ICL: Eye surgery as seen by a patient

I’ve seen and read a few pieces and blogs about how ICL (Implantable collamer lens, like a contact lens but inserted inside your eye) goes, the before, the after, the long view over the years. One thing I haven’t read is an account of the during. The actual surgical operation. So, at the risk of putting off the queasy and the doubting, here’s how my experience went.

A few details to start with: I was short-sighted at –10 or –11 in both eyes, my cornea is too thin for Lasik, so I chose to have ICLs at Eye Institute, with Dr Gray, in Auckland, New Zealand. My vision is now 20/20 in one eye and slightly less in the other, I don’t need glasses at all after wearing them all the time for, oh, about 15 years. It’s been about 36 hours since my operation at the time of writing.

I describe only a part of my full days, there was a lot of the time at the clinic where doctors and nurses explained everything that was going to happen and the medication regimen and the things I should expect and what I should mention if they happened because they weren’t normal (basically: if they don’t tell you beforehand it’s expected, or if you have a doubt, tell them). My mom was with me and was present for a lot of it (but not the actual ops), which helps a lot as she remembered a lot more than me and thought of everything.

The staff and doctors were all very kind and extremely competent, which was absolutely great.

Day one: pre-op laser

One day prior to the surgery, I needed to have two incisions done in each eye with a YAG laser, that the lens would be inserted through and manipulated during surgery. They specifically told me, multiple times, that this would be the hardest part. It was.

Before the YAG laser, I was given eye drops to make my pupils small, then I had to wait 10 minutes for them to work, and another examination to check. Upon examination, they gave me more drops and made me wait another 10 minutes. They also gave me paracetamol for a headache which started five minutes after the first round of drops.

They told me it would feel like small electric shocks. They didn’t tell me it would be many shocks, not just two per eye as I expected.

The laser was done by Dr Gray himself (the drops and all other care was done by nurses and assistants and ophthalmologists): I was in one of those eye machines with my chin and forehead pressed against straps. In my eye was shone a red dim light in the centre (the actual laser, I suppose) and a bright white light from slightly aside.

I was told to focus on the doctor’s shoulder, and I did, then the lasering began. With a sharp pain and a very click noise, which caused my vision in the targeted eye to suddenly become half light and half dark, very sharply divided; then a second click and my vision was all light in that one eye; then another, and another — about ten times, at a cadence of maybe three or four per second. Then a brief pause, maybe a full second, and again for the second incision.

(Is it called an incision when done by a laser, not a cutting instrument?)

After that was done, it was the other eye’s turn. My first eye was completely blurry, and I had residual pain or shock or something, so the second eye was a bit more painful than the first. I nearly cried out once, and I certainly whimpered. The entire thing took about three minutes.

In total it was about 40–50 pulses and as many surges of pain. Ouch!

During it all, Dr Gray kept saying “very good” which was really helpful and reassuring that everything was going well.

After the YAG laser, I was left to rest for a little while, then given drops again, then examined briefly to check it was all good, and then released and sent home. I had a mild headache and felt tired, so I slept for an hour or two, after which I was fine enough to walk into town and go visit my brother. My vision stayed somewhat blurry well into the evening, and I was certainly not well enough to consult my phone, let alone drive.

Every few hours I administered drops (two kinds, with a few minutes in between each) into both eyes.

Day two: surgery

I woke up at 6am and got at the clinic at 7.40am. This day was all at another floor of the clinic, where the main operating theatre was.

After waiting a little, I was taken to a room in pre-op and a nurse went through the entire clinical check: who I was, what my date of birth was, that I was allergic to wasp stings, that I had eaten in the morning, at what time, that I had no other medical condition they should know about (she listed several and left the last one generic), that I had not taken paracetamol 4 hours prior, that I had read and understood the consent forms and that this was my name and signature there.

I removed my glasses and gave them to mom who kept them from then on.

She then asked me if I had contact lenses on or if I had worn any recently (I hadn’t). She gave me three different pills, and explained what they were and would do. One was for regulating the pressure in my eye, another I don’t remember, and the third was codeine. She put a sticker with my name on my shirt, a bracelet with my details on my wrist, and a red dot over the eye that would undergo surgery first. Then I was given a regimen of eye drops (about two rounds in both eyes, and four or five more rounds in the eye I was about to have surgery on). Some of those were anaesthetics. My pulse and blood pressure was checked. Finally, she put blue covers over my feet and shoes and over my hair and ears. During that entire process she explained everything she was doing; she had a habit I found peculiar for a human but is probably natural and expected for nurses to narrate absolutely everything, even when it may seem superfluous.

Then she guided me to the pre-op zone and handed me off to the staff there. (Mom was guided back to the waiting room.) I was made to lie down on my back on a bed, one of those curvy ones not a flat for sleeping. A blanket was draped over me. I was asked if I was comfortable, especially my neck and head, and they adjusted the bed in response. A nurse read out my name off my bracelet, checked something on a clipboard, and asked my date of birth for confirmation.

Another nurse introduced herself by name, showed me my informed consent forms and had me confirm my signature, then explained she was an op nurse (unlike the others who are pre-op nurses) and would be in the theatre with me, that if I had anything I should yell out her name, she explained what would happen in the operation room, and that they would be checking my heart rate and if it went up abnormally she would take my hand to calm me. In the background there were at least one or two nurses checking various things — I was facing the ceiling and my peripheral sight isn’t the great, not to mention that I was still short-sighted then! My forehead was taped in place to keep my entire head still for surgery.

A gel was poured into my eye; it made everything way more distorted. Quite a large quantity of it, I could feel it cold against my skin at the edges of my eye. It kept me from blinking. My eye was taped shut to keep the gel in, although I could still see through. I couldn’t close my eye willingly, the only way was to slowly relax until my eye closed itself; I found that by experimentation. Then I was left to lay there for about five minutes as they finished preparing their side of it. For the second eye they left me there longer, I think; I nearly fell asleep.

I was rolled into the theatre by at least three nurses (one behind, one in front, and the nurse I knew by name next to me). The surgeon spoke and introduced himself. A nurse read out my name, date of birth, the current date and time, the operation and which eye it was, and that they had gotten consent. I’m not sure if that was purely for procedure or also because the operation is recorded.

Dr Gray removed the tape on my eye, then placed a wedge of plastic over it, completely obscuring my vision. From that wedge a plastic covering was unfolded until it draped my face completely, only my eye was exposed. He cleaned around my eye with cotton soaked in yellow Betadine-like solution, I could smell its particular scent. Then another cleaning or wiping with a scentless, colourless product on a cotton ball. It might have been water.

Three bright white lights shone down on me, being short-sighted I saw them as big splotches of light. Throughout the procedure he said “very good” and “it’s going very well,” finishing by a “it went perfectly.” As I mentioned above, it really helped in keeping me calm and reassured.

The operation began in earnest. I couldn’t feel anything, apart from the slight pressure of his fingers on my forehead, the coldness of the gel running down my face, and occasionally the metal of his instruments as they touched on the skin around my eyes. But I could see his instruments when he had them above my eyes, long thin pieces of metal, less than a millimetre wide as per my estimate, although it was hard to do so under those conditions.

Most importantly I could see the distortions in my vision as he inserted the lens, then unfolded it within my eye, then positioned it just right, and finally I could see the image tremble slightly as he anchored it onto my iris. The three bright splotches of light became nine small spots, rotated, moved, and finally coalesced into three again. That was my first experience of seeing without glasses: being able to see a spot of light completely focused and neat and defined, even though it was a metre or so away.

Then I was wheeled back out and into post-op, where the tape around my forehead was removed, the plastic covering my face taken away, my bed reclined into more of a chair. A transparent eye protector was placed over my eye to keep me from touching it.

I was led to a seat, mom was brought in, I stayed there recovering for about five minutes until we were taken to a darkened room so I could rest properly. I spent the first half hour talking with mom and looking wildly around me with my now-good eye. The difference between my eyes, one seeing well, the other still completely blurry, was disconcerting: I kept one eye closed for most of the time. I then put on my newly-purchased audiobook of Neil Gaiman’s Neverwhere (I recommend!) that I’d prepared in advance, closed my eyes, and spent thus the two and a half hours before my next surgery.

During this time, I was starting to get a pretty nasty headache. They had told me to expect that, though.

For my second surgery, everything was done exactly the same way. Finally, I was done! I could see quite well from both eyes, although I couldn’t read anything unless it was in centimetres-high font. I was getting a very painful headache, though, and pain around my eyes. I asked when I could take my next dose of codein, and waited miserably 30 minutes until I could. It took a while to start acting, and even then it didn’t completely numb the pain. Still, I was well enough that we drove to the lodge we were staying at. It was maybe 1.30pm.

Upon arrival I slept until 5pm, then took another painkiller, then slept again. I had a bit of a dinner, but really didn’t feel like eating much, and slept again after brushing my teeth. Apparently (according to mom) I started breathing rapidly in my sleep, and then calmed down, but I don’t remember anything myself.

In the morning I woke up and thought I’d slept with my glasses on! Old habits…

Day three: post-op check

We went back to the clinic on the morning of the third day, and I went through two checks: one for my ocular pressure, which was nominal (18) in one eye and slightly higher “but still normal, nothing to worry about” (21) in the other, and the other examining my eye to verify everything was as it should.

I was given a third bottle of eye drops and they went through the medication and eye drop schedule again: three of the drops 3–5 times a day for a week, then only one for a further three weeks, and pills twice a day at meals for a few days.

At that time I could already see much better, being able to read 50cm away from my eyes. They assured me it would get even better in the coming days.

They also tested my vision: 20/20 as mentioned at the top (or 6/6 in metric), and gave me a certificate for driving that I can use to apply for the removal of the mention on my driver’s licence that says I need glasses.

And then we drove back home. (Mom drove, I really couldn’t have.)

Right now I’m finding that changing focus between near and far vision is slower than I’d like, that my perception of depth and sense of self-space is weird (lots of banged toes, missing tea cups by centimetres, even clipped a few walls with my shoulders), and sometimes I can’t focus on things properly. I can read at, what is this, 25cm from my eyes (and beyond, but no closer) which is great. I can use my phone and laptop. Bright light (even daylight) hurts my eyes, so I wear polarised shades outdoors and often indoors too. I have good in-focus peripheral vision, but as that’s something I haven’t used for literally a decade it will take some getting used to.

So, hopefully if you’re considering having ICLs you’re not put off by this article! It’s going to change my life. It’s going to be awesome. But before that: sleep.

One month later

Just finished the regimen of regular drops of Acular. My vision is great. I get halos and starburst effects, but I already had starbursts and wedge-like distortions around bright lights in low-light and night conditions before, so it’s not a big deal. The halos I get aren’t as pronounced as the ones in the picture. Focusing on the source of a halo makes them disappear for a while, probably because it causes my pupil to dilate or constrict or something.

When watching a movie at home or in the cinema, or when looking at a device screen in low light conditions, I get diffused halos around, well, every pixel. That causes a “glow” that overlays on top of whatever I’m trying to look at. At first, it stopped me from being able to read or view screens, but it got better, or I got used to it, or something. Now I notice the glow when I first look at a screen in low-light, and it does prevent me from reading small text for about a minute, and then I don’t notice it anymore. It’s still there, faintly, but I can see through it effortlessly. But it did cause some mild panic as I thought I wouldn’t be able to watch movies anymore! Not to worry— it’s fine now.

After one week I still had some difficulty focusing quickly. Changing my focus distance took several seconds, instead of being instant. My optometrist acknowledged this happened, and said it was expected, and that if it still happened at my next visit we would see what could be done (exercises and drops apparently). I exercised by myself before then, trying to get my eyes to focus on particular objects around a room at various distances and switching between them as fast as I could, which at first was a switch every few seconds. After a few 10-minute sessions spread over a few days, it became good enough that I didn’t worry about it anymore. Now, it’s as normal.

I still have to consciously focus my eyes properly sometimes, especially with high contrast situations, such as low-light conditions sometimes, but especially when lighting chimney fires: the bright flames contrast with the dull wood and background, and that throws off my focus. It’s a rare enough situation that I don’t particularly mind, and I expect it will get better with time.

When I had my glasses, my frames chaffed a bit against my ears, which at times caused pain (and prevented me from wearing headphones, so I always used earphones). Now, not wearing glasses anymore, but sometimes I get “phantom” pain: my ears are painful at exactly the same place it did with glasses, but there isn’t anything there to cause the pain. It disappears after a few seconds, so it’s baffling, but not annoying.

Apparently I look more tired now, but I don’t feel more tired, so I think what’s happening is that my glasses used to hide some features of my face that are now revealed and show my general tiredness more.

My glasses were photosensitive, so became sunglasses when exposed to daylight. Now that I don’t have glasses, and even if I do remember to carry sunglasses around, I find I narrow my eyes a lot more in response to light. With photosensitive glasses, the glasses took care of darkening themselves appropriately at the slightest increase in light; with sunglasses, I only put them on if I expect to keep them on for more than five minutes, so I definitely notice the sun more.

I don’t have refraction colour distortion anymore, which was completely expected as they were an artefact of my high-prescription glasses, but is still occasionally jarring when I expect the distortion to be there and it’s not.

My lack of glasses is very evident when in the rain or shower or cooking, as I can now see at all times. It makes a big difference!

There are many other little things, but that’s enough for this. It’s a great experience! Definitely worth it.