Cataract Surgery for a High Myopia Monovision Patient, Toronto, Canada: Log

I am a high myopia patient wearing glasses, in Toronto, Canada, and it was time for me to have cataract surgery. As a monovision user I’ve long had one eye focused on near reading and computer work, and the other eye focused on far distance. This strategy has worked out well for me, with no perceived loss of function. Here’s my cataract intraocular (IOL) surgery journey notes.

IOL1 Day 0: Surgery day
Fasted for 18 hours, no drink, not even water the last 4 hours before surgery, and the prior 10 no more than 2/3ds of a cup of water. Of course no food. I had a one piece hospital gown over my clothes. As it was a rare 20C day I was in shorts and a short sleeve shirt. A sphygmomanometer BP cuff was put on my arm, and an IV line was inserted and taped to my hand.

At the hospital I asked for only local freezing and no sedative, but was told hospital rules required me to have sedative, so they gave me a baby’s volume. The surgery is only 15 minutes long. There was local freezing of the eye with eye drops, along with multiple blood pressure readings. The antibacterial/corticosteriodal drops I was asked to buy were dropped in. It took over 2 hours of waiting for my turn. I had a discussion confirming what was to be done with the eye surgeon, as well as the anesthesiologist. Two male nurses greeted me and said they would be assisting me in the OR, but after I was wheeled in I could not see them, or anyone else and I could not move my head. My jacket and other personal things were wrapped in a plastic bag, tied and placed between my legs.

The surgery is in a small room, with the standard two big 5 bulb lights. The bed has an indentation for your head, so you can’t really move your head left or right. After being wheeled into the OR an oxygen tube was draped over my chest and a cloth drape was put over my head, with a small opening for the eye.

While totally awake, the doc told me he had a lazer for accuracy and it would be best not to talk. The surgery was quite fast. There were many bright and moving lights, especially three bright green lights. The surgery was quickly over. I did not even notice when certain parts of the procedure were being done. The new lens was inserted and positioned even before I realized it. The surgeon taped a clear eye protector over my eye. There was no pain, and only minor pressure on my eye. It was a really non-eventful surgery.

After I was wheeled out of the OR, I was able to get up, grab my things and walk to the nursing station. While waiting in the stretcher I overheard the nurse rattling off her discharge instructions, so heard her instructions twice. I have an appointment with the eye surgeon the next day, and then a week later. No driving, no washing, no showering, but otherwise all normal. No eye drops until the next day’s appointment with the surgeon.

Right away I could see images with the cataract eye, but they were out of focus and in a slight white fog. Still I could see colours and shapes such as packages, doors, garbage cans, medical equipment. There was no dizziness, headache or nausea. Outside the light did not feel too bright, but it was late afternoon. I noticed the IOL eye’s light was bluer and brighter, while the old eye ad a yellow hue.

At home I tried to put on my glasses, but the clear eye shield did not have room for the arm. I had to cock my glasses up, throwing off the central focal point. I then took out the lens for the IOL side, which helped a little. Without my glasses I was seeing two images, one corrected IOL and the other the old one. My brain was trying to reconcile the two new images, and getting really confused. I was running into walls and furniture. It was actually easier to walk around without glasses. There was a little irritation in the IOL eye, feeling like a bit of dust, but not a problem. I went to bed early. A bit dizzy with motion sickness.

Day 1 Post-OP Eye surgeon appointment
After a 10 hr sleep, the IOL eye had not changed significantly, but I did have a good night’s sleep, all with no pain or irritation. There was no way I could drive. The appointment was quick, with no really issues. The IOL was well positioned, the eye on its way to healing. The clear eye protector was removed, only to be used for cat naps nad sleeping at night. I was able to now wear my glasses, with the IOL side lens removed. Initially my brain was thrown into confusion, so it was easier to not wear glasses.

At home I initially started with no glasses, allowing my brain to stitch the two images together. I then started wearing glasses so that the non-IOL eye could clearly see, but I was bumping into walls and furniture on the IOL eye. It seems like my brain was not sufficiently spatially adapting, so I had to remember to move a little more over.

Lights are getting brighter on the IOL side, with a bit of rings

The two eye drops are: an antibacterial/corticosteriod (4x/day, rise, noon, 5pm, before bed) and a non steroidal anti inflammatory NSAID (2x/day, rise, before bed). The NSAID stings my eyes for a couple of seconds.

As the day progressed the white fog was reduced, then went away completely. My mid-vision (12″/30cm) has improved, up to 8″/20cm. I can now read my laptop without glasses. This has been a very quick progression. With glasses my dominant non IOL eye still dominates. Without my glasses my IOL eye now dominates, reversing my monovision. Interesting switching of monovision. It looks like I may not need glasses for computer work.

Day 2
The transparent eye shield makes sleeping very easy, but upon rising my eyes were a little dried out. They felt better after adding the medicine eye drops, but that was permanent. They did feel better after a couple of hours.

It seems that today I was able to use my glasses with the lens on the IOL side removed, and I did not have as much of the double image issue. I can read and type on my computer without issue. My brain has melded the two sight sources seamlessly together.

Taking my glasses off the IOL side for near sight is clearer, but there is still a blur from the other eye.

Day 3
I had no dry eye from waking. Near distance vision (computer at 16″) is much clearer with the IOL now. Close up reading minimum is 11″. The eye drops first thing in the morning did not sting.

I’m getting a bit of motion sickness when I move my head quickly. My eyes are a little slower at adjusting to the motion. This does not usually happen.

Also an issue is some depth perception on my IOL side, where I slightly hit or brush furniture closer than I’ve ever done.

Day 4
I awoke without issue, the clear eye protector does its job and is not obtrusive. Though I did not have dry eyes upon waking, in the afternoon I started having some dryness. It is not severe, but I hope the 5pm eye drop will help.

The colour rendition of the IOL is much cooler than the original, which is a bit yellow. The IOL is much more cool, morning light type blue colour. It is not bad in any way, just more clinical, more morning light coloured.

The depth perception experienced on day 1 and 2 are largely gone. My brain has gotten used to the IOL and guides me properly. No more close calls with corners and furniture.

Day 5
I woke up to a dry eye today, a but scratchy. It felt better after I put in the drops, but there is still some scratchiness after a few hours.

I notice that when my IOL eye is dry, the vision quality is not so clear. Then the IOL near vision is also blurry, ok for videos but not for reading text.

At the end of the day my eyes grow tired and the IOL eye seems to dry out, leading to less clear vision.

Day 6
I again woke up to a dry eye, a bit scratchy. The drops did not help much. Then I read the dropper bottle instructions and they were different from what the eye surgeon and nurses said. Following the eye dropper instructions you push the bottom of the bottle and you then get a much bigger drop!

Day 8: Eye Surgeon Checkup
The day again started with a bit of eye dryness and grittiness. The eye surgeon said the IOL was well placed and healing was good. I can now reduce the eyedrop schedule to 2 drops for one type and a single drop for the other medicine.

The eye surgeon stated that it usually takes up to a month before the IOL becomes sharper, so I must be patient. It has only been 7 days so far.

Day 9
I awoke to a swollen IOL eye, unsure what happened. My eye drops moistened my eye and there were enough tears, so it was not dry. Still, a little swollen. Then I realized that I was told by my doctor to cut the eye drops in half. After going back to the original eye drops prescription, and after taking two mid-day naps, the eye has settled back to what it was yesterday.

I’ll have to see how it goes when I wake up tomorrow. Though cataract surgery is relatively minor, it is still trauma to the eye, and the eye needs time to heal. This is my learned lesson for today. IOL vision quality seems to be the same or a little better when it is not swollen.

Day 10
The IOL eye was much better after waking up, and felt pretty normal after the first morning drops. There was a bit of visible swelling on the lower lid area. By the afternoon at 3:00pm I needed another drop. I’ll slowly try to reduce to the required 2 times/day.

Outside the house my IOL vision is much clearer, probably due to more light. This is probably just me.

Day 11
Woke up with a pretty normal eye. Though there was increased pressure on the IOL side, there was no visible swelling. I am delaying the drops, especially the NSAID until I feel I need it, in an effort to reduce the drops down to the recommended schedule.

Did a second NSAID drop at 10pm, as the IOL eye was starting to bother me.

Day 12
Non eventful day. Felt pressure on my IOL side, but tolerable. Did less drops

Day 13
Woke up to a pretty normal IOL eye feeling, with much less pressure. After almost 2 weeks of waking to an eye with some scratchiness, this is a good feeling. Supplemental drops at 5:00

Day 14
Not much difference, still feels a bit scratchy. Did the regular drops in the morning, IOL2 surgery in the afternoon.

Day 15
Woke up ok, with no issues, but as an hour went by I started feeling some scratchiness. Did drops. There is a bit of pressure on the eye.

Day 16
Started the day fine, but then got a little pressure feeling. Continuing with drops.


IOL2 Day 0
I opted for no sedation, and the anesthesiologist complied. I did not feel any pain. Nurses were Mary (Filip), Daniele (Filip), and Christy (Asian). Having no sedation means I remember the experience better and more accurately, and my recovery is, well, immediate. I confirmed with the eye surgeon the procedure. The surgery was pretty fast. I did not see as many colourful and flashing lights this time. Mainly there were three round lights with green fringes, in a triangle. The light show was still calm and interesting. Betadine stained my surgical mask, but not my 3 layer cloth mask. Some liquid ran down into my ear, but was not a bother.

Vision change was pretty immediate. I could read text pretty quickly, such as the brand names of the machinery such as the Zeiss optical laser used above me. Pretty remarkable. The glare outside was really strong. I needed some wrap-around sunglasses to tone down the glare. Even looking out the window is quite bright.

The new IOL has become blurrier as the hour passed, but better than my original eye was without glasses. There’s again a white fog. I keep trying to push my glasses up on my face, but I’m not wearing any eye glasses now. This will take a bit of getting used to.

The hospital’s surgical area lost my prescription eye drops, but gave me a replacement. Not a big deal. It is the same medicine. At the end of the surgery the surgeon allowed an intern and a nurse to see the implanted IOL, “beautiful” both exclaimed.

So far a 19 hour fast and not a problem. I don’t really feel hungry but should drink water.

There was a lot of Tagalog in the hallways while waiting for my surgery time.

At the end of the day my mid distance vision has improved. The IOL2 is a bit darker, but is still usable. Both are not super sharp.

IOL2 Day 1: Post-op Check
Very little to complain about. Long distance vision is reasonably clear, much better than with glasses, but not sharp. No pain, itchiness, redness, inflammation.

Mid distance vision is binocular and very clear, even though both eyes are a little blurry by themselves. Computer vision out of IOL1 often blurs when the IOL dries out or has tears. There is improvement yet.

IOL2 Day 2
Awoke without discomfort, but decided to follow the drops regimen anyway, both the anti-bacterial and NSAID drops. at my desk with the window on my left I often see flickering light source from IOL2, but not from IOL1.

Outside I experience extreme glare, so need to use sunglasses. Distance vision is extremely sharp with sufficient light, though when I cover up IOL1 I notice there is still a slight blur. Nevertheless I am still quite pleased after only day 2. Staying outside is a real treat.

End of the day, both IOLs are tired and a bit scratchy when I blink. It is like I have slightly dried contact lenses that should come out. I have some drops still left to do. The end of day drops really provide relief.

IOL2 Day 3
The IOL is functioning very well, with long distance quality pretty stellar. It is quite remarkable. There’s no pressure at all. IOL1 still has some dryness and a little pressure.

Late in the day, some irritation and dryness. Added eye drops.

IOL2 Day 4
Started the day with no dryness in IOL1. Of course IOL2 was fine. Did drops anyway.

In the afternoon both started to dry out, but after I put drops into IOL2 it was ok. The vision from IOL2 is becoming sharper and sharper. I just started noticing facial defects on news anchors on the news.

Today the IOL1 does not feel scratchy or pressured. There is progress. Overall a great visual day!

IOL2 Day 5
The day starter really well. No scratchiness or pressure from either IOL. I will still continue my drops.

IOL2 Day 6
An overall good day, IOL2 is good, but IOL1 is sometimes dry. Drops help, but with computer work there is a cycle of tearing and dryness that causes blurry vision.

IOL2 Day 7
Woke up and felt very normal. After 2 hours both IOLs felt a little dry, so I added drops. Vision quality is stellar in the morning.

For IOL1 I wait until the eye feels dry, then add a drop as per schedule. IOL2 does not need this because I’m still on the 4 drop/day schedule, which is pretty regular

IOL2 Day 8: One Week Checkup
IOL2 is doing well, I’m 20/20. IOL2 is a little dry but the drops help. IOL1 has a small abrasion on the cornea, which was causing me discomfort. It should heal within a week. Otherwise healing is on track

Vision is extraordinary for me.

IOL2 Day 9
IOL2 is healing nicely, but IOL1 is causing tearing and scratchiness. The NSAID seems to help reduce the scratchiness. Otherwise a very good IOL day.

IOL2 Day 10
Woke with no problems with either IOL. IOL2 has no issues, but IOL1 still has some irritation, so I added an NSAID drop. After a couple of hours it subsided. Vision, especially the TV is very vivid.

IOL2 Day 11
The day’s results are repeating: IOL2 is great, IOL1 is a bit scratchy in the afternoon. Went to the gym for a 50% weight workout, not a problem. It felt like no workout at all. As it was quite windy, I was worried about the dust and pollen in the air getting into my eyes.

IOL2 Day 12
I awoke to no irritation in either IOL. So far so good. Mid afternoon needed to add an NSAID to IOL1

IOL2 Day 13
Both IOLS were good upon waking, I cycled to the gym, and on the way back did not wear sunglasses, so maybe the IOLs dried out. Still, no need for any NSAID drops in IOL1, the first time. IOL2 received the required drops.

IOL2 Day 14
Both IOLs were goo upon waking, but dried out a little throughout the day. IOL1 needed an NSAID drop. IOL2 was fine, as usual. Even though it was an overcast day it was very glarey, had to use sunglasses.

IOL2 Day 15
Both IOLS were good upon waking, IOL1 was ok today without any NSAID. IOL2 got all required drops. Both were not a problem.

IOL2 Day 16-18
Both IOLs are stable all day. Vision is excellent. I’m still doing drops for IOL2

-first time when water splashed on my face, near my eye
-first time in forever when taking a shower, vision was clear
-first time sleeping at night when the clock was clear
-when putting on a shirt with a closed collar, you don’t need to be careful of your glasses
-coming into a warm room after being out in the cold, your glasses don’t fog up
-I can see rain falling on my driveway and gutter from my front window

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