to say that, in my specific case, contrast is actually better than it was before my surgeries. Probably because everything is so much more clear and not because I'm actually getting more contrast. After my first eye was fixed, I would spend a lot of time comparing how I was seeing out of one eye vs. the other. There was no contest on contrast. After worrying so much about the risk of losing some of it, it was bizarre to find out that there was improvement. I went out walking around three nights in a row, and it was always the same... left eye in glasses: blurry mess where it's hard to pick out details... right eye after surgery: crisp with good definition. I know this won't be the case for everyone, so I feel fortunate. It does kinda make me wonder if I should have gone for the 3-Zone lenses after all. But no regrets. I love what I have, and feel good in my decision to go the more cautious route (because it's not like you can just swap for a new pair of lenses).

HALOS: When it comes to bright lights in darkness, yes there are halos that appear. But it's nothing compared to what I was seeing with cataracts. No more big blurry blobs dancing across my vision and obscuring my sight. I can watch movies in a dark room. I'm no longer afraid to drive at night. It's a huge plus. Yes, there's still glare, but I'm told that as my brain starts to adapt it will lessen more and more.

So... that's all the pros of my cataract surgery... are there any cons? We'll find out tomorrow!

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Lens Replacement Theory: Part Three

Posted on June 5th, 2024

Dave!I'm talking about my cataract surgeries this week! If you missed Part One, you can find that here. And if you missed Part Two, you can find that here.

So... I've consulted with my doctor. I've consulted with the cataract clinic. I've selected my lens. I've selected the paralyzing injection. I've wiped out my Health Savings Account. Time to operate!

But first, a warning: so that you always have an operational eyeball, most cataract surgeons will not operate on both of your eyes on the same day. You'll get your worst eye done, then come back in a week or two to get your other eye done once you've healed up. If you have insurance which has an annual deductible, be absolutely sure that both of your surgeries and your follow-up appointments will be in the same deductible year, or else you'll be starting over and end up paying more money!

As I mentioned yesterday, I opted for the paralyzing injection so I'd be sure my eye wouldn't move during surgery. Once I've had my injection, my eye got taped shut so it doesn't dry out while I was waiting to go to the ER. They sat me in a comfy lounge chair where I was hooked up to a heartbeat and blood oxygen monitor. Both times I very nearly fell asleep.

Once I was in the ER, I was seated in another comfy chair and reclined until I was almost laying flat. They then taped a drape over my face and cut out the part over the eye getting operated on. They removed the tape forcing my eye closed, clipped my eye open, then irrigated it with saline until my surgeon arrived.

I truly wish that I could have gotten a DVD of my surgery, because it sounds fascinating (you can see surgeries and animations of surgeries on YouTube if you are interested).

A small incision is made into your cornea on the side that's closest to your ear. Then the surgeon inserts an ultrasonic wand to pulverize the lens that's in your eye so it can be sucked out in tiny pieces with a teeny-tiny vacuum. I heard a bunch of weird noises during this whole ordeal, as you can imagine, but I didn't feel anything. There was a bright light shining in my eye, so I couldn't really see what was going on either. It was just a bunch of shapes moving around.

The new lens is rolled up in a syringe, which they then insert into the incision. The doctor shoots it in the empty cavity, then it flattens itself out. The entire surgery took about ten minutes each time. But all told, I was probably at the clinic 90 minutes each time.

After surgery they tape your eye closed since it will still be paralyzed for 3-1/2 to 4 hours and you don't want it drying out since you can't blink. I was not able to feel most of the side of my face, including that side of my forehead to the top of my head.

Once you feel your eye waking up, your upper eyelid will hurt a bit because it's taped over your lower lid. With my first eye surgery, I assumed that this meant it was time to take the tape off. I was wrong. My eye was stuck looking up and off to the side! I am not embarrassed to say that it freaked me out a bit. I looked like a literal zombie. This isn't a big deal... you'll just be seeing double until your eye drifts back to being in sync with your other eye, and you'll have to keep douching your eye with saline until you are able to blink again.

They have to dialate your eye for days (literally, your eye won't be normal again for 2 to 3 days!), so be sure to have sunglasses handy if your clinic doesn't provide them to you.

Depending on the policy of the clinic you go to, you'll either be given a blend of medicines in a single eye drop bottle... or be given different bottles of individual medicines. This helps your eye heal and keeps it free from infection. I was instructed to use the single-drops I was given 4 hours apart from when I first wake up until they're gone.

Other than the drops, I was given two instructions: 1) Do not rub your eye, especially over where the incision is made, and 2) Do not get your eye wet.

And that's surgery. It probably sounds more scary than it is. Fortunately, I had an amazing clinic with amazing staff and amazing doctors and an amazing surgeon, so the entire ordeal simply wasn't a big deal to me. But I've had so many eye surgeries and procedures that it was just more of the same. I'd like to think that if you get an amazing clinic and staff, it won't be a big deal even if it's your first eye surgery.

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Lens Replacement Theory: Part Two

Posted on June 4th, 2024

Dave!I'm talking about my cataract surgeries this week! If you missed Part One from yesterday, you can find that here.

The first step in addressing your cataracts is to have a consultation with an expert. There are choices you'll need to make and, while you can read about this stuff on the internet, you really need to talk things over with somebody who can guide you to the best options FOR YOU... not for some random social media influencer or YouTuber or (most definitely) me.

CHOICE #1: Which lens is right for you? During the discussion with my doctor, I was given four options...

  1. Monofocal Distance. You can see things far away, but near-to-mid-range vision will require glasses.
  2. Monofocal Near. You can see things close-up, but mid-to-far-range vision will require glasses.
  3. Multifocal 2-Zone. You can see things from about 24 inches away to far away, but near vision will require reading glasses. Some halos and glare possible. Diminished contrast possible.
  4. Multifocal 3-Zone You can see near to far without glasses. Halos and glare more probable. Diminished contrast more probable.

Thanks to the shitty state of "health care" in America, the cost of the lenses will likely factor into your decision depending on your insurance. My insurance would only cover monofocal lenses (outside of whatever deductible I had left, of course). Any other lenses would be 100% my responsibility to pay for (though the surgery itself is still covered). If I wanted multifocal lenses, they are $2,900 each... $5,800 for the pair!

Now, my first instinct was to skip right to the Multifocal 3-Zone lens. No more glasses at any distance? Sweet! But I work as a graphic designer and love photography. The idea of losing any contrast in my vision scared the shit out of me. Would I even be able to do my job any more if I lost contrast? This is mostly a factor in low-light conditions, but it can creep into any situation because the light entering your eye is split between three focal zones. Most people in most situations would be fine with that. But after telling the doctor my concerns, she agreed that I'd be "safer" with the 2-Zone lens because the light is only split between two focal zones. This gives me the best compromise between not wanting to wear glasses and preserving the most contrast in my vision. Since these lenses are going inside your eye, it's not like I could replace the three-zone lenses easily or cheaply, so better safe than sorry.

Pacific Cataract and Laser prefers Alcon brand lenses, and their 2-Zone lens is called AcrySof IQ Vivity. I, of course, read reviews and experiences online from people who had this lens implanted, and no red flags were raised. Yes, there were a few people unhappy with them, but those were outlier opinions that didn't match what the vast majority of people were saying.

CHOICE #2: Which anesthesia is right for you? Which, to me, wasn't a choice at all, but I'm not everybody. I was given two options...

  1. Paralyzing Injection. Let's just cut to the chase... they stick a syringe full of paralyzing solution via a small needle under and behind your eyeball to paralyze the muscles which allow you to move your eye (which also removes your ability to blink). I heard this and was like "SIGN ME UP!" Because it seems as though NOT HAVING YOUR EYE MOVING AROUND WHILE SOMEBODY IS CUTTING INTO IT IS A NO-BRAINER. Spoiler Alert: You feel a small pinch. That's it. The paralysis wears off about 3-1/2 to 4 hours after surgery. The only residual pain is from your top eyelid being taped over your bottom eyelid so your eye doesn't dry out while you're unable to blink. I also felt where they poked me a little bit for a few hours after the paralysis wore off. No regrets. Highest possible recommendation. Safer for you. Easier for your surgeon. 17 out of 5 stars.
  2. Topical Anesthetizing. I asked the guy injecting the paralyzing solution into my eye muscles why in the heck anybody would choose to not have it. His answer? Fear of needles. For people with that fear, they offer a topical anesthesia which makes it so you can't feel any pain while they're operating on you, and no needles are involved. I cannot fathom going this route. They offer an oral anti-anxiety drug for people to not freak out during surgery, but they give it to you before your eye is either paralyzed or anesthetized, so that may help you with the whole needle thing. I've done all this before, so I didn't need the drugs... but you should ask the doctor about it if you think you might need them.

And thats the end of Part Two. Tomorrow we operate!

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Lens Replacement Theory: Part One

Posted on June 3rd, 2024

Dave!Over a decade ago I was trekking through the Costa Rican rainforest when a branch snapped back on my face and cut into my eyes. This caused a series of problems with my eyes and eyelids, and I had a half-dozen procedures and minor surgeries over the years because of it. And now I've had two more so I could get the lenses replaced in my eyes. I decided to write about it in case anybody out there is curious about cataract surgery.

A couple years ago my optometrist had told me that cataracts were starting to form in my eyes and I would need to eventually have surgery to improve my vision. As we age, the lenses that focus light on our retinas can get discolored, cloudy, or both. Called "cataracts" they negatively affect normal vision because it obscures and changes what we see.

Recently it's gotten increasingly difficult for me to drive at night. There's a weird glare from headlights that's uncomfortable. Not to a dangerous degree, but certainly enough to keep me from driving after dusk. But even more critical? Watching movies in a theater or at home when the screen is bright and the room is dark was not a great experience. That was something I couldn't deal with.

And so at my last appointment my doctor and I talked about it, and she said I met the criteria for getting cataract surgery now.

Long story short if you want to skip the next couple days...

  • My overall surgery experience was excellent, which I'm told is typical.
  • They fix one eye at a time, so you always have one working eye while the other eye is impaired.
  • I had functional milky-vision four hours after surgery when I untaped my eye. Full vision was there the next day.
  • I am seeing better now than I have in a decade.
  • I selected multifocal two-zone AcrySof IQ Vivity lenses. I will explain why next entry. Be aware that while cataract surgery is covered by most insurance plans (with or without routine vision care), only the basic lenses are covered. Fancy two and three zone lenses are most likely not covered at all.
  • Yes, it's freaky having your eyes sliced into. Maybe it's because I'm so used to dealing with eye surgery stuff that this didn't faze me, but it seriously wasn't a big deal. I understand that many people will be afraid to have cataract surgery even if they need it because the mental game can be overwhelming. If that describes you, I'd urge you to at least look into it. They can give you relaxing drugs and there are options that will make it not so terrifying for you.
  • After being recommended by my amazing eye doctor, I selected Pacific Cataract and Laser in Bellevue, WA for my surgeries. Cannot possibly tell you how thrilled I was with them every step of the way.
  • All in all, cataract surgery has improved my life for the better and I highly recommend it to those whose vision is being compromised from cataracts.

Tomorrow I'll talk about my lenses and the surgery itself.

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