Cataract Surgery with Crystalens - My Experience

To paraphrase Dr. McCoy from Star Trek: "Damn it Jim, I'm an engineer/photographer, not an eye doctor!" ;-)
So while my layman's research/experience may be helpful/informative, please consult a medical professional for your personal situation.
Scroll down for full details, but since the 2011 surgery, I continue to see well and am glad with the choices I made and the results.

While I've been fortunate to have had good health, my eyes have always been a bit of a problem. As a child, I was quite near-sighted (ending up around -7 diopters of myopia- i.e. is that an "E"? ;-) but this was correctable via glasses and (later on) contacts. Fortunately, I did not have much astigmatism (which is harder to correct, especially in contacts) and my vision was fairly stable from ~20 to age 40. One "nice" thing about being so Myopic is that without glasses/contacts, I can focus very close. I did consider having Lasik, but the combination of high Myopia and thin Cornea meant I was a borderline case. In contrast, my wife Wendy at -3 diopters had Lasik done in 2002 by Dr. Donald J. Keller of Boulder Eye Surgeons (ironically our neighbor across the street) and she had excellent results.

Around age 40, it slowly started becoming more difficult to focus (when wearing correction) at close distances, especially in low light. This is a very common condition called Presbyopia which is due to your crystalline lens becoming less elastic. This loss of accommodation is analogous to camera lens that won't focus close. So I started wearing reading glasses (when wearing contacts) or a different glasses prescription for computer/close-in work. Wendy made fun of me, but I said "wait until your turn" and yes, a few years later, she had to start wearing reading glasses - her distance vision remains excellent.

In 2010 (age 46), I noticed that my right eye had more difficulty seeing things. I had been told it had a "small" cataract, but these can often exist for years with no impairment of vision. Unfortunately, I had a Posterior Subcapsular Cataract - these "grow" faster, are more prevalent in younger people, and cause greater visual degradation due to the location at the rear of the visual axis. Because of the cloudiness, you are no longer able to correct to 20-20. An analogy would be a blown window that now has a permanent haze. In addition, the cataract causes a "Myopic Shift" which means increased spherical power (also noticeable via reduced minimum focusing distance) and astigmatism - i.e. a new pair of glasses/contacts every several months which is a bit of a PIA. Cataracts typically don't interfere with vision and lifestyle until age 70 or later ... so it kinda sucks to have it happen to me a few decades early - darn!

I'm a bit of a photographer who analyzes camera gear (and shoots with my right eye - bummer!), so I'm aware that image quality encompasses more than just seeing "20-20" on the eye chart. For instance, I check the MTF curves and will often see various visual defects in my pictures such as Chromatic Aberration that might not be apparent to others - sometimes it's not good to know more. Being an Engineer, I'd periodically "test" my vision and needless to say, even pre-Cataract, I knew it wasn't sharp as it could be, but you just have to manage with the eyes you get.

Even with best correction, the cataract impairs the vision and causes all sort of visual aberrations beyond just blurriness due to the cloudy lens. Point sources of light are "replicated" (as seen below) and high-contrast or low-light situations are difficult. Interesting enough (to me at least!) is that with one "good" and one "bad" eye, it's fairly easy for me to compare the visual degradation. It's amazing how the brain is able to "filter/figure" out the "bi-polar" vision (up to a point) but it requires a lot of "work" to see and I often get visual fatigue. Below is an image that simulates (as of July/2011) the difference I see between the left and right eye - HEY, less wrinkles with the later! ;-)

When a cataract is fully "mature" (mine was grade 2+), you can actually see them as an opaqueness on the eye ... but needless to say, by then they are causing a severe decrease in vision. While I'm fortunately not there (yet!), I wondered if (using my Canon 7D and (poor man's Macro) 18-200 lens) I could take a picture of my eyes to see the cataract. The only light is from the three windows and I don't see any opaqueness ... but it was amazing to me how much clearer (10 year old) Kyle's eye was than mine. I think (!) the right eye looks more cloudy, but obviously a much more appropriate examination/determination would be done by an Opthamologist using a slit lamp looking at dilated eyes.

Cataract Surgery has been around for thousands of years but fortunately, we have advanced from sticking needles and/or using extreme pressure on the eye! A British surgeon noticed after WWII that Plexiglas from Spitfire canopies was inert in the eyes of fighter pilots and figured out it could be used as an Intra-Ocular Lens (IOL). Cataract surgery is now fairly routine (several million operations a year in the US) and basically involves making a small (~3mm) incision into the capsule of the eye, inserting a "chopper" to break up the lens, and then sucking it out - this process is called phacoemulsification. An IOL is then inserted into the capsule which unfolds and replaces your old lens. Total time for the entire operation is usually less than 10 minutes! As with any surgery, there can be complications as infection is always a risk, the capsular bag may break, the IOL power can be mis-calculated, the IOL can be mis-placed or subsequently move, dry eyes, and in the worst case scenario, you can (basically) lose your vision. These are all rare and in many cases, vision can be restored to at least close to 20-20.

But recall that accommodation (or focus) is done by your eye's Ciliary muscles moving your natural lens ... which has now been replaced. So until about 10 years ago, IOL's were "mono-focal" - i.e. you could see 20-20 distance, but had no ability to focus at Intermediate or Close-in. Therefore, you'd still need to wear glasses for reading, and the fuzziness at Intermediate distances would affect your day-to-day life.

In the last decade, two competing technologies have tried to address this shortcoming. Multi-Focal lens are basically concentric rings of far/close focus so two images are presented to the brain and it is able to "pick" the sharp one depending on if you are looking far or near. Advantages are that you have a good chance of seeing well at far and near. Disadvantages are that your Intermediate will be fuzzy, and high contrast situations can be difficult with halos and glare. As an engineer, this is obviously a compromise solution ... but if no perfect solution is available, one often uses what is available/works ... and Multi-Focals are commonly used today.

The other approach is Accommodating Lens which uses the eye's own Ciliary Muscles (which focus your natural lens) to change focus. Obviously this would be the "Holy Grail" of IOL's ... if it works. As of 2011, the Bausch and Lomb Crystalens is the only accommodating IOL to have FDA approval. There seems to be more variable results with the Crystalens, but ideally, you should end up with excellent vision at Far and Intermediate, but you almost certainly will need Reading Glasses for close-up work. I.e. If all goes well with the Crystalens, you will have at least a diopter of accommodation and be able to go glasses-free for most day-to-day life, but need glasses for reading. Because it's not a compromise solution, halo/glare is less of an issue and I would expect better low-light vision than multi-focals.

It's interesting talking to Eye Doctors as there definitely are Multi-Focal and Accommodating "camps" with both believing their solution is the best and the other is (basically) no good. So as a layman (or at best a eye-doctor-wanna-be), it's quite confusing who to believe and select an option. And what is really a bummer is that there is lots of research (and money!) in this area so even a couple of years from now, there probably will be other options. For example, Synchrony and Tetraflex are two lens awaiting FDA approval that claim greater accommodation. Femtosecond Lasers may soon be the new scalpel in eye surgery, offering more precision and consistent results.

My guess is that by time I'm 70 (when most people start to be affected by Cataracts), technology will progress such that Accommodating Lens with multiple diopters of accommodation (so you can see Far/Inter/Near) will probably be commonplace. In fact, it would not surprise me that (similar to Lasik), refractive Cataract Surgery becomes popular as an elective option to correct vision and address Presbyopia.

Note that you really do NOT want to remove an IOL after it has been in your eye as the risk of complications goes way up ... so "upgrading" years later would be difficult. But speaking from first-hand experience, the degraded vision from the Cataract really affects your lifestyle (and it is rapidly getting more annoying) so I'd like to do something about it rather than wait for the "next great thing." People describe Cataract Surgery as an incredibly positive life-changing experience ... lets hope that is the case for me.


So what did I decide to do? Turns out that Dr. Don Keller (who you may recall did my wife's Lasik) is huge fan of the Crystalens ... and was actually the first Doctor in Colorado to use 'em. So he obviously has a lot of experience doing them ... and while Cataract surgery is fairly routine, there certainly is a skill/experience element involved. He also spent a lot of time with me discussing the various pros/cons/aspects of Cataract Surgery. I'm OK with wearing glasses for reading, but it would sure be nice to see 20-20 (or better!) at Far/Intermediate for sports and normal day-to-day life ... and hopefully no halo/glare at night. So Crystalens seems to be the right choice for me at this time.

Some additional concerns are that due to my high Myopia, I'll have an even higher risk of Retinal Detachment during my lifetime. Also, I will probably have Posterior Capsule Opacity (PCO) sometime soon after the operation, but this is fixable with a ND:YAG laser that basically burns a hole in the back of the bag to clear the visual axis. My astigmatism (pre-cataract) isn't too much, but am hoping that a Limbel Relaxing Incision (LBI) during the operation may be able to reduce most of this. Note that while a Lasik tune-up is possible afterwards, you can't do a "custom" job after the IOL is in place since it messes up the measurements. Also, if you have had Lasik BEFORE cataract surgery, it will make the IOL measurements more difficult ... so it is helpful to have your eye measurements before you had that done along with the parameters of the Lasik surgery. Exercising the eye muscles by reading afterwards is highly recommended to "get/tune" them back into shape with the new accommodating lens and may take several months.

I should add that while the cataract in the left eye is not interfering with my vision too much, with -7 diopters of correction, you really need to have both done to balance things ... plus in dry Colorado, there is no way I could wear contacts all day long, every day. So another decision will be whether to do a ~1 diopter offset in the other eye (i.e. like mono-vision) to provide better near vision ... but this gives up some clarity at distance along with depth perception. For similar reasons, I'll want to do the 2nd eye as soon as possible (one week) after the 1st eye.

Cataract Surgery is covered by insurance, but only for mono-focal lens. The upcharge for premium lens (multi-focal or accommodating) is about $2,000 an eye. This is in addition to insurance deductibles, so it's not cheap ... but since I'm not even 50 yet (and hopefully have some good years left in me), it would sure be nice to see well after a lifetime of vision issues ... so I plan to have it done after Labor Day, 2011.


Expectations: While everyone wants 20-20 (or 20-10!) at Far/Inter/Near, that's not realistic with today's technology and Dr. Keller thinks that "20-functional" is quite doable. A very successful outcome for me would be sharp (good contrast with no halos, glare, etc.) 20-20 vision at distance and intermediate to 1/2 meter ... i.e. would be super to get a full 2 diopters of accommodation and he says my high myopia may help in that area as the football'ness shape of the eye provides more flexure on the IOL.

As noted before, there are risks with any surgery, but they are pretty low for Cataract surgery and obviously I hope none of the short or long term problems crop up for me. One thing I'll have to worry about for life is retinal detachment ... with high myopia and cataract surgery, it seems this happens to over 5% of people - not insignificant!

Cataract surgery is often described as life-changing since it restores vision. And as someone who has always been very near sighted and needed glasses/contacts all my life (and now has presbyopia), that hopefully will be the case with me.

So ... thanks for reading this far and I hope it was helpful/informative to 'ya. Wish me luck! ;-)

Aug 19th, 2011: At the pre-Op appointment, my right eye (w/cataract) best corrected visual acuity (BVCA) was 20-50minus (missed several letters) with a correction of -7.75 -1.00@155 ... and there is still significant triple vision, especially on point sources of light. The left eye seemed especially sharp that day and was able to do 20-15 with -7.25 -1.00@012. When trying to read print at 18", 1.75 diopters of correction were needed to get to 20-25 ... which is close to the theoretical maximum of 2 ... so lotsa presbyopia there! ;-)

The Corneal Topography showed 1.12 diopters of astigmatism in the right eye and 0.63 in the left, so Dr. Keller will perform Limbel Relaxing Incisions (LRI's) and hopefully reduce most of this. The IOL calculations recommend an 11 Diopter lens in the right eye that will (ideally!) result in a refraction of -0.16. For the left eye, he may slightly under-correct the power to allow for a bit more close-in vision depending on how it goes with the right eye. BTW, my pupil size was ~5mm in a dim examination room.

Biometric information on my eyeballs - click on the image to see in full-res

I'm scheduled to have the right eye done on Monday, September 12th, 2011 and the left eye a week later ... assuming no complications. By happy coincidence, my Mom is visiting Boulder, Colorado then, so for the first operation, it will be nice to have her around to help. BTW, the main reason for doing the two eyes "only" a week apart is that it will be very difficult to live/function with the right eye corrected and the left eye still needing over 7 diopters of correction ... talk about bi-polar vision! Check back after then for a (hopefully positive) update!

Sat, Sep 10th: I start putting eye drops in the to-be-operated eye. One drop of Zymaxid and Acular/Ketoralac (stings a bit) four times a day. After the surgery, I'll add one drop of Pred Forte (all 5 minutes apart) and after a week post-op, drop back to twice/day for the 2nd week.

Mon, Sep 12th: I had the right eye done this morning - here's the op-report. It seemed to go routine, but my memory isn't that great as I found out afterwards the Anesthesiologist used Versed initially which impairs memory. I was then knocked out with Propofol; literature says you are out in 40 seconds and I counted to about 20 before I said "here we go." Dr. Keller said afterwards I started talking and moving about a bit ... not unusual and overall I handled the anesthesia well. They woke me back up part way through the surgery and I was semi-lucid for the last couple of minutes. Recovery was quick and my Mom drove me home ... after a Smashburger stop for lunch - yea!

Dr. Keller inserted a Crystalens model AT-52AO 10.5 diopter lens (SN#10-681616) through a 3mm opening - an 1/8" inch! This is slightly less than the 11.0 power "recommended" from the biometry data. He explained that as the eye heals, it usually "pulls back" a 1/4 to 1/2 diopter, so he's hoping the 10.5 will result in me ending up plano - i.e. focus point at infinity when relaxed and hopefully clear 20-20 (or better) vision.

I didn't feel any pain in the eye and the most annoying thing is that the patch is not opaque ... so you have a "white veil" image coming in from the right eye that totally messes up your brain when it combines with a "good" image from the left eye. So I put a "pirate patch" over it to better obscure the right eye which makes it *much* easier to see - too bad it's not Halloween! ;-)

So far, so good ... the patch comes off Tuesday morning and we'll "see" what my vision is like.

I get to wear this colorful hospital patch after the Cataract Surgery - it stays on for a day

Pirate Patch makes it easier to see - too bad it's not Halloween as I could go as a Hulk'in Jack Sparrow! ;-)

Tue, Sep 13th: I had the "morning-after" post-op appointment with Dr. Keller who removed the patch ... and WOW, I could see ... and good! There was still some residual dilation and halo, but I was able to get almost all the letters on the 20-20 distance line ... HOLY COW!!!

This is obviously an excellent sign and after examining my eye, Dr. Keller said everything looked good and healthy and he'd expect some improvement in distance vision by the Friday appointment. I was able to read (barely) 20-40 in an intermediate vision test 24 hours after my surgery, but the accommodation can take several months and you don't want to be over-corrected. Recall I had -7 diopters of myopia so I could focus 5" from my eyeball - knew I'd lose this ability and will miss it. Initial impressions are low-light/night vision is improved. I do see some occasional "shimmering" on bright light sources in my peripheral vision along with a few dark floaters - I believe both are normal.

Another thing I have noticed is colors are more vibrant plus generally brighter. This is very common after cataract surgery and is probably due more to the yellowing of the natural lens with age ... which is pretty subtle as it "sneaks" up on you less noticeably than the loss of vision.

The human crystalline lens at various ages from Sidney Lerman's "Radiant Energy and the Eye"

The image below gives an idea of how a cataract shifts colors. I used Photoshop to simulate this by applying a +15 with Selective Color (Yellow/Yellow) and -15 on Brightness. Note that this is based on a direct comparison between my right eye (new lens) and my un-operated left eye (48 year old natural lens) which did not have a vision impairing cataract. I.e. the cataract was surely causing even more dullness - see what it did to Monet!

Image "flip" simulation showing how aging of your natural lens causes yellow hue & dimness - cataract was more!

There are other subtle color shifts and I've also seen a few "big" shifts a handful of times ... which may be due to me seeing some Ultraviolet light that was filtered by my natural lens before ... or maybe I'm just much more sensitive to the bottom of the visible spectrum around 400nm. The shift goes away when I used a camera UV filter. Some info here and another plus an eye surgeon report here and I'd like to test my color vision with a Monochromator. Using an online FM100 Hue test, I scored an 8 (seems pretty good) with the few errors in the green-blue area. I re-took the test (only takes a few minutes) in early/2018 and got none wrong - perfect score!

Here's a picture taken in the shade on a sunny day of my son's Colorado Rockies shorts and other misc.
The camera (and other people) don't see the purple glow - simulated with +20% Red & Blue channel
If I put a UV filter (or a pair of plastic biking glasses) in front of my eyes, the purple glow goes away
Click here to read more details/analysis on the violet glow as seen through a Crystalens

My mom volunteered (!) to take a few closeup pictures of my eyes after the first Cataract Surgery
Note Dr. Don Keller's initials (placed pre-op) next to the right eye

Closeup of right eye - believe that is the Limbel Relaxing Incision (LRI) and entry point at top - click to see lower one

One challenge is that the right eye is now close to 20-20, but the left eye is still -7 diopters ... so there is a big variance between the images from the two uncorrected eyes. You'd thinking that wearing glasses on the left eye would make it better (so now both are close to 20-20), but in some respects, this makes it more difficult due to the "Coke Bottle Effect" - i.e. the glasses make the image smaller and create distortion at the edges - this is called Aniseikonia and more info. So this is why I want to do the second eye one week after the first rather than wait.

Aniseikonia ("Coke Bottle Effect") flip simulation comparing image as seen by the right eye with no glasses (after cataract surgery and corrected to 20-20) compared to the uncorrected left eye with -7 diopter glasses

The combined image isn't this "bad" in real life, but still quite the challenge for the brain to sort out

Speaking of how the brain processes visual info, here's one of many interesting demos. The areas that "appear" to be blue and green (i.e. different colors) are actually the same color with RGB values of 0,255,150. Look at the closeup merge on the right and bottom.

Fri, Sep 16th: Dr. Keller said everything looked good; no issues with eye health and shimmering/floaters are normal. I was able to get most of the 20-15 letters on the distance chart, although there is a slight ghosting as I still have a diopter of residual astigmatism. I'm hoping that will reduce a bit more as the LRI's heal, but realistically, there will unfortunately be some leftover. This can be addressed with Lasik ... although doing a surgical procedure for a slight increase in visual acuity isn't clear-cut. The 20-15 line was quite sharp when +1.00/-1.00@155 was dialed in and once you have sharp vision, you can't help but want Superman-sharp! ;-)

We debated whether to go with an 11.0 Crystalens or an 11.5. As mentioned earlier, one can "offset" the two eyes so you have better closer vision, but at a loss of distance acuity and depth perception. According to the calculations, the 11.0 in the left eye would be 0.08 diopter more myopic than the 10.5 is in the right eye - the 11.5 would be another 0.31 diopters myopic. My goal is still the same - hoping to have sharp vision at distance with adequate accommodation for intermediate computer work ... and am willing to wear reading glasses for close-in. We decided to go with the 11.0 to match hopefully match the right eye as I would surely "notice" the mono-vision option.

Recall one main reason I selected the Crystalens was for the accommodative ability. Using the FAA Eye charts, I'm seeing 20-20 at distance (not quite as good as measured at the eye doctor), 20-40 at an intermediate range of 32" and 20-100/J10 at close-in range of 16". I'm hoping in the weeks to come to "see" some improvement in those areas. For comparison, while wearing my (distance) glasses on my (un-operated) left eye, I see 20-20 at distance, 20-25 at intermediate, and 20-50/J5 at near ... the accommodation is worse with contacts.

To test my vision, I've been using the FAA Eye charts: Far - Inter/Near - Near ... and Astigmatism

Mon, Sep 19th: Dr. Keller inserted a Crystalens model AT-52AO 11.0 diopter lens (SN#11-717456) in my left eye this morning. It also seemed to go routine - here's the op-report. I had much better memory of what happened due to the Anesthesiologist using Remifentanil instead of Versed. Ironically, one of the side-effects is "itching, especially around the face" and that is what I felt as I actually asked Dr. Keller near the end if I could scratch my nose - he said just don't poke your eye! So I was much more awake/aware for the operation and could see the tools and then the lens being inserted in the eye which I thought was cool. Just before being patched up, I could look out that eye and while the ceiling artwork looked very dim (Dr. Keller said this is normal), it did appear to look a bit sharper than at -7 diopters pre-op. Half an hour out of surgery, my wife had picked me up and we were heading for lunch - Smashburger again - yea!

I have a bit of a "dull ache" in the left eye (more than I remember in the right) but nothing alarming. I was able to "function" around the house (with only one eye of course) and go for an extended walk around the neighborhood with my wife. I again used a "pirate" patch to darken the semi-translucent patch ... so I'm scary looking and can say AYE MATEY! ;-)

So far, so good ... the patch comes off Tuesday morning and we'll "see" what my vision is like.

Tue, Sep 20th: I had the "morning-after" post-op appointment with Dr. Keller for the left eye. There was a bit more residual dilation and halo than the right eye (plus I think some of the anti-biotic ointment was still smeared on my eyes), but I could seen distance at 20-30. Overall, a very similar experience to the one-day post-op on my right eye ... except now I can simply view the world with both eyes which is GREAT!

Right eye correction didn't change much at +1.00/-1.00@145 so (applying half of the cylinder power) I'm slightly Hyperopic (means I "lose" some of the accommodative power) ... but Dr. Keller thinks I might see a quarter/half diopter pull back which would make me plano. With the correction applied via glasses, the 20-15 line was very clear plus I got some letters at 20-10, so my visual system is working well - WOOT! ;-)

Closeup of the left eye after Cataract Surgery - believe that is the LRI/entry point at top

The next day, I gathered up all of my glasses and leftover contacts - there's been countless more over the years
Therapeutic and uplifting to see the pile - will donate the glasses and other misc. and toss the rest - don't need 'em anymore! ;-)

Tue, Sep 27th: Once again, Dr. Keller said everything looked good and was healing well - always nice to hear that. He said my distance results were quite good and he'd guess that I might be able to get down to J3 for reading. I mentioned that I can clearly see more astigmatism shift in my right eye than my left - very noticeable when I compare eyes on letters and especially on a red alarm clock. As mentioned before, bummer that the LRI didn't pull more of this out, but one has to be realistic.

I had some +1.50 reading glasses, but picked up a +1.00 (for $3!) so my eyes will have to work "harder" for intermediate and close-in work. Spent a good part of the day on the computer without glasses, but I get tired after a while ... good exercise/training for the Ciliary muscles! ;-)

The refraction for the right eye didn't change much in the 2nd week ... in fact, she originally got the same +1.00,-1.00@145, but Dr. Keller showed that +0.50,-0.75@145 was very similar. The left eye was 0.00,-0.50@180 after one week, but I feel like it sees less astigmatism. Not perfect numbers, but not too shabby!

I still have occasional shimmering in my eye - typically when a strong light source is at the edge of my vision. This is called pseudophakic photic phenomena or Dysphotopsia and is common in Cataract patients, especially initially. A related phenomena is Negative Dysphotopsia - an occasional dark spot pops up in my peripheral vision. This catches my attention - was that a person (or animal/bird) over there! ;-)

Both are due to the different light paths through the intra-ocular lens (especially the edges) and in many cases, these will go away as the brain figures out they can be filtered away. That's been my experience as I hardly see 'em anymore from the right eye, but still periodically from the left eye, which is one less week post-op. Dr. Keller says a common occurrence that should go away soon ... so I basically just try to ignore 'em.

Dr. Keller and I discussed the "violet glow" I mentioned earlier - this is seen equally on both eyes. I stopped by a Halloween store yesterday and when looking at a (fluorescent) black light, it appeared a very bright blue. When I put some poly-carbonate safety glasses on, it went back to being a dim deep purple. Several other adults saw the later with no difference with/without the glasses ... and my 13 year old son only saw a very slight difference with/without the glasses. Medical literature says that the photoreceptors are capable of seeing UV light, but it's typically filtered by the natural lens, especially as it yellows with age. So now that my lens has been removed, I'd consider the test case above fairly conclusive evidence I'm seeing in the UV spectrum. Dr. Keller doesn't have the right gear to test this and has heard this rarely happening with the Crystalens and other IOL's - presumably those that don't filter UV. Read more about the Ultraviolet glow.

Overall, I'm very pleased so far with my Cataract Surgery and Crystalens implants. There's a few oddities (but I'm very analytical), but being able to see sharp (!) without glasses is great and the brightness and vivid color of the world is fantastic to look at.

Thu, Sep 29th: I purchased a Black Light to test my UV vision and I see dramatically different that others in this corner case.
So while I don't have a "Sixth Sense" that allows me to say "I see dead people" (!), I'm pretty sure I'm seeing Ultraviolet light! ;-)
This unusual side effect gives me a "superpower" so I need a purple cape! Read more analysis of my experience seeing Ultraviolet light.

Simulation of how I see in the Ultraviolet

Captain Ultraviolet to the Rescue - click here if you need a crime-fighter wearing super-cool Blue Blockers!

Mon, Oct 3rd: It's been two weeks since the second eye had the Cataract removed and the Crystalens IOL implanted - continue to test with the FAA eye charts. A bit discouraging that I haven't seen more accommodation, but I've read/been told that can take months so not unexpected.
I continue to try to "train/exercise" my eyes by trying not to wear reading glasses or just the minimum +1.0 power ones ... but it's a challenge to read in low-light conditions - hopefully I'm not just seeing increased depth-of-field in good light. Distant vision continues to be excellent - night driving is soooo much easier with very minimal halo/glare. I still see occasional shimmering (usually if my eyes are dilated and a bright light source is at the periphery of vision) and hardly ever see (especially negative) Dysphotopsia anymore.

It's been great playing some sports recently as I can see the spin of the baseball, arc of the frisbee, and trajectory of the football. A week before my surgery I mountain biked to the top of Rollins Pass and remember how difficult it was to see coming down as my eyes/brain didn't seem to be able to process the distorted/fuzzy imagery as I bounced along. I did some off-trail biking with my younger son today and it was night-n-day difference ... the world is in focus and just stays that way without having to "work" on it. In a similar fashion, stuff such as running around on the frisbee field and driving are much easier - I'm excited to see what it's like snow skiing this winter.

I no longer feel even the occasional "piece-o-sand" in my eyes plus there is minimal dryness. Another interested aspect is that I think (!) I can "hear" the world a bit louder - most notably birds chirping when walking. Perhaps my brain was working so hard pre-op on deciphering my blurry vision that I just didn't hear so well ... or (more probably) I'm just imagining it! ;-)

I still have some old habits such as sometimes reaching under the bed for my glasses when I wake up in the morning - don't need 'em anymore! And if I'm wearing reading glasses and want to focus even closer, I periodically look above the glass, since in the old days, my -7 myopic vision would allow me to focus very close - doesn't work anymore. Another peculiarity is that the world is not only brighter and more vivid, but larger. When I was wearing glasses, the magnification was outside my eye and things appeared smaller - remember my "Coke-Bottle" commentary early. While the image sizes are now matched (thankfully!), I truly do notice that things look a little bigger than I remember them such as golf/ping-pong balls and the moon.

Finally, a number people who have read my writeup (and visual examples) of seeing ultraviolet light have written to say they see exactly that. So while I'd still love to do some rigorous testing at an optics laboratory, I'm pretty darn certain now that I'm truly seeing in the UV spectrum.
I continue to sometimes see purple on grey/black items, but at least so far, this hasn't been annoying and it's more an interesting oddity.

10/13: My son has a small prism that casts rainbow colors which are well highlighted on the kitchen wall.
I put a yellow sticky where I saw the violet color end, and then asked my wife and kids (age 13 & 10) to show me the "end of the rainbow" ... which was less than I saw ... and about the same as the camera sees.

Thu, Oct 27th: Everything went well at my final post-op appointment with Dr. Keller. I was seeing 20-15 distance uncorrected and able to read the 20-10 line with a little bit of spherical/cylinder added. Some OD's call this the "whiner appointment" because patients are still waiting for more accommodation for inter/near vision. Right now, my mildly presbyopic wife can see better close-up than me, but it seems like occasionally my eyes "flex" and the computer screen/print comes into tighter focus, especially if I'm trying without reading glasses ... but I get "tired" doing that for a while. I sit about a meter away (i.e. 1 diopter) from the screen and usually try not to use glasses, although I'll put them on for fine print and when checking images for sharpness. Dr. Keller said more accommodation is coming, but will be "done" in 3-6 months. After examining my eyes, he said the posterior of the capsular bag is crystal clear (his OP-report said it was meticulously polished!) so be great if I never need YAG surgery. I mentioned occasional shimmering, but he felt that would go away as did the Dysphotopsia. So we're back to annual checkups unless something unusual happens - it's always good to be medical "boring" and I continue to enjoy my new eyes! ;-)

Nov 8th: Andy Goris at Hewlett-Packard thought my UV vision was worth testing and graciously provided access to a Monochromator in his Lab. This uses an extremely bright light (which requires special cooling) and a diffraction grating to produce a very narrow (10nm) wavelength of light that is projected on a sphere with an exit port for viewing - i.e. this is some pretty serious test equipment!!!

There's more pictures/analysis on the Ultra Violet page but in summary, I was able to see down to 340/350nm ... whereas similar aged people cut-out between 410-430nm. So this seems to conclusively prove that I'm able to see into the Ultraviolet spectrum.

The Oriel Instruments MS 257 Monochromator emitting at 450nm - note massive cooling radiator for source light

Nov 23rd: Distance vision and general comfort continues to be good. But I'm a bit disappointed that I have not "seen" more accommodation ... and in fact, seem to have a bit less than a month ago with the right eye struggling slightly more at close-in distances. I use the computer a lot (at an intermediate distance of 1 meter - i.e. one diopter of accommodation) and putting on +1.0 readers really sharpens the screen. So I don't seem to be getting much actual flexure from the Cystalens. Note that in bright outdoor light, close-in vision improves, but this is due to increased depth-of-field from constricted pupils. Dr. Keller said he was hopeful I would get to J3 (which would be an awesome improvement from J5) and still feels my eyes will improve with time. I continue to spend a bit of time either without glasses or minimal correction to force my eyes to work, but it makes for slower reading and can be tiring. On a positive note, I still think it's cool I can see the alarm clock in the morning and the Colorado mountains (and the world in general) certainly looks better with sharp distance vision!

Dec 19th: No major changes at the 3 month point from what I wrote a month ago. The right eye seems to have gotten a tiny bit worse at close-in ... but the left eye is a tiny bit better. Still a bit disappointed not to have more accommodation ... although occasionally things seem to snap into better focus ... so maybe there is some flexure of the Crystalens going on. Overall comfort and distance vision continues to be good ... and since the days are shorter this time of the year, it's real nice to be able to see well while driving at night.

I also picked up 400nm and 365nm UV flashlight to "test" my vision more. While both have leakage into the visual spectrum (which starts around 400nm), the 365nm light is a faint/pale grey to "normal" people ... whereas I see a bright purple. So makes for a very easy demo of my ability to see UV. Here's a picture of them "lighting" a non-fluorescent wall - remember that the camera doesn't "see" UV.

Mar 18th, 2012: All continues to do well at the 6 months point. Comfort is good, but recently, I occasionally have dryness/itchiness - mostly in the left eye, but could be due to allergies. Perhaps related to that is it seems the left eye "fuzzes out" more frequently ... although this could also be floaters obscuring the optical path. Distance vision remains excellent (also at night) with the right eye appearing to be slight sharper.

In terms of accommodation, the left eye has gotten a bit more, but the right eye has regressed slightly. Both are less capable in the evenings; perhaps the muscles are tired at the end of the day. When looking at the 32" intermediate chart at arm's length (~30") in good light with +1.0 readers, the left eye can read 20-15 and the right 20-20 ... my layman's interpretation is that this is about a 1/2 diopter of accommodation.

Close-up vision in dim light remains a challenge - I need readers to make out the menus at restaurants unless very good light. My son had an eye appointment with Dr. Brain Nichols (Dr. Keller's partner) and he was gracious enough to take a quick look at my non-dilated eyes and said it looked like a slight amount of posterior capsule opacification with a bit more in the right eye ... so it's possible this may be contributing.

Finally, an interesting "visual" while taking an evening walk with my wife tonight as we spotted a Great Horned Owl in a heavily wooded area. With the fading light, it was very difficult to pick him (her?) out as the owl's feathers blended in with the branches. Wendy is an extraordinary wildlife spotter ... and pre-surgery, she pretty much always saw wildlife before me. But in this case, I actually was the first one to pick out where the Owl had landed. I.e. an impressive demonstration of (distance) visual acuity in a cluttered low-contrast, low-light situation.

Jun 3rd, 2012: I get quite a few Emails from people about this webpage - JohnH wrote a particularly interesting one:
Back in the 1960's when I was a biology grad student at UCSD, there were reports that a spectroscopist named, IIRC, Gregorio Weber could see UV after cataract surgery too. At the time there was speculation that what he was seeing was not UV directly, but rather the UV-induced fluorescence of pyridine nucleotides and other fluorescent cellular constituents. The result was the same, of course, he could now perceive UV light with his eyes. I suppose the idea could be tested by looking at the action spectrum or by determining is the spatial resolution for UV was the same as for blue light.

That's a good question in terms of the actual mechanism of UV vision ... and I actually have not done any spatial resolution tests which would require an eye test on a chart only seeable in the UV spectrum ... seeing the purple'ish ting on a pair of "black" shorts doesn't count!

Jun 22nd, 2012: No major changes at the 9 month point except my accommodation seems to be getting worse, not better - darn!

It's not a big difference on the eye chart (which is very sensitive to the amount of light) but quite noticeable in my day-to-day routine as I am reaching for reading glasses more often, especially in low light. At night, I struggle a bit to read the newspaper at about 18" away even with +1.5 readers ... which should correct to 1/1.5 meters or 26" ... so I don't seem to be always getting that extra 0.5 diopter of accommodation. I also notice the limited depth-of-focus when the newspaper is on the table since the print is at varying distances. My arms and head seem to be moving things back-n-forth more as the focusing mechanism! ;-)

This may be due to posterior capsule opacification (note comment on March 18th) which I'm hoping is the case since this is semi-expected and should be fixable with a YAG laser. I'll do a formal eye appointment at the one year point and we'll "see" what happens.

Sep 19th, 2012: Exactly a year after my 2nd cataract surgery, I had an uneventful annual checkup with Dr. Keller - distance and night vision plus comfort remain good. We talked about my desire for more accommodation but he measured me at 20-40 and J3 (using both eyes) under very good light. After dialing in some slight spherical/cylinder correction, he felt I was getting about 1.5 diopters - again under very good light - possible some of that is depth-of-field. So my residual astigmatism is working a bit against me and I have to be realistic in my expectations.

He felt the change in the right eye was probably due to some slight scar tissue that may be preventing movement, but otherwise the inside of the eye looked good with some very slight PCO. He also saw some floaters in the right eye, although the left is much more noticeable to me. So no need to do YAG at this point (from a visual point of view) although he did say that people often see a slight improvement in accommodation from this procedure as it can allow the Crystalens to flex more posteriorly.

May 14th, 2013: So mid-afternoon today, I noticed my right eye was seeing a bit unusual ... and if I looked down and then up, I could briefly "see" a jagged (fortunately not straight - aka a "curtain" due to possible retinal detachment) black line across the top of my vision momentarily. This is seemed to go away after an hour or so ... but now there is a monstrous floater of mild opacity in the right eye. It sloshes back-n-forth most notably when moving my eye left-right-left. Plus there also is an occasional/intermittent small black floater on the far right - it's like there is a fly that comes in and out of my vision.

There was no difference after rinsing the eye with a few drops of saline - just wanted to make certain this is something internal to the eye rather than on the surface. It is completely localized to the right eye and there is no associated pain/feeling - just a slight obscuration of vision that mists over in normal activity due to the "floater" - I did not see any "flashes" of light - another sign of possible retinal detachment.

I was a bit concerned as my risk for vitreous separation (and retinal detachment) is much higher after cataract surgery and especially being highly myopic. Fortunately, Dr. Keller was able to see me the next morning, and after a dilation, he confirmed his suspicion of a posterior vitreous detachment (PVD) in the right eye. These are actually quite common, especially as we age ... and fortunately, I don't have a retinal tear or detachment as these require surgery. Earlier that day, I had a pretty good (accidental) collision while playing Ultimate Frisbee, and getting bumped can cause a PVD.

There is no real treatment for PVD - it eventually heals itself and most symptoms (including hopefully the floater) will go away. Dr. Keller said keep an eye out (pun intended) for an increase in floaters (especially black or red ones), flashes of lights, and the before-mentioned curtain ... as in the short-term, my chance of a retinal tear/detachment increases. However, over the long-term, he said it actually does down after PVD.

On another note, Bausch+Lomb received FDA approval for their astigmatism correcting Crystalens that they call Truelign. This would have been a good choice for me if it had been available in 2011 since despite the LRI's, I have some residual astigmatism.

June 25th, 2013: After over a month, I still see the floater which is a bit annoying ... but it seems to gotten smaller (or I'm getting more used to it) but as mentioned, these take a while to "dissolve." I have had several instances where I see some bright flashes out of the "side/corner" of my eye, but these seem very transient and has only happened a few times ... so I think just another "normal" visual oddity that one notices if they look closely.

Happened to noticed that the Skeptics Guide to the Universe did a podcast that talked about my UV vision - here's an excerpt just about that.

July 14th, 2013: I have been having a fascinating & informative Email discussion with Tom Clive, Dr. William Stark, and Dr. Klaus Schmitt about UV vision. While I can describe/Photoshop what something looks like in Ultraviolet, actually doing UV Photography is quite the challenge. I don't have the budget to replicate Dr. Schmitt's excellent setup, but it motivated me to fashion a "Rube-Goldberg" UV-Pass filter using Wood's Glass for my 50th birthday! ;-) I used that to view various things such as burning Natural Gas and flowers - click here to read how I was able to see 'em in a new light! ;-)

February 25th, 2014: So the good news is that annoying floater in the right eye (from the posterior vitreous detachment back in May) is much less of an issue. However, the bad news it that the floater in my left eye (that has been there since pre-surgery) has gotten pretty annoying the last couple of months. I notice this when reading and/or looking at the computer screen - the print just "fuzzes" out. Shifting my eyes left/right-up/down helps clear it (almost an unconscious reaction), but my wife says I look a bit funny doing it. There also seems to be a reduction in peripheral vision which I presume is due to reduced visual acuity. What is most annoying is driving at night, as there is glare/smearing of bright light sources that makes night driving sometimes a bit taxing. I.e. the right eye looks fairly sharp with well defined edges on the bright lights and decent contrast in the shadows ... but the left eye looks dimmer with smeared highlights and much less contrast in the shadows. So ends up being a bit of a challenge for the brain to combine/decipher these. Again, I can usually "clear" this by moving the eyes. There's not much you can do about floaters ... but maybe I should pop in to the eye doctor to confirm that's all that is going on.

April 25th, 2014: So about a month ago, I started seeing a "dark dot" in my right eye - this is a "solid" floater rather than nebulous "stuff" floating around. It is most obvious on (surprise!) white backgrounds and initially, one thinks it is a moving bug! ;-) Dr. Keller took a close look at my eyes today and said just some detached vitreous - nothing abnormal. My visual acuity was about the same, so that is a good sign ... and I've decided to pick up a some prescription astigmatism correcting glasses for when I want super-sharp vision.

September 20th, 2014: The dark dot mentioned earlier disappeared, came back, and then went away again. While a bit annoying, floaters are common as you get older. There's a "waxy" one that shows up periodically in my right eye, and a "globby" one in my left eye which can often be annoying, especially at night. Moving my eyes left/right-up/down moves it out of the way ... but then it drifts back into the optical path - darn old age! ;-)

Since my corrected vision has been pretty stable, I treated myself with a pair of prescription glasses for both distance and +1.0 Intermediate that also correct for the residual astigmatism and slight over-correction. There's isn't much correction for distance, but they do make things a bit sharper, especially at night ... you can also see that I do better on the eye chart. While I can read the computer screen without glasses, the "+1 readers" really make it sharp ... and easy/faster to read.

The amount of light makes a HUGE difference in how much I can accommodate for closer vision ... although what is actually happening is depth-of-field is increasing as my pupil contracts in light. I can read newspapers/books in sunlight ... but in normal indoor light, like to use at least +1.50 readers to do so.

I continue to get a lot of Emails about my webpage and I'm glad that it has been a helpful resource to so many people. I'm often asked how I'm doing ... and can say that after 3 years, I'm happy with the decision and results. Sure, I wish I had more accommodation ... plus if there was less residual astigmatism, I'd have that extra sharpness. But I analyze my vision more than most and one has to be realistic in their expectations.

March 1st, 2015: The floaters continue to be a bit annoying - more at night and in the left eye ... which seems to just get "lazy" sometimes and defocus. It's possible something else is going on - I've thought maybe Posterior Capsule Opacity but the vision does sharpen up if I move the eyes around, so PCO (sometimes mistakenly called a "secondary cataract") seems unlikely as that would probably stay in the optical path and always obscure vision.

Speaking of floaters, the general medical consensus is there isn't much you can do about. Some people are able to "tune 'em out" ... but being an analytical engineer, that unfortunately hasn't worked for me! One possible solution is a Vitrectomy which removes the vitreous humor (and hopefully the floaters) but as with any surgery, it has some risk ... and this is only indicated for severe floaters. Another approach is using a laser to "zap" the floaters, but very few doctors do this - here's a good survey piece by a retired ophthalmic consultant. I've actually had folks Email me about there positive experiences having this done ... so it does appear to work in some cases. Regardless, I have a checkup with Dr. Keller at the end of April, so I'm curious to hear what he sees/recommends after examining my eyeballs.

Oh yeah, and speaking of medical stuff, earlier today I fractured my Fibula snow skiing at Copper Mountain - darn! :-(

May 6th, 2015: So I had an appointment with Dr. Keller a week ago - pretty uneventful. I've updated the refraction numbers - slight visual degradation in both eyes, but perhaps I was having a bad day. He noted the floaters (which I feel have gotten worse) but not much I can do about 'em. I also feel there is a bit more "shimmering" in both eyes, but this is mostly noticeable in specific situations such as a streetlight at a high angle at night.

I got an interesting Email today from another eye doctor who wrote: "As an eye surgeon who has had a lot of experience using the lens, I found your experience to be pretty normal. Since the average lens power is closer to 20 diopters, the accommodative effect is significantly greater than a weaker lens like 10-11 diopter. [which mine were] Imagine if you were so nearsighted that a zero lens was needed. How much of an accommodative result could you expect with this? None!" That does seem logical, although there may be more to the accommodative effect as suggested by this paper - I could not find much medical literature in this area.

Feb 27th, 2016: I continue to get several Emails/month from people who also are able to see Ultraviolet and have stumbled across my website; almost all say "thank you for explaining what I didn't understand." HankR is a pretty technical dude who understands and has lived with a single IOL since 1994 - "Comparing 405nm for example is stunning -- faint violet with natural eye, brilliant purple with white center spot with operated eye (and yes it's scary)." He graciously sent me some "visible-light filters" (for UV flashlights) to test and I've updated my Natural Gas test which indicate they are superior to Wood's Glass in filtering visible light, but allowing UV through.

July 8th, 2016: I continue to get a variety of Emails from people thanking me for this website and sharing their experiences. RobinB wrote me first 3 years ago when he had his left eye done and sent an encouraging update recently. He had some PCO and underwent YAG laser treatment to clear it up and writes: Within a day or so I could really notice the difference and suddenly knew why they call the Crystalens and HD lens. The TV and any backlit screen was fantastic! Super sharp and clear. Unfortunately, I did have a complication in the form of a vitreous floater. This floater looks like a large foggy blotch that lives in the upper right quadrant of my left eye and is not visible until you look far left and then back to center, or far down and back to center. Then it sweeps down in the opposite direction of eye movement like a blurry windshield wiper. Yuck! How discouraging, especially when that left eye can suddenly focus and read - it is 20/20 distance, 20/30 near(reading) and I’m guessing 20/10 or 20/15 for computer distance of 2 feet up to perhaps 4 feet (intermediate) as they didn’t test this distance. I couldn’t be more happy with the sharpness of my 3 year old left eye Crystalens now and will not hesitate to do the same for the right eye (which he had done a month ago) if at the one year mark the sharpness is not approximately equal to the left. I would even consider it if there isn’t any noticeable cloudiness to the capsule as I think these lenses may be best when unimpeded by the capsule? This is even with the complication of the Vitreous floater that cropped up after the YAG. I asked about YAG several years ago, but didn't have enough PCO to warrant it ... plus as Robin noted, there are possible side-effects as he noted. But I'll probably see Dr. Keller later this year and will definitely ask again about YAG for me as some extra sharpness is always good, plus I'd love to get some more accommodation.

August 26th, 2016: Had an uneventful (the best type!) eye appointment with Dr. Keller. He said a bit more PCO going on, but not enough to warrant YAG laser'ing it. He has a new "eyeball camera" which clearly shows the floaters in the left eye near the optical path - not surprising as these can be a PIA. The refraction number suggest a very slight increase in far-sighten'ness which I don't find surprising. Unfortunately, we didn't do a "how low can I read on the eye chart?" with the refraction dialed in, but I was able to read several of the 20-10 letters with correction.

February 24th, 2017: For several years, I have been corresponding with BrianG, who had Symfony IOL's implanted - these have worked out well for him. I actually knew Brian a few decades ago in the computer biz - super sharp dude back then - and just as sharp about eye stuff. He's been a wealth of information and helpful to bounce ideas off of. So we are talking about using a YAG laser to address PCO - per my earlier comment, I may increasingly be a candidate for this. I always thought YAG simply addressed the cloudiness of the back of the bag (by basically blasting it out of the way), but Brian pointed out that myopic refractive shifts can occur due to fibrosis of the capsular bag ... and one study suggests a slight hyperopic shift after YAG surgery. If so, this would be a bummer as I'm slightly hyperopic already. However, I may be having ACCS (Anterior Capsular Contraction Syndrome) as I feel I've gotten a slightly more hyperopic with corresponding decrease in accommodation ... as I more easily reach for +2.0 rather than +1.5 reading glasses. A good read here ... plus a video about YAG from the first US surgeon to implant the Crystalens. I'm real curious to ask Dr. Keller about this next time I see him.

February 1st, 2018: Another uneventful appointment with Dr. Keller. The Floater in the dominent left eye continues to be a PIA, but not much can be done about that. There are a few doctors who use a YAG laser to blast 'em, but Dr. Keller strongly recommends against doing this. He saw some slight PCO in the right eye, but not a concern ... plus with correction, I read 4 out of 5 letters on the 20-10 line ... WOOT!

July 15th, 2018: I get Emails all the time from people about cataracts, so my writeup must be helpful. SteveR wrote to me about his surgery and mentioned a clever way to "look" at your floaters - "The trick for seeing your own cataracts, floaters, etc., is to get into a very dark room with only one tiny faint LED on the other side of the room, wait a few minutes to adapt to the dark, and look through a magnifying glass at the LED. You will see a colored disk, in which you will see the shapes of everything in your eye that absorbs or scatters light." It's a little tricky getting the magnifying glass at the right length and position ... and then keeping it steady ... but WOW, that really works well. The other approach is looking at the blue sky (or any bright uniform light source ... but NOT the sun) with a very strong monocular or binoculars ... and you'll see the floaters moving around as stringy filaments and blobs. If you do both of these correctly, you should be able to get the floaters in focus. You can also do that approach by just closing your eyes and looking up at the sky (obscuring one eye and then the other) and you can see some stuff floating around. Another way to see them (but out-of-focus) is when driving around, look at a strong point of light such as reflection of the sun during the day ... or head/street light at night. With my left eye, I'll see the unfocused floaters swirling about ... but if I blink/move my eye, they move out of the way ... but then eventually return. They are much less noticeable with the right eye. Unfortunately, floaters are very common (especially as you get older) and there aren't any "good" solutions to getting rid of those annoying rascals! ;-)

July 23rd, 2018: Last night, I noticed a (new) large floater sloshing around in my left eye. This can be caused by a Posterior Vitreous Detachment ... which are not uncommon for someone my age and especially with myopic-shaped eyeballs. I had one 5 years ago - see my comments from May 14th, 2013. More concerning was that I saw "lightning" flashes of light around the left periphery (image below of what I saw) , which can be a sign of a retinal tear or even a retinal detachment. Those are pretty bad mojo since as if left untreated, you can go blind.

I "saw" these very brief "lightning" flashes every 10-15 minutes, especially if I moved my eye back-n-forth. The pattern was random, but typically a crescent and often some small separated "jaggies" - all on the upper left periphery of my vision. Much less the next morning.

Even though Dr. Keller does surgery on Monday, he was able to squeeze me in and confirmed it is a PVD ... but NOT a retinal tear/detachment. He said good decision to be looked at in case it was ... since if a tear, he would have literally right then, done a quick outpatient retinal laser surgery to seal the tear before it got any worse.

Dr. Keller advised me to take it easy for the next week (hiking OK, but no mountain biking or other impact/head-turning activities) and all should be fine ... but come back if the flashes return. Good news is assuming that the vitreous cleanly detaches, it actually reduces your odds of a retinal tear/detachment.

January 1st, 2019: I've been meaning to write this for at least a month, but the annoying floaters in my left eye are no longer present. I realized this after driving at night, which used to be a bit of a PIA because it would periodically obscure the vision in my dominant left eye. While I can still see some stringy filaments and blobs in both eyes, it's not near as annoying as it was. So presumably they got re-absorbed. My guess is we'll see more of 'em in the years to come ... but in the meantime, it's nice to have 'em (mostly) gone for now.

October 30th, 2019: Had a routine eye exam with Dr. Keller. I've been meaning to write about this, but there has been a slight blurriness in the right eye for some time. This was confirmed by not only the slight reduction in uncorrected visual acuity at all distances, but also by the drop in best-corrected visual acuity. Dr. Keller felt this was because the PCO had become more pronounced ... so might be almost time to have a YAG laser treatment. He explained that some people see a +0.25 hyperopic shift ... but that some also see increased accommodation due to relaxing of the Crystalens hinges. Here's hope we do NOT get the former (I'm already slight hyperopic) but do get the former (my guess is current accommodation is less than 1/2 diopter). I've talked about using a YAG laser to treat PCO many times in my diary since it is quite common - see in particular my Feb 24th, 2017 entry which has links to medical articles. Here's a May/2019 article that focuses on capsular contraction syndrome ... but note table #1 that also shows an average of +0.25 shift after YAG. Dr. Keller pointed out that while that may occur, the additional accommodation and clearer optic path should hopefully offset it. I suspect in the next year, I'll have YAG in at least the right eye.

August 26th, 2020: No major updates ... except the blurriness in the right eye continues to get worse which is presumably due to PCO ... so I need to figure out some insurance stuff and will probably have it done in the next couple of months - they actually do both eyes at the same time. Speaking of having eye surgery, I continue to get periodic Emails from people about my writeup. Roger Dunkley had some good questions and then underwent cataract surgery. Click here to read his detailed "Sight Story"

September 7th, 2020: First, a few days ago, I noticed a reddish tinge to my vision ... which is almost certainly caused by a Vitreous Hemorrhage. This happened the day after a hike above 13,000 feet with cold winds up to 50MPH ... so it's possible some sort of trauma from that (right eye was a little "redder") ... but also could have been just stuff happens. Fortunately, it went away after a couple of days.

The main reason I'm writing this update is the blurriness in the right eye has gotten progressively worse - this is almost certainly being caused by Posterior Capsule Opacification (PCO) which commonly happens after cataract surgery. I've been fortunate it has taken this long to develop since my cataract surgery in late/20111. Dr. Keller first flagged it in early/2018 and the visual deterioration become noticeable starting about mid/2019 ... and has been slowly gotten worse.

When I cover up the left eye, my vision is noticeably fuzzier using the right eye at all distances. Applying "plus" near correction doesn't improve distance ... so I haven't gone hyperopic. Fortunately, I don't "see" this too much in normal activities (although binocular vision would be affected) as my brain is using the "good" image from my dominant left eye. But being an OCD Engineer, I notice it probably more than most and find it pretty annoying. BTW, I was kind of surprised that my right eye vision almost goes back to "normal" using a pinhole occluder ... since I would think that the haziness would affect that more.

The fuzziness is more pronounced in high contrast situations and especially bright points of light. The left eye will see it reasonably distinct, whereas the right eye will see a blurry ball around it. Floaters can create a similar visual pattern, but you'll see it change if you move your eyes around as they float in-n-out of the visual path.

So it's time to have the YAG laser surgery to clear it up. This takes just a few minutes (totally outpatient with no anesthesia) and basically is a focused laser that "burns" away the back of the capsular bag so the hazy section falls away and doesn't obscure the optical path - here's a good writeup. While any procedure has some risk, this one is very minimal and should clear up the right eye fuzziness right away ... and since the left eye will also be done, it could also provide better vision there due to a clearer optical path. Note that after the hole is "blasted" in the back of the bag, trying to replace an IOL would be much more difficult ... but ideally that should never have to be done anyway.

Per my October 30th, 2019 update, Dr. Keller said there's a chance of a slight (~+0.25) hyperopic shift (which I hope does not occur) but also that the YAG treatment may "relax" the Crystalens hinges and provide some accommodation - i.e. better near vision. I would be ecstatic if that actually happened ... although realistically, I think the odds are low.

Both eyes are typically done at the same time, so I'm looking forward to next Monday when Dr. Keller will fire a laser at my eyes! ;-)

September 14th, 2020: First, Dr. Keller confirmed that my self-diagnosis of a Vitreous Hemorrhage was almost certainly the cause of the reddish tinge to my vision that I had for a few days and was probably due to trauma from hiking in the 50MPH winds. Since there was no additional symptoms (such as flashing lights), no cause for concern.

He then "shot" both of my eyes with the YAG laser to "blast" the PCO. Just before that, I got a drop of 0.5% Apraclonidine (proactively to reduce IOP) and 1% Tropicamide (dilate the eyes) and afterwards another drop of Apraclonidine. The laser itself takes about a minute per eye. The left took 37 shots (each at 1.8 milliJoules) for a total energy of 68 mJ. The right eye (which had more fuzzy vision and Dr. Keller confirmed looked much hazier to him) took 109 shots for a total energy of 198mJ.

One thing I noticed right away was all sorts of floaters in both eyes, which is to be expected ... since Dr. Keller basically blasted a 5mm hole in the back of the capsular bag. It's kind of wild using high powered binoculars to look at the sky (NOT the sun!) and see the pieces floating around. These should dissipate in the next couple of days.

My initial impression (while the eyes were still dilated) is the fuzziness from the right eye was cleared up ... it actually seems sharper at distance than the left. I'll do some testing in the next couple of days to see how I'm seeing at near/intermediate/far and I'm hoping there is minimal hyperopic shift. I have a follow-on appointment with Dr. Keller at the end of the month, so real curious to see the refraction numbers.

FYI that there were no pre-op prep/restrictions and I drove myself home afterwards (wearing sunglasses) with no post-op limitations.

September 15th, 2020: As a wanna-be-eye-doctor, I did some quick self-testing. The right eye is clearly (!) better than before - as expected since the "hazy" posterior section of the capsular bag that was in the optical path is now gone. The left eye seems to have gotten slightly better than before (probably had some haze) and both eyes are fairly "balanced" and I'm able to read most of the 20-15 line with each eye at distance.

As mentioned, there is the possibility of a hyperopic shift from YAG and I don't really have the ability to measure/infer small amounts of this ... but my guess is that at least so far, that hasn't happened - WOOT! ;-)

This seems to be reinforced by the improvement in my near/intermediate vision. The right eye is without a doubt better from just before YAG - again, not surprising since the hazy section was removed. My initial testing shows both eyes are comparable to several years ago and (maybe!) slightly better. While looking at the intermediate/near vision charts, it seems it will sometimes clear up even better .... which suggests (maybe!) some accommodation is going on. I'm real curious to see if this continues and hopefully improves. Note the visual acuity is dependent on good light, so depth-of-field "accommodation" is playing a significant role.

I noticed right away when I put on my +1 readers (with astigmatic correction) that the computer screen (at a meter intermediate distance) is really sharp and dark - love it! With that correction, I'm getting most of the 20-15 letters on the intermediate chart even in not-so-bright light. Another thing easily noticed is when looking at bright points of light, the "blurry ball" (caused by PCO) is no longer seen from the right eye.

Just for grins, I fired up my 365nm UV flashlight and grabbed a piece of Woods Glass (filters visible light) and a UV filter. When my son looks at the flashlight through the Woods Glass, it goes almost completely dark (he can't see UV) ... whereas I can still see quite a bit from the UV. Putting the UV filter in front of the flashlight (both with/without the Woods Glass) makes very little difference for him (he doesn't see UV) ... whereas for me it's a big difference (since the UV is now being filtered). None of that is surprising - the YAG procedure removed material so if anything, I might see a bit more of the UV spectrum that was being filtered by that. But I don't have adequate tools to evaluate that - would need to do another round of testing with a Monochromator as I did 9 years ago.

September 21st, 2020: So a week after YAG surgery to clear the PCO, things are "looking" good. For Distance, both eyes are pretty balanced and seeing 20-15 and even some of the 20-13 line on my eye chart. The world looks more "crisp" and I feel I'm "seeing" the frisbee better which is probably due to much improved binocular vision. The pinhole occluder provides a little extra sharpness, but very comparable to when I put on my "distance" glasses that provide a very small correction - mostly astigmatism in the right eye.

For Intermediate, the left eye can see some 20-25 and it's better than before. In fact, I usually wear +1 glasses when using the desktop computer, but I'm much more able to do so without correction now. While it's not as sharp, I figure this is good accommodation "exercise" although it's tempting to put the glasses back on for razor sharp vision. The right eye sees 20-50 and maybe some 20-40. So far, I don't seem bothered by the imbalance and I've tried putting a patch over the left eye to "make" the right eye work "harder" - I don't want it to go "lazy" on me. With pinhole occluder, the left goes to 20-15 and right goes to 20-20 ... man, I wish I had that uncorrected! ;-)

For Near, the left eye will get to 20-50 ... and sometimes 20-40. Again, this is an improvement. The right eye is still struggling and usually is about 20-100 ... but sometimes 20-70. I have to be careful not to squint because both eyes will improve. With the pinhole occluder, the left gets down to 20-20 and right gets to 20-30.

Note that all of the above is in decent light ... so my close-in vision is being "helped" by depth-of-field accommodation. However, I think there is some real accommodation going on ... as my near vision improves if I work on it. When I "work" on the right eye (by covering the left eye), I will every once in a while get a focus improvement ... but have to be careful not to squint which improves both eyes. It's kinda funky to immediately uncover/switch to the left eye (which presumably was trying to focus in sync) and I can read some of the 20-40 line right away.

I continue to have some floaters, but those are decreasing. There are only a few dark spots (looks like fly or gnat out of the corner of your eye) but they are mostly noticeable when I'm doing "eye tests", I'll see some amorphous floaters blur up the vision, but I don't notice it day-to-day. When I look at streetlights at night, there is very minimal glare/haze in both eyes - no more "blurry ball" as seen before with the right eye.

So what this wanna-be-eye doctor make of all that? The laser surgery appears to have been pretty successful. The (annoying) haziness of the right eye is gone and the left eye improved also. The clarity has resulted in better vision at all distances, but the left eye seems to have some "real" accommodation ... it would be awesome if the right eye decided to start flexing ... but I'm probably overly optimistic about that. It also remains to be seen how things change over time.

I see Dr. Keller on October 8th, so I'm curious what a real eye doctor says and what a formal refraction will show.

October 5th, 2020: No significant changes from my report two weeks ago. Floaters continue to decrease as I no longer see scattered small black specs. I do have some amorphous floaters still around, but seems less ... and mostly noticeable when I'm "testing" myself or "straining" - i.e. using computer without correction. I suspect this is because in "normal" usage, if a floater "fuzzs" up one eye, the brain uses the image from the other. I feel near/intermediate vision has regressed very slightly ... but seems to get better after I "work" on it for a while. I'll report back from the doctor appointment on the 8th.

October 8th, 2020: Dr. Keller says everything looks great. I'm seeing 20-15 at distance in both eyes and per the refractive numbers below, the left eye stayed the same but there may have been a slight hyperopic shift in the right eye - overall the numbers (and my vision) "look" good. Dr. Keller feels the refraction should be pretty stable at this point.

I mentioned how the left eye seems to have some actual true accommodation whereas the right one does not - he said that is basically the luck of the draw. I'm spending a bit of time "under-powering" my eyes (i.e. no readers or less than normal) with the hope that the IOL will start to flex. I'm not too hopeful, but will give it a shot.

IOP was 18 in both eyes - glaucoma becomes a possible concern if over 21. There is a slightly increased risk of Retinal Detachment from YAG surgery, but the "football" shape of my eyes (remember I was very myopic) would be a bigger reason for that to occur. I'm overall pleased with the results ... although a little more accommodation would have been icing on the cake! ;-)

April 21st, 2021: I haven't posted any updates in a while, but that's "good" because it means minimal vision issues. I attended a presentation (virtually) by Dr. Brian Nichols, who is a partner of Dr. Keller's at Boulder Eye Surgeons. The first half of his talk was an excellent summary of Cataract Surgery and then he focused (pun intended ;-) on the very recently FDA-approved Light Adjustable Lens. LAL is a "Holy Grail" ... since post-operatively, you can adjust the refraction non-surgically!

In summary, it's made out of a UV sensitive material, so after things have "healed/stabilized", the doctor can use UV light to re-shape the lens (multiple times) to adjust it plus/minus 2 diopters of Spherical and 4 diopters of Astigmatism. Note that you *have* to wear UV glasses *always* until you are happy with the results ... at which point it is "burned in." So this not only can fix any refractive surprises, but also allows you to really nail the target endpoint. Here's Dr. Nichol's video presentation with associated slides. It will be interesting to see if this technology fully "works" and becomes commonly used.

November 1st, 2022: I had an uneventful eye appointment with Dr. Holly Hughes at Third Street EyeCare who I highly recommend! Refraction basically hasn't changed and with correction, I was able to read all the letters on the 20/10 line with both eyes ... although I think their eye chart was a bit "easy." My IOP was 20/20 (getting up there - was 18/18 two years ago) but after a thorough (dilated) examination, my eyes looked "very healthy" ... albeit lots of floaters. These aren't concerning, although they are annoying as they periodically become more pronounced. The doctor also saw a "half moon pigmentation dropout" in the Supra-Temporal (upper right) of my right eye. They asked if I had any retinal repairs (since it looked like that), but I have not. Some research I did afterwards show that it's possible this might be a early sign of various eye disorders, so I'll ask at the next appointment. They were not concerned about it and neither am I.

November 5th, 2022: Kathy and Jerry Oltion write "Cataracts and the Amateur Astrononomer" which is a real interesting read about the aberations from Cataract Surgery that keen-eyed Astronomers see. Excellent "optics" info ... and fortunately has a happy ending.

November 7th, 2022: I came across a 2014 paper in the American Journal of Opthalmology that evaluates how much TRUE accommodation the Crystalens provides using laser ray tracing. It found less than 0.4 diopters in all eyes (11 patients - both eyes) ... which is consistent with what I believe I have. And it suggests that earlier studies showing 1.74 & 2.42 diopters were achieved via psuedo-accommodation. And yes, in bright light, squinting (or with a pinhole occluder!), I can see much better up close up. So this calls into question how (truly) accommodating the Crystalens is ... and may contribute to the reason it's not become more popular.

October 15th, 2023: Another excellent & uneventful eye appointment with Dr. Holly Hughes. My right eye seems to have lost a little bit of sharpness - I was guessing about a quarter diopter, and that's what it came in at ... but remember there can be daily fluctuations. This time, I was only able to read a couple letters on the 20/10 line (when corrected), so either there has been a very slight loss of vision ... or their eye chart isn't as easy as it was last year! ;-)

My IOP was 20/20 (getting up there - was 18/18 three years ago, but same as last year) and after a thorough (dilated) examination, my eyes looked "very healthy" ... albeit lots of floaters. I forgot to ask about the "half moon pigmentation dropout" in the Supra-Temporal (upper right) of my right eye which was mentioned last year, but presumably it's not there as she did not mention it. So no eye health concerns.

I had them measure my distance (+0.50/-0.50@155 & +.50/0.75@000) and reading (+2.75/-0.75@163 & +2.25/-0.50@179) glasses which I've had for years. Those are still "close enough" that no need to change 'em

September 16th, 2024: I stumbled across this "Review of Opthalmology" article that talks about the current state of accomodative IOL's.     The Crystalens is NOT mentioned as it seems you don't hear much about it these days and has fallen out of favor - see 11/7/2022 entry above. What's possibly coming down the pipe sounds pretty exciting - three diopters (or even more) of TRUE accomodation would be pretty amazing.

November 13th, 2024: Because of *&^%$#@! insurance, Dr. Holly Hughes was no longer in plan , so ended up seeing Dr. Alessandra Roa at Front Range EyeHealth who did an excellent job. Vision was about the same as last year.

My IOP was 22/18 ... so starting to get concerning ... and we "looked" and discussed this quite a bit. Dr. Roa was not concerned as I don't have any significant risk factors ... and my cup-to-disc ratio was 0.25 ... which is considered low. If this was larger (or increasing), that would be an indicator for glaucoma. Plus she said everything looked very healthy. She said I could do an IOP check in 3-6 months, but thought it was unnecessary ... which I agree with.

She did notice (but was not concerned) with what I think was the "half moon pigmentation dropout" in the Supra-Temporal (upper right) of my right eye (seen in 2022), but I forgot it had been flagged before - FAIL by me for not better reviewing my medical history beforehand!

People often ask how much does Cataract Surgery cost?
My insurance is with Cigna and since Cataract Surgery is a medical condition, they help pay for the operation and a "standard" IOL ... but with a $250 co-pay plus 20%, my out-of-pocket expenses added up to $2,894.90 ... plus $3,700 for the Crystalens upgrade (billed as a markup for the product and the surgeon) for both eyes. So while not cheap, it was less than the $6,000,000 that Steve Austin's bionic eye cost! ;-)

Item		Billed	Discount	Adjusted	Insurance	Out-of-Pocket
Anesthesiologist #1		630.00	210.00	420.00	336.00	84.00
Anesthesiologist #2		540.00	180.00	360.00	288.00	72.00
Eye Surgeon Pre-Op		280.00	85.04	194.96	154.96	40.00
Eye Surgeon #1		2,240.00	1,322.25	917.75	534.20	383.55
Eye Surgeon #2		2,240.00	1,322.25	917.75	734.20	183.55
Hospital #1		6,902.00	2,710.00	4,192.00	3,153.60	1,038.40
Hospital #2		6,318.15	2,126.15	4,192.00	3,153.60	1,038.40
Crystalens Premium x2		1,800.00	0	1,800	0	1,800.00
Eye Surgeon Premium x2		1,900.00	0	1,900	0	1,900.00
Pre/Post-op Eye Drops		181.83	0	181.83	126.83	55.00
TOTAL		23,031.98	7,955.69	15,076.29	8,481.39	6,594.90

While "20-whatever" doesn't tell the whole picture about the overall visual acuity of your eyes, it's what most people are familiar with.
I track my vision with the FAA Eye charts (Far - Inter/Near - Near) and Astigmatism - the eye doctor measuring slightly better numbers.
Note that right eye was done on September 12th, 2011 and the right eye a week later.

Date		OD - Right Eye		OS - Left Eye		Best Corrected Visual Acuity/Comments
Pre-Op		20-50w/-7.75-1.00@155		20-15w/-7.25-1.00@012		Pre-op numbers are BCVA - needed +2 for reading
+1 Day		20-20/40/100/J10		20-25/40/70/J7
+1 Week		20-15-/30-/70-/J7-		20-15-/30/50/J5		OD:20-15w/+1.00-1.00@145		OS:20-15+w/+0.00-0.50@180
+2 Week		20-15-/30/50-/J5-		20-15-/30/50/J5		OD:20-15+w/+0.50-0.75@145		OS:Not tested
+1 Month		20-15-/30/50/J5		20-15-/30/50/J5		OD:20-10-w/+0.75-1.00@152		OS:20-10-w/+0.50-0.75@005
+2 Month		20-15-/30-/50/J5		20-15-/30/50-/J5-
+3 Month		20-15-/40/50-/J5-		20-15-/30-/50-/J5
+6 Month		20-15-/40-/70/J7		20-15-/30/50/J5
+9 Month		20-15-/40-/70-/J7-		20-15-/30-/50-/J5-
+12 Months		20-15-/40-/70-/J7-		20-15-/30-/50-/J5-		OD:20-10-w/+0.50-0.75@155		OS:20-10-w/+0.50-0.75@005
+18 Months		20-15-/40-/70-/J7-		20-15-/30-/50-/J5-		OD:20-10-w/+0.75-0.50@155		OS:20-10-w/+0.00-0.50@177
+30 Months		20-15-/40-/70-/J7-		20-15-/30-/50-/J5-		OD:20-10-w/+0.75-0.50@147		OS:20-10-w/+0.50-0.50@177
+3 Years		20-15-/40-/70-/J7-		20-15-/30-/50-/J5-
+4 Years		20-20+/40-/70-/J7-		20-20+/30-/50-/J5-		OD:20-15+w/+0.50-0.50@145		OS:20-15+w/+0.25-0.75@002
+5 Years		20-20+/40-/80/J8		20-15/30-/70/J7		OD:+1.00-0.75@155		OS:0.50-0.75@005
+6 Years		20-15-/40-/80/J8		20-15-/30-/70/J7		OD:20-10-w/+0.75-0.75@155		OS:20-15+w/+0.25-0.50@005
+8 Years		20-25/50-/100/J10		20-20/30-/70/J7		OD:20-15+w/+0.75-0.50@155		OS:20-10-w/+0.00-0.75@010
+9 preYAG		20-40/70-/125/J12		20-15-/30-/70/J7
+9 postYAG		20-15+/40-/70-/J7		20-15/30-/50-/J5		OD:20-10-w/+1.00-0.75@155		OS:20-15+w/+0.00-0.25@177
+10 Years		20-15+/40-/70-/J7		20-15/30-/50-/J5		OD:20-10-w/+0.75-0.75@151		OS:20-10-w/+0.25-0.50@007
2022_11_01		20-15+/40-/70-/J7		20-15/30-/50-/J5		OD:20-10-w/+0.75-0.75@156		OS:20-10-w/+0.50-0.50@180
2023_10_16		20-15/50/80/J7-		20-15/30-/50-/J5		OD:20-15+w/+1.00-0.75@154		OS:20-15+w/+0.25-0.25@179
2023_11_13		20-15/50/80/J7-		20-15/30-/50-/J5		OD:20-15+w/+1.00-1.00@150		OS:20-15+w/+0.00-0.50@179

Some summary points - remember I'm not a medical professional so consult with your eye doctor about your specific situation.

• While Cataract Surgery is fairly routine these days, there is risk with any surgery - I'm very happy to have had no major complications.
      This may actually be a "better" option than Lasik, especially if you are middle-aged and want to try to correct Presbyopia.
• Educate yourself on the pro/cons of the various solutions and what you want - I don't believe there is a "best" IOL ... yet.
      Along those lines, I really appreciated Dr. Keller's candid comment - "results are limited by limitations in current technology"
• You can over-research Cataract Surgery (as I did!), but ultimately you have to trust the eye surgeon who does it.
      This sounds good in theory but is realistically difficult as every doctor claims the lowest complication rate, best results, etc.
• Be realistic in your visual expectations for far/inter/near and low-light
      Especially true if you have any amount of astigmatism - make sure you understand what your surgeon can/can't do about that.
• Cataracts "sneak" up on you as the vision slowly degrades, so keep an "eye on your eyes"
      The dullness/dimness is subtle (plus your natural lens yellows) and everything looks so much more vivid and bright after surgery.
• After seeing my wife go through Breast Cancer Surgery a year earlier, Cataract surgery was a piece of cake in comparison.
      I was able to "function" that afternoon and drive the next day - there's little pain/discomfort associated with the process.
• Ask the Eye Surgeon/Anesthesiologist if you can stay awake/aware during the operation - it was pretty cool ... for me! ;-)
• If you have significant correction, minimize the time between operations - it's tough have one "good" and one "bad" eye.
      Putting a "pirate patch" over the translucent patch really reduces the strain on your brain by producing a dark image.
• It's amazing to see 20-20 the very next day, but be patient as there are some visual aberrations that last longer.
• Also have patience (on a longer scale) for the Crystalens accommodation - I'm still waiting/hoping for more, especially in low light.
      I don't expect to be able to read without glasses, but one diopter of accommodation would be nice for intermediate viewing at a meter.
• Activities that require motion such as sports, driving, etc. are much easier with sharp vision.
• While you won't "see Dead People" (Sixth Sense), you might see Ultraviolet light which is kinda interesting.
• Consider having Cataract Surgery done sooner rather than later - as one MD found out.

I've worn glasses/contacts since childhood, so my Cataract surgery has been especially life-changing for me.
I consider myself fortunate to have a fairly successful outcome and "see" the world in a whole new light! ;-)

WOW - you actually read this far! ;-)
I hope my longgg writeup was informative and useful - contact me with any corrections/questions/suggestions.
And if this was helpful, there's a link on that page if you want to buy me a beer ... or some Big Mac's! ;-)

I get a LOT of Emails about this webpage ... and AndyG's (nearby Fort Collins, Colorado) sums it up ... plus was right up my alley!
Holy cow Alek, there is so much good information in your cataract description.As an engineering manager with a long history in color science, optics, and image processing, I totally geeked out at your descriptions. I've wondered how multifocal lenses work. Now I know. I wondered what the state of IOL's with accommodation were. Now I know. I knew you see more deep blue after cataract surgery, but wondered what that's like. Now I know. I'm 55 and still have 20/20, but when I ask my eye doctors about any of this stuff, they can't explain it nearly as well as you do. I was chuckling the whole way through your cataract diary thinking "I'm blown away by the amount of research Alek did. I'm blown away by all the self-experiments. And I'm blown away that you wrote the whole thing up in so much detail. You're an excellent writer, too."
Thanks for sharing !!!!