Saturday, June 27, 2020


Post #4: Surgery Day - June 24, 2020

Surgery Day - June 24, 2020

As soon as I first arrived at the waiting room, thee staff there started giving me eye drops. I think they were dropping in 5 different kinds of drops and they came around and dropped them in about four or five times a few minutes apart. Not sure what they were all for but at least some of them were intended to dilate my pupil. They worked.

I was then shown into another waiting room where I was sat in a reclining dentists type chair where they took my blood pressure and gave me more drops. I was offered a sedative if I wanted it but I wasn't apprehensive at all and declined the offer. When it was just about time for me to go in for the surgery, the anesthesiologist gave me some xylocaine infused anesthetic drops. I was then led into the operating room and told to lie on a bed/table.

The Surgery

Cataract SurgeryThe whole procedure only lasted a few minutes. I chatted with Doctor Mitchell all the way through it asking what he was doing at the moment and finding out a little about the history of cataract surgery. Doctor Mitchell, has been doing cataracts and other eye surgeries since 1980. Talk about experience! I consider myself lucky to have had one of the most preeminent, reputable and experienced eye surgeons in the city of Calgary and I daresay, all of Canada. Dr. Mitchell had no idea how many cataract surgeries he had done in his career (it has to be several if not into the tens of thousands) but during our conversation, Dr. Mitchell did say that he had installed at least 3,000 of the Lentis MPlus IOLs which I was getting and had almost zero complaints of unacceptable results with those lenses. I will be blogging about those lenses and why I chose to go with them over the other types that were available to me in a  later post.

All I could see during the surgery was two or three bright lights from the Doctor's microscope. They seemed to move around a bit during the procedure; sometimes from side to side and other times in a circular motion. The video below is not of my surgery and does not involve the insertion of the same type of multi-focal IOL that I had implanted but the basic procedure is the same so the video will give you a very good idea of how my cataract was removed and the IOL was inserted in its place.


In a few minutes Dr, Mitchell was done his work and said everything had gone quite smoothly. No hitches at all. I then went to another room where I was given a kit bag with a pair of sunglasses and a clear plastic eye shield to cover my operated on eye while I sleep. I was given instructions about using the three types of eye drops I had been prescribed, told not to shower or get water in my eyes for 48 hours and told not to sleep on my right side which was the side that was operated on. I had to chuckle about that last request. Sure, I can make sure I lie down on my back or left side while I'm awake but once I fall asleep all bets are off as to which side I may turn over onto. Fat chance my subconscious sleep/dream-state mind is ever going to remember not to roll over onto my right side!

After leaving the medical building (the old Holy Cross hospital), I had to go down to the Mitchell Eye Centre for some post-operative checks. They gave me an eye test which I didn't do well at because everything was pretty blurry out of my right eye and they checked the pressure on my cornea which they said was good. My eye was also examined through some sort of magnifying scope and I was told everything looked good in there. The IOL was in the right place and everything looked normal.

By the time I arrived at the Mitchell clinic for the check-up, the anesthetic had started to wear off in my eye. I was starting to feel some discomfort there - like my eye had been scratched or a piece of grit was lodged under my eyelid.  I was told this was all pretty normal and that the discomfort and the blurry vision might continue for a couple more days.

Here's a video of a cataract surgery that I think was pretty similar to mine in terms of procedure. The type of multi-focal IOL inserted in this video is different than what I had installed. They all go in the same way though.

A Few Hours After the Surgery

Later on that evening, I tried looking around the room I was in through just my right eye. I could see shapes and colours but it was as though everything had been put into very soft focus and most detail had been removed. Here's an image of a room full of objects I pulled off the Internet. Following that is my Photoshopped rendition that more or less shows what I was seeing out of my right (operated on) eye that evening.

room full of objects

Here's kind of what it looked like to me looking out of my operated on eye a few hours after the cataract surgery:

Room full of objects blurry

Thursday, June 25, 2020


Post #3: Why I Chose the IOL I Chose

When I finally realized that I had cataracts and that my only option for improving my vision was IOL replacement surgery, I started researching the various options that were available to me and learning the pros and cons of each type of IOL.

Mono or Multi-focal?

Being that I had cataracts and not just Presbyopia, that meant that our socialized healthcare/medicare system would pay for the IOL replacement surgery up to a point. Medicare would pay for all of it if I were to go with a basic monofocal lens. Such a lens would allow me to see very well at distance but for anything within about 2 m, I would need glasses or contacts. I've heard of people choosing one multi-focal IOL optimized for distance vision in one eye (the dominant eye I think) and one that's better for mid-range in the other eye. Intuitively, it seems that would require more neural-adaptation than having both lenses the same but it might give you more range in your vision. On the other hand, both of these options still require you to wear glasses or contacts, although maybe you'll only need a pair of magnifiers/reading glasses for the close-up stuff.

The upside on that type of lens was that they're reportedly easier to neural-adapt to and "reportedly" cause less issues with night glare, halos and starbursting than multi-focals although I've been told by at least one person who got monofocals that they had these night vision problems as well.

The bottom line for me though was that no matter which way you go with monofocals, you still need to wear glasses at least some of the time. I never wore glasses for anything until presbyopia started setting in during my 40s forcing me to have to use readers/magnifiers for close-up stuff. I don't like wearing glasses and I don't want to wear glasses for anything if I can help it so monofocals were definitely out for me.

Which Multi-focal Should I Choose?

That left me with having to decide which multi-focal I should go with. There are a lot of them out there to choose from. The choice is made somewhat easier, however, because not all multi-focals that are approved and in-use in other parts of the world like Europe (where the selection of available multi-focal IOLs is incredible) are approved and available for use in Canada. From what I learned when doing my research, some lenses which are approved in the US are not approved in Canada and some that are approved in Canada are not approved in the US. Typically, however, it's generally cheaper and easier to get an IOL approved in Canada than it is in the USA so a lot of lenses become approved and available for use in Canada well before they're approved and in use in the USA. This was the case with the Alcon Acrysof Panoptix tri-focal lens. This lens received US FDA approval in late 2019 whereas it was approved and in use in Canada a few years before that.

After doing some research, I learned that the multi-focal lenses that were available to me here in Canada are as follows: (Note: there may be others but these are the ones I know about)

Alcon Acysof Panoptix - A concentric ring tri-focal IOL.

PhysIOL FineVision - Another concentric ring tri-focal IOL similar to Panoptix. In Canada, this lens is marketed by optics giant, Bausch & Lomb.

Zeiss AT Lisa 809M - A concentric ring bi-focal IOL.

Bausch & Lomb Crystalens AO - An accommodating IOL. This means that rather than try to give an IOL multiple focal lengths by giving different parts of the IOL different refractive properties, an accommodating lens allows the eye muscle to flex the IOL to change its focus from far to near, etc., in much the same way as your natural lens works.

Oculentis MPlus MF30 - A fully rotational asymmetric multifocal IOL. This IOL has a very unique design that is not at all similar to any of the above concentric ring IOLs or the Crystalens AO. Below are pictures showing what the MPlus MF30 looks like compared to a concentric ring IOL.

Oculentis MPlus MF30 (Tri-focal IOL)
MPlus MF30 IOL

Concentric Ring Tri-focal IOL (FineVision)

FineVision IOL

As you can clearly see, the two lens designs are very different from each other.

After having my first thorough eye examination at the Mitchell Eye Centre, I got to discuss the results and options with my surgeon, Dr. Mitchell. Dr. Mitchell told me my eyes were in excellent health, and due to their shape, would likely see very well once the cataracts were replaced by new clear IOLs. He said I would likely do very well with any lens but he was recommending either the PhysIOL (Bausch & Lomb) FineVision or the Oculentis MPlus MF30. When I asked him what other options there were and what he was familiar with, he said he was also very familiar with the Zeiss AT Lisa Bi-focal and the B&L Crystalens AO having implanted hundreds of them many (like up to more than 10) years ago. He said everybody was implanting the Crystalens AO back then but as far as he knew, nobody was now. He also said he didn't recommend the Zeiss AT Lisa because they simply didn't give as good and as consistent results as either the FineVision or the MPlus and so for the last several years these have been his go-to choices. 

When I asked him about the Alcon PanOptix tri-focal, he said he hadn't implanted any and thought it was pretty much the same thing as the FineVision, owing to the fact that the two lenses have pretty similar designs. He never saw the need for switching over to using the PanOptix because he was getting such good and consistent results with the FineVision so he was more comfortable staying with what he knew worked well and produced very few complaints from patients. I thought of asking him if he would implant the PanOptix if I said I wanted it but I decided not to because I figured the guy's been implanting IOLs as long as anyone on this planet has and had literally implanted 1000s of them so he obviously knows a lot more about it than I do. As such, I don't know what he would've said if I had asked for the PanOptix.

The other reason I didn't ask him if he'd consider implanting the PanOptix was because up until that meeting, I hadn't heard of the Oculentis MPlus and was very curious to do some research on them. I also wanted to do some more research on the PhysIOL/B&L FineVision because I hadn't looked into those much either. No sense asking him if he'd consider implanting something he hadn't recommended when I didn't know enough to be picky about what he was recommending.

The Two Finalists and Why I Chose the One I Did

I will finish this section when I have more time.

Tuesday, June 23, 2020


Post #1: What is About?

Eye Photo


This blog will document as much as possible about my journey through the various stages of cataract (intraocular lens (IOL) replacement) surgery and recovery. I plan to document the diagnosis, testing, surgery, post-surgery and subsequent adjustment/neural-adaptation processes. I plan to document what it was like before I had the surgery, immediately afterwards and then also document the changes I notice at various times after the surgery so it will be possible for anyone who is contemplating undergoing IOL replacement surgery to see what they might expect to happen with their surgery.

I'm drawing inspiration from the excellent blog done by Alek Komarnitsky documenting his journey with cataract surgery and the Crystalens IOL which can be viewed  at and the excellent YouTube video blog series put together by Kurt V. documenting his experience with the Physiol FineVision Tri-focal IOL. In North America, that lens is marketed through Bausch and Lomb. A link to Kurt's first video in his extensive series is here.

If there's enough interest in this site, I'm also hoping that in time it may become a site where others can also blog/share information about their experiences with IOL replacement surgery so it will become a repository of people's shared experiences with the life-changing procedure. I will need some people to volunteer to help me with the programming in order to do that though. I can do some very basic website programming but something that sophisticated is definitely way out of my wheelhouse.

Who am I?

My name is Roger and I am a 58 (well, nearly 59) year old man who resides in Calgary, Alberta, Canada. Throughout most of my life I was blessed with excellent eyesight. I was the only one in my family who didn't have to wear glasses. My father had to wear glasses ever since he was a young child and I think my Mom did too. She had a weak (I think 20/70 or 20/80) left eye with bad astigmatism and both my older brothers had the same thing. Even my adopted sister had to wear glasses from childhood but that's neither here nor there since she isn't genetically related to us. For some reason though, I ended up with excellent eyesight in both eyes and never needed to wear glasses for anything. I don't know what my vision was back when I was young because I don't remember ever being tested. My eyes were good, I could see well so what's the point of getting a test done? Right? That's the way I always looked at it anyways. So if I had 20/15, 20/20 or 20/whatever vision in the past I'll never know. All I can say is that my vision was very good and I seemed to have no astigmatism, myopia or hyperopia.

Well, sometime in my 40s, things started to change. Presbyopia. That thing that happens to everyone's eyes where the lenses in their eyeballs become more rigid/less flexible and we start to lose our ability to focus on close-up things. I found that it was especially difficult to see things close-up or read fine print if the light wasn't perfect. That's when I started relying upon magnifiers/reading glasses for anything close-up. Distance vision was still quite good but the intermediate vision also started to become a bit of a problem. Ordinary drugstore magnifiers/readers don't seem to work well in that range so I struggled through with that part of my vision. That was problematic as I spend a lot of time on the computer for my work and also for personal interest and entertainment.

When did the Cataracts First Appear?

To be honest, I'm not really sure. I think a couple years ago maybe. I am a (North American) football season ticket holder and for all last season and maybe the season before, I had to use binoculars to watch the games where I could always see the plays and read the numbers and names on the players' jerseys without them before.

As far as all the other things like the multiple images, halos and starbursts around lit objects, I'm not really sure when they started to happen. I guess I'm so out of touch with things that happen with my body that I never really noticed that it was happening until all-of-a-sudden I did notice and these effects were already very prevalent.

The truth is, I didn't know what the symptoms of cataracts were. I thought that cataracts only made your vision hazy/foggy because your lenses get milky. I figured that what I had was just more advanced presbyopia. What I did know was that our health care system will not pay for any surgery to correct presbyopia because presbyopia is viewed as a natural part of aging like getting wrinkles and grey hair. I also knew I didn't have the money to pay for the surgery myself so I didn't even bother to see what treatment options there were for it.

The Awakening

I'm not sure if I knew or if one day I just heard that at least basic cataract surgery is covered under our healthcare system and then suddenly the idea just popped into my head to actually find out what the symptoms of cataracts were vs presbyopia. One two-second Google search later, I had the information at my fingertips and all-of-a-sudden I knew (or at least I was pretty sure) I had cataracts. 

I made an appointment to have my eyes tested by an optometrist and he didn't get very far into his testing before he just gave up and said, "I'm going to refer you to an Opthamologist for your cataracts. Come back and see me after you've had your eyes fixed."  That was earlier in 2020. I was 58 and as far as I can remember, it was the first time in my life I had my eyes checked by an optometrist. If they were ever checked before it was probably as a little kid standing in the hallway of a GP's office reading a standard eye chart at the end of the hall. If you could read one of the lower lines on the chart you were good to go and no further testing was needed. I certainly know I never had an eye test done during my teenage or later years until I finally went in to be checked at the age of 58.

To be told I had cataracts was actually good news because it meant I could get the eye exams and surgery completely paid for through our government healthcare plan if I just wanted to settle for straightforward mono-focal IOLs or I could get some of the eye exams and part of the surgery costs paid for if I wanted to upgrade to a premium multi-focal IOL. 

I wish I would have figured this all out a couple of years ago. Living with the bad eyesight I've had for the last year or more has not been easy. Among other things, it has caused or contributed to some physical problems I'm having with my back from having to lean in so close to the computer screen so I can see the text clear enough to read. I've been raising the font size on the screen to try and compensate but even with the font size increased quite a bit I still have to lean in close to see it clearly.

What is my Eyesight Like Right Now (Pre-surgery)?

Right now my eyesight is pretty bad. I see multiple overlapping and slightly offset images even with one eye closed. None of the images are all that clear either. Photography is one of my hobbies so I'm pretty good with Photoshop. This gives me the ability to create images that will give you a good idea of what I see when I look at things. Here's an example of what I mean. Not to long ago I was walking my dog down by the Bow River which I live close to. A bald eagle was flying down the river maybe 150 - 200 yards away from me. The sky was light overcast so the contrast between the darkly feathered bird and the uniform light grey sky was pretty high. 

This is what someone with "normal" eyes would have seen:

Soaring Eagle seen through "normal" eyes

This is what I saw with my Cat-o-vision. I knew it was just one bird as the wings on all three images flapped in complete unison.

Soaring Eagle seen through cataract eyes

But for all the problems I have with daytime vision, night vision is FAR WORSE. The other day I was sitting in an outdoor hot tub looking up at a full moon shining brightly in a clear dark sky. If I covered my left eye and looked just through my right, I could count at least 8 overlapped and offset images of the moon. A few of these images were brighter but many were dim ghost images. When I covered my right eye and looked just through my left I could count at least 5 images. With both eyes open I could count at least 13 overlapped and offset images of the moon but there may have been more.

This is what a person with normal vision would've seen:

Full moon seen through "normal" eyes

This is a representation of what I saw with my Cat-o-vision. The image I've constructed here shows 12 overlapped and offset moon images and gives you a very good idea of what it's like to look at a full moon with my cataract impaired eyes.

Full moon seen through cataract eyes

Night Driving

Driving at night is really tough so I try to avoid it as much as I can. When I do it, I really have to concentrate on what I'm doing. As I'm writing this, I'm  just one day away from having my first eye surgery done so hopefully, my problems with night vision and night driving are nearly at an end.

To describe what I see while night driving is a bit difficult because there is so much to say. I see multiple images of tail, traffic and headlights. I see large dense halos around red traffic and tail lights. The halos around green lights are there too but they're darker and not so dense. I see a lot of starbursting around on-coming headlights. 

This picture sort of tells the story but not exactly.

Night driving with cataracts

The differences between what is shown in this image and what I actually see are as follows:

Headlights: I see less numbers of starburst rays than are shown in this image but the rays I see are much longer. Instead of dozens of spiky starburst rays coming from the each headlight, I see maybe 5 - 10 but they are much longer. They would come all of the way from the car to or past me.

Traffic and Brake Lights: The halos I see around the red lights are about as large as shown in the image but they are less spiky/starbursty and more like dense round disks of red light surrounding a brighter red light in the center of the halos.

Despite the differences between what I actually see and what I've shown in the above image I've conjured, it still should give you a pretty good idea about what driving at night with cataracts is like. Now try to imagine what it looks like with a stream of several sets of brake lights up ahead at the stoplight and a stream of several cars with headlights on coming at you the other way. It's messed up!


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