Post #14: Second Surgery Day - August 26, 2020

First thing in the morning today I went in for cataract surgery on my weak/non-dominant left eye. If you have been reading my earlier posts you will know that I had my dominant right eye done back on June 24th. For various reasons, I opted not to have the second surgery at the first available time afterwards (July 22nd) and instead chose to have the second surgery done a full two months after the first surgery. I know it's typical for the second surgery to occur 2 weeks after the first and that most eye doctors prefer to do the weakest eye first (instead of the way I did it) but as it has worked out, I'm really glad that I had a full two months between surgeries and that I had my strongest/dominant eye done first. I'll explain why later in this post.

Just like the first time, the surgery went very smoothly with no issues at all. Dr. Mitchell was very smooth and efficient in his procedure and I don't think the procedure lasted much more than 5 minutes. Certainly no more than seven.

If you read Post #2 in this series you will learn that all I could see out of my fixed (right) eye a few hours after surgery was shapes/areas/blobs of light and dark and colours with almost no detail at all. I created an image in Post #2 to illustrate what I mean. This time, it was much different. Right out of the OR I could see much better than that out of my newly operated on left eye. Everything was a little blurry but it wasn't bad and I could see much more detail right off the bat than I could through my right eye when the first IOL went in.

After the operation (which again was at the old Holy Cross Hospital for Calgary people) I was told to go straight to the Mitchell Eye Centre for a quick checkup. During the checkup, they give you a quick vision test on the newly implanted eye and do a close-up examination using a machine to light up and magnify the interior of your cornea so they can check to make sure the IOL is sitting and centered properly in there. When I had the vision test done right after surgery on the right eye, I tested a dismal 20/140. My vision in that eye with the cataract was 20/40 so my vision was far worse right after surgery than it was just before.

With the left eye, things were entirely different. My pre-surgery vision was 20/70. One and a half hours after surgery my  left-eye vision checked out at 20/40. That's a nice improvement from 20/70 and hugely better than the 20/140 score I got with the right eye about the same amount of time after surgery. I don't know for sure why my vision an hour-ish after surgery was so much better after the second surgery vs the first surgery but it may have something to do with the fact that my brain had already neural adapted to that IOL on the right side so maybe some of that adaptation was able to be transferred over to the left side right away. I'm not a neural scientist and don't know much about how the brain works and adapts to various stimuli so I really can't give any credible explanation about why things were so different and so much better after the second IOL went in vs the first. All I can do is report what I experienced and that is what I'm doing.

The really good news is what's happening with my right eye. After they finished testing and examining my left eye, I asked if they could give me a quick vision test on my right. They were happy to accommodate me. I went 5 for 5 on the 20/20 (6/6 in metric) line and it was easy. I saw every letter quite clearly and didn't have to struggle on any of them. I then asked them to go to the next (20/15) (6/4.5 in metric) slide because I thought I could maybe read it but the technician said they didn't have that available. Bummer! I guess they figure that once they can establish you've got 20/20 they don't need to go any further. But from my point of view I want to know that, if only for boasting rights.

In hindsight now I am really glad I chose to have my surgeries spaced 2 months rather than 2 weeks apart and that I chose to have my good/dominant eye done first. If you go back and read my earlier posts , you will see that I wasn't seeing all that well through my right eye 2 weeks after the first surgery. My near vision was pretty good but the mid-range and far vision wasn't very good. It took me closer to a month to start getting really good vision in all ranges on the first eye. Had I had the second eye done after just two weeks, I would've had pretty poor overall vision for a couple of weeks until I got neural adapted on my right side.

After living with having very good vision in my right/dominant eye and poor vision in my left/non-dominant eye, I think my right eye became even more dominant and my brain was filtering out almost all input from my left eye when I was looking at things with both eyes. This is evidenced by the fact that just before the second surgery when I was looking at my computer screen, I was seeing the type on the screen very clearly with both eyes open. When I covered my good/fixed right eye however, and just looked at the monitors with my crappy cataract afflicted left eye, it was so blurry and there was so much double/ghost imaging I couldn't read any of the text. With both eyes open, however, I saw the text every bit as clear as I did as when I covered my left eye and looked only through my (fixed) right eye. Obviously, none or almost none of the input from my left eye was being used because my brain was filtering it all out.

So when the second lens got put in, I wasn't using the input from the left side anyway so nothing seemed to change with my vision right after the second lens got implanted. My vision was still excellent and clear because my brain continued to rely on the side it had already neural adapted to for almost all of what it was seeing so it didn't matter that I was dealing with an entirely new lens on the other side. And because my newly implanted left eye wasn't seeing too bad right after surgery, I actually had good depth perception right away. My vision with both eyes open right after the second surgery was so good that as I was being driven home post-surgery, I remarked to my friend who was driving me that I could easily have driven myself home just as safely as I could've the day before. My overall vision and depth perception was at least as good if not better than it was right before the surgery. Everything was perfectly clear because I was still seeing mainly through my neural-adapted right eye and I had as good or maybe even better depth perception than I did before as my vision had just improved from 20/70 to 20/40 in my left eye.

I don't think the transition from having one eye done to just having the second eye done would've been near as smooth and easy if I had chosen to have my weak/non-dominant eye done first and if I had the second surgery only two weeks after the first. Now everybody is different and will neural adapt to their multi-focal IOLs at different rates but this is what I experienced and what my thoughts are based on that experience. I hope this information and these insights are useful for people who are contemplating having IOL replacement surgery.

Postscript: During the surgery, Dr. Mitchell said I will likely neural adapt to the second lens more quickly than I did the first and that my vision in both eyes will continue to improve for up to a year after the IOLs were implanted. I already have very good vision at all distances and I'm already crushing the 20/20 (6/6) line with my right eye. Hearing that my vision still may improve makes me very optimistic for the future. Who knows, maybe 20/15 (6/4.5) in both eyes is a possibility? Wouldn't that be a splendid result!  👀

Dr. Mitchell was also surprised to hear that I have really clear and detailed near-field vision in my right eye down to 20 cm (8 inches). Typically, the closest people can focus with the Lentis MPlus IOL is 30 - 40 cm (12 - 16 inches). He says I'm a bit of an outlier in that respect. I'm stoked about it because it means there's a good chance I'll be able to thread a needle, and more importantly, tie my little fly hooks on the leader without the aid of reading glasses/magnifiers. That's something I haven't been able to do for close to 20 years! Keeping my fingers crossed on that one.

Post #13: Update: 9 Weeks after Surgey - Aug 25, 2020

Well, tomorrow I go in for surgery on my non-dominant/weak left eye and then I will begin the journey of neural-adapting to that lens. I can't wait to see how clear my vision is when I can look at something with both eyes open and have clear images reporting back to my visual cortex from both eyes.

An interesting thing happened with my vision while I was away 3.5 weeks on vacation. Before I left, I was seeing the text on my desktop computer monitor fairly clearly. My eyes would be about 70 - 90 cm (~28 - 36 inches) away from the monitors when using that computer so that would be in the near mid-range. After nearly a month of staying off the computer except for very brief periods of time on rare occasions and not spending much time focusing on things in that range, I could not get a good focus on the monitors for an entire week after coming back home. Even with my bad eye closed I was seeing double text which told me that I was seeing images of the text from more than one part of the IOL and my brain could not figure out which image to filter out and which to focus on. I had lost my neural adaptation to seeing at that distance due to lack of practice.

After a whole week of working on the computer, I'm finally getting it back and now see the text on the monitor much clearer and no double images, Correct that. I do get a very faint double image if I look at the text with both eyes open but see only a single image of the characters if I close the bad eye. I can't even begin to read the text if I close my fixed (right) eye and look only through my cataract riddled weak left eye. These things tell me that with both eyes open, my brain is taking a little input from my left eye but is filtering out almost all of it and almost all of the image coming out of my visual cortex is from my right eye. 

It will be interesting to see if I neural adapt faster to the new lens about to go in my left eye than I did to the first lens that went in my right eye. Will the adaptation process be fast-tracked because by my brain transferring what it has learned about how to use the lens in my right eye over to the left eye once the change is made? Or will the process of neural adapting to the lens in the left eye take about as long as it did with the first eye because both sides are independent so the exact same adaptation process has to be gone through on both sides? 

After having gone with the vision in my fixed stronger/dominant eye so much better than in my cataract buggered weak/non-dominant eye for two full months, I suspect that right now my brain is using all of the input from the good eye and filtering out almost all of the input from my bad eye. In other words, I suspect this has made my dominant eye even more dominant than it was before. The question is then, what will happen as I start to neural adapt to and get good vision from the weak/non-dominant eye after tomorrow's cataract surgery? Will my right eye still stay as dominant and will my brain continue to filter out almost all input from my left eye and only look at the input from my right? Or will my brain start to utilize more input from the left and the balance of what input from what eye gets processed/used start to balance out over time and what will that balance be after I've fully neural adapted to both IOLs? These are very interesting questions and I intend to try and answer them in the coming weeks and months. 

The other big question is whether the effects the IOL is (the effects the IOLs are after tomorrow) having on my night vision begin to diminish over time? I hope so, because night vision in my fixed isn't very good yet after 2 months. I will write more about this issue in a future blog. Stay tuned!

Post #12: Progress Update 6 Weeks after Surgery - August 3, 2020

Things have progressed well with the vision in my right eye over the last few weeks. I am now getting very good focus at all distances and my brain seems to have really figured this IOL out. I can quickly change from looking at objects in one range to looking at objects in another and whatever I shift my focus to comes pretty much instantly into focus.

For example, I can be sitting up on a deck looking at the palm of my hand 15 - 20 cm (6" - 8") away and I see every little line and detail in my hand in very sharp focus with very fine detail. I can then look over my hand at the deck railing about 1.2 - 1.5 m (4' - 5'0) away and instantly, the railing appears sharp and focused. My hand now appears out of focus as are objects off in the distance that are visible through the rails. If I then shift my focus on some object 40 - whatever m away off in the distance that I can see through the rails, those objects come nearly instantly into focus and the rails which I was just focusing on, now appear slightly out of focus in the foreground. If I switch back to focusing on the rails or my hand again, whatever I want to focus on, comes nearly instantly into sharp focus. And no matter what the range is, I'm getting a very sharp focused image with amazingly fine detail.

Sometimes, when I close my bad (unfixed) left eye and look at something at whatever distance with with my right eye only, I will notice that just for a fraction of a second that object may not appear to be in perfect focus and then, all-of-a-sudden, it is in perfect focus.

These things tell me that my brain has neural adapted to this IOL so well that no matter how close or distant something is that I shift my gaze to is, my brain knows virtually instantly what part of the signal on the retina to process and which parts to filter out in order to get the sharpest possible image. To me, it seems remarkable that our brains are so resilient and adaptable; that Doctors can rip out the optical lenses of our eyes that we have lived with and gotten used to for several decades and replace it with a new lens that's completely different in EVERY way and even if we are older, our brains can completely adapt to and master that lens within just a few short weeks.

So I think at this point, it's safe to say that the question of whether I could neural adapt to and see well at all distances with the Lentis MPlus IOL during the daytime has been answered. Yes I have and I can. The next big question is whether the haloing, starbursting and glare effects I'm getting at night (especially when driving) are going to diminish over time. I will begin to address that part of the equation in future posts. 

In the meantime, I'm scheduled to have IOL replacement surgery to fix the cataract in my left eye on Aug 19th. I will be having another Lentis MPlus IOL implanted into that eye as well.