Last updated: Dec 29, 2005
A cataract is a cloudy portion of the normally clear lens. This is caused either by the lens material becoming overly compressed or by impurities within the material. The size and severity of a cataract varies among patients as does the location on the lens and the amount of impact to the visual acuity. Often once a cataract starts to form is will continue to grow, though the rate also varies widely. Cataract may develop in one or both eyes and will likely be different in each.
A doctor may not always advise removal of a cataract. The biggest factor is usually the impact to the vision, but patients overall health and needs also play a part in that decision. Because the surgery involves penetrating the eye, there are risks involved too. Each patient will have to consider all of the information in order to make an informed decision that is right for them.
Sometimes laser surgery is used to remove cataract, which involves the laser beam breaking up the clouded part of the lens. This leaves a portion of the lens missing, which may impact the vision. Many patients need to wear glasses or contacts after laser surgery for this reason.
If the cataract is big enough, the surgeon may advise that an artificial lens be used. The original lens is destroyed and a new lens is put in its place. This requires an incision into the eye to place in the new lens. This is the type of surgery I will have and what the rest of this document covers.
The actual surgery will be of the outpatient type, which means there is no hospital stay. The surgery is performed at either a hospital or other surgical facility and the patient is released afterwards. A family member or friend must be with to transport the patient to and from the clinic and the patient is strongly advised to not be alone that night at minimum.
Either local or regional anesthetic is used during this surgery. The goal is to cease all eye movement during surgery and to halt any pain sensation. Tools are used to hold the eyelids as wide open as possible as well as hold the eye in place. During my last surgery, I experienced only mild feelings of pressure and movement but very little pain during the operation. The patient is able to watch what is going.
The patient may be required to wear an eye shield during sleep for a period of time after surgery. This prevents reflex rubbing or touching of the eyes. The patient will use eye drops for a few weeks after surgery also. These are usually to stop infections but may include pain relief or moisturizers. There is normally no restrictions on using the eye if the patient feels no adverse effects from doing so.
One thing to consider about an artificial lens is that the curvature of the original lens is controlled by the brain to allow for focus on near or far objects. There is no such control with an artificial lens, so there is a great chance that the patient will have to wear glasses or contacts for either close or distance sight.
This very brief account of the surgery is my personal experience only. Different surgeons and patients will likely have different accounts and experiences. This is only written to give an idea of what can be expected during the surgery itself. Both of my eyes will eventually get this procedure, but for now we just dealt with the left eye only.
Most of the experiences before and after the surgery were very similar to the KLAL surgery discussed in the previous section. In some ways, even the surgery itself was similar except that it dealt with the lens instead of the cornea.
There were four steps to the process. First, the surgeon cuts a small incision in the corner of the eye so they can access the lens. Next, a portion of the original lens is removed. How much of the lens is actually be taken depends on how damaged it is. Thirdly, an artificial lens is placed where the removed lens was at, positioned, and anchored into place. Finally, the incision is closed.
The eye is bandaged after the surgery and after a short time in post-op, the patient is released to go home. A follow up exam will occur on the next day.
There were two notable differences between the KLAL surgery and the Cataract surgery. First, the recovery time from the Cataract surgery was quicker due to the fact that less corneal tissue was affected. Also, the resulting vision is obtained much quicker since the new lens is in place as oppossed to the corneal tissue having to grow in over time. However, there is a period of time where the eye and brain have to get used to the "new" lens and figure out how to focus with a less controlable lens.
Like the surgery section above, this is my personal account of my recovery process. Everybody will differ in their experiences, but I want to briefly share some things which others may encounter.
The first two weeks after surgery brought on similar encounters as the KLAL surgery (and I assume most other eye surgeries). Antibiotic eye drops and an eye shield help the incision to heal properly and limited activity and movement allow the sutures around the lens to heal. The eye can be used normally after the bandages are removed (the following morning in my case), but care should be taken to not touch or rub the eye or surrounding facial areas.
While my left eye was bandaged or during the times shortly after the application of eye drops, I had to rely on vision from my right eye. In my case, I have started using the right eye more often since the KLAL surgery six months earlier. I increased my intentional usage of the right eye and over the next five months. I noticed the quality of vision in the right eye seemed to be much improved over its status one year prior even though none of the surgeries involved it. Now I really can't say if this is actually a physical fact or maybe a psychological feeling, but I navigate much better with the right eye now. Even so its image quality is still very poor.
In my case, the artificial lens implant did not result in a major visual improvement although it did produce some better quality. The resulting vision improvement did allow me to get a little more benefit from visual aids and allowed for slightly more use of lesser strength glasses. Clarity imporved more than image size and I was able to better distinguish between 8's, 5's, and 2's as well as get better accuracy on the letters also.
While I did get some visual quality out of the surgery, the most worthwhile result was that the blank spot in my vision was finally gone. The spot, caused by the Cataract, was not as evident in my regular vision as it was while using visual aids. I would notice the spot while using magnifiers or binoculars. Since the spot was in the center of the image, it bothered me a lot. Within the first week after surgery, I definitely noticed the difference in the image without the blank spot hanging around. The size of the Cataract in my left eye is not as big as the one in the right eye, so I am looking forward to having the same procedure done in the right eye eventually.The biggest drawback to the surgery is that now I am experiencing double vision in the left eyes image. Rather than being two seperate pictures, objects appear two or three times in the image as more of shadows of the original object. This is much more evident in bright light or outdoor situations. Since noticing this in the first week after surgery, my brain has learned to accomodate for it and I don't notice it much while inside unless I stare or concentrate on certain things. Thankfully it doesn't impact me much anymore while reading or typing at the computer.
It is unclear what the exact cause of the double vision is. It may be due to a lack of maturity in my retina, my oddly shaped eyeballs, or the fact that I have Aniridia. Because people with Aniridia have no (or little) iris and pupil, the visual field is greater than average people have. Since the lens implants are sized for average people, I can actually see images around the outside of the artificial lens. So some doctors feel my double vision (or shadow images) are caused by the light rays boucing off the sides of the lens. There are options that could restrict my visual field to a more average level, but for the moment I am not actively persueing them. I mention the double vision information in the event that other Aniridia patients might be reading this experience and can consult their doctors accordingly.
All in all, I have to say I am pretty happy with the surgeries of 2005. At least, the vision deterioration of my left eye since 2000 was not only halted but was reversed by these procedures and the Cataract is now gone. The experiences of the last five years have strengthened my feelings of not taking vision (or other life functions) for granted and to be thankful for whatever abilities you have because you never really know when you may lose them.
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