Brain adjustment

I knew that my brain had adjusted to my glasses, which were progressive bifocals I wore all the time, so there would be a period of adjustment to my new vision.  The surprise is that my close vision keeps getting better as my eyes adjust.  I keep going back to Dollar General and buying weaker reading glasses.  I started out with +2.50 but now I'm finding +2.00 stronger than I want for reading or writing with my book or pad on my lap.  For my laptop I am now happy with +1.50 instead of +1.75.  I'll keep a pair of +2.50 for close work such as sewing.

I took a walk today with my kids and found that I had a bit of movement of the road as my head moved with my stride.  I don't know if that is a brain adjustment to glasses with progressive lenses that I am unlearning or possibly a little distortion in my lenses (which are not aspheric).  I'm confident my brain will adjust and filter it out.

I was warned when I got progressive lenses that they were hard to get used to.  What no one warned me is that it is just as hard to adjust back to not having them.  My brain had compensated for the progressive lenses to give me an accurate sense of the position of steps and the like.  So without them, my brain at first gave me the wrong information about where to put my feet (making a correction that was no longer needed).

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange

second vision correction surgery

I just came back from the ophthalmologist, where I had my day-after-surgery appointment.  20-20 in both eyes!  Happy Dance!!  The 20-20 line of the eye chart was a little clearer with the eye that had surgery last week (clearer than it was the day after surgery), so I'm hoping with further healing for the right eye I will be better than 20-20.  The world is more three dimensional than it was with glasses.

I noticed different things in the second surgery than than first (and I had some trouble getting them to listen to me about what had been done differently the first time).   But I did get my half dose of Versed, and the experience was no worse.  The day of surgery was pretty miserable with the scratchy discomfort of the eye, but I had hope it would feel fine the next morning and it does.  Between surgeries my vision was so confusing that I wanted to stay home most of the time.  Now I want to go out and give my brain lots of opportunity to adapt to my new vision.

I'm still getting used to how I look without glasses.  My first reaction is that I don't like my eyes.

Getting used to reading glasses for actually reading isn't a problem.  I'm wearing them on a chain around my neck so they are with me.  I have a less powerful pair for my laptop (because it is further away), and they sit next to the laptop (I bought a four pairs of $6 reading glasses in some different strengths).  What is hard to get used to is things that mix reading and computer distances, such as cooking, or laptop and middle distances, such as looking at my food and the others at the table when eating.  I need to see how much improvement I get in those things now I have both eyes working together.

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange

The week between surgeries

If you are too nearsighted to be able to read comfortably without glasses, plan very carefully the timing of the week between surgeries. I am finding it quite difficult to function. It might be a little easier if I were wearing my glasses and using the eye that has not yet had surgery. But my glasses broke so I am using the eye that had surgery and cheap reading glasses. In either case, there is no avoiding the vision of one eye being totally blurry. This is a particular problem for driving at night because every bright light has a big blur around it. If you need to do significant driving at night, get an eye patch beforehand.

The adjustment to using glasses for closeup is such a reversal of all my habits, and it is harder to make that adjustment when the vision from one eye is completely blurry at the same time.  Yet it seems like a good thing to use the eye with the new lens, to have brain and vision settling in together right away.

Cooking turns out to particularly be something that requires working at a variety of distances.  But I'm glad not to be working.  I don't have much feeling that my body is recovering from trauma, but it does feel right to take it a little easy.  And doing a lot of reading either on a screen or from papers would be hard.  Christmas is nice because I can enjoy sitting around with my family, and I have my daughter to help with the cooking.

One of the improvements in the corrected eye is a greater sense of depth, the world is less flat.  But I am using only one eye and therefore lacking binocular depth perception.  Add to that that reading glasses make things appear a lot closer--it seems as if my arms have gotten shorter.  Pouring things was hit and miss at first.  Because I used progressive bifocals, I also had gotten used to odd information about the lower part of my field of vision.  No longer wearing glasses, I have missed stairs several times because of that and one time actually fell (luckily going up my front steps).

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange

day after surgery

I woke up with my eye feeling much better.  I went to the doctor for a scheduled check, and I could read the 20-20 line on the eye chart.  I was very happy.

But living with one eye fixed and the other not is a mess.  I got fed up with wearing my glasses and having my brain trying to put together a clear image and a totally fuzzy image, so I asked the optical shop at the doctor's office to pop the lens out of my glasses on the side that is fixed. I also  bought $6 reading glasses and sunglasses at Dollar General.

The doctor was right that it wouldn't work to take one lens out of my glasses because the size and angle of the two sides would be too different.  I had a lot of double vision trying to wear them that way walking around.  It might work better than anything else if I were sitting still doing close work, but I didn't get much chance to try that because I put the glasses in my purse just in a soft case and they broke (they were 4 or 5 years old).  Outdoors I find the sunglasses a big help--wearing just non-prescription sunglasses and using the good eye is working well for me.  For reading and the computer I am struggling to get used to using reading glasses that only work for one eye.  It is doable, but not fun.

Getting used to reading glasses is hard.  I am someone who adjusted smoothly to progressive lenses, so I am used to having the whole range from distance to closeup just by tilting my head.  I needed to buy different reading glasses for my laptop than for actually reading.  And what am I supposed to do about eating?  It is nice to be able to see my food clearly, but then I can't see my family members as clearly.

I may in the end decide that I want a pair of glasses with progressive lenses, particularly for things like cooking and eating.  But I want to wait a few months and let my vision fully settle in, and get used to using reading glasses.  For now, I'm tired and discouraged (just for the moment--I know it will be better in the morning).  I did too much today--was out of the house almost all day.

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange

First eye surgery

After three days of eye drops I had my first vision correction surgery today. I was scheduled to arrive at 7:45 and my son went with me to drive me home. It was a dark and foggy drive to get there and I was feeling nervous this morning.

It seemed like a long wait in pre-op. I didn't have to undress at all; they just put a cap over my hair and various drops in my eyes. The anesthesia was Versed by mouth. I said I was medication sensitive and the usual dose might put me to sleep, so they gave me a half dose. I then worried I would regret not getting more but they wanted me conscious. I was a bit fuzzy headed but definitely could focus my rational mind if I tried. They checked many times which eye they were doing and the doctor marked my eyeball somehow while I was sitting up to make sure to line up the astigmatism correction accurately.

When the took me back to surgery they attached a plastic drape over my eye and then various devices I won't go into. The doctor told me to keep focused on the light above me, which was painfully bright. I focused on that task and also on calming my breathing. The doctor didn't speak as he was working so I didn't have a sense of what was happening, just that the light kept changing. And then he said he was done and they wheeled me into recovery.

My eye was still numb so I really wasn't uncomfortable at all. They put a protector over my eye I was supposed to wear until I got home. I was given instructions for eyedrops and they sent my son to drive the car up to the door and we headed home at about 9:30 am.

Not having had significant anesthesia, I really don't feel badly at all. My eye is miserably scratchy, but I don't feel badly enough to stay in bed. I've been sitting in the living room with Christmas carols playing and knitting (which doesn't take much close vision--I can do it in large part by feel).

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange

Refractive lens exchange

I've decided to go forward with surgery to correct my vision, and since an number of people are interested I want to post both the results of my research and my experience. So this is the pre-surgery post.

I'm a 56 year old woman with a prescription of: R -725 sphere -275 cylinder, L -600 sphere -300 cylinder. That is, I am quite seriously nearsighted, though not in the extreme catagory, and have very significant astigmatism. My vision is too bad to be fully corrected by Lasik. I have never worn contacts because I couldn't bear the thought of touching my eye.

If I were under 40 I would be waiting for the Visian Toric implantable contact lens to be approved in the U.S. Implantable contact lenses are lower risk than the surgery I am scheduled for, and should give the same quality of correction. But they aren't used over age 45 because of the risk of needing cataract surgery in relatively few years.

The procedure I am having is called Clear Lens Exchange or Refractive Lens Exchange. It is exactly the same as cataract surgery with the implantation of a corrective lens, but in my case I am having it done even though I don't yet have any signs of cataracts. I will have a monofocal toric lens implanted, which will correct my distance vision but leave me needing reading glasses. Most people who have such a procedure get a lens that does both distance and close up, but they don't yet make a lens for people with significant astigmatism that corrects both.  And I am not interested in waiting until one comes on the market because the multifocal lenses come at some compromise of sharpness of vision and clarity of night vision. I prize the sharpest possible vision more than not having to wear reading glasses. I am paying for this out of pocket--if I did have cataracts the insurance would pay for the surgery and simpler lenses. My total cost is around $3k per eye.

I had my pre-op appointment yesterday. The most serious risk in my situation is of retinal detachment--perhaps a 1% risk. That risk is greater for people who are nearsighted, particularly with a correction over 9, and for men and younger patients. The risk is less if the vitreous has already detached from the retina, but that is not the case for me. The doctor is at least confident that my retinas show no problems.

He said that 85% of their patients end up with half a diopter of normal, that is, they would have a prescription between 050 and -050. They did a lot of measuring of my eyes, which is very important to me because I really want that accurate correction. My eyes were different lengths so they did an ultrasound to confirm those measurements. It was hard to tolerate the ultrasound sensor on my eyeball even well numbed--I didn't realize that I tolerate the usual pressure measurement well only because it is so familiar. I am going to need that sedation for the procedure.

The two surgeries will be done 6 days apart, Dec. 22 and 28.  In between I will have to use only one eye, as my glasses make things smaller in a way that the lenses will not, so even if I popped one lense out of my glasses it would be too hard for my eyes to work together.

Posts in this series (reverse chronological order):
Eye Surgery Follow-up
Brain Adjustment
Second Vision Correction Surgery
The Week Between Surgeries
Day after Surgery
First Surgery
Refractive Lens Exchange