Upcoming Surgery for Congenital Cataracts at 36

I had a 3 week post-op this week as I'm having my LE done on Monday and my surgeon wanted a final read on how my RE has taken to the IOL. Overall things are really good - very little inflammation remains in my eye, the IOL continues to be well positioned in my sulcus, and I can read 20/25 uncorrected distance (the best I've ever seen in my life) and can read 20/20 with a spot of power correction and astigmatism correction.

I do have a spot of PCO that will need to be treated in a month or two - I'm told that's very common in young cataract patients such as myself We'll do a little zap zap with the laser to deal with that soon.

Two main adjustments so far post-op. My main adjustment (besides being farsighted for the first time in my life, and the monovision I currently have) is that I do feel like I can see what must be the edge of my lens in my peripheral vision if I look for it. The edges of my peripheral vision aren't sharp (such as seeing my wife in the passenger seat of the car while I'm driving, or sitting next to her at a bar/counter but am looking ahead). I can especially see it if I'm around things with vertical lines (like wall to wall bookshelves, or a hallway with lots of doors in the office) if I rotate my head and allow my eyes to swing with the rotation - I'll see the lines go from being sharp to going fuzzy. It's not a flash, even if it catches a light (like my bedside lamp), just a line where the sharpness clearly falls off. It's a somewhat strange feeling. When I brought this up to my ophthamologist, she did say that especially in younger people, this can happen since the IOL is fairly smaller than your natural lens. I suspect it may continue to improve a bit as my eye keeps healing, but otherwise I think I'll likely just grow to ignore it. I do see it in my left peripheral vision as well (over the bridge of my nose), but suspect once my LE is done, that will get cancelled out due to sharper vision in my LE.

The other adjustment is the "lens flare" I see from point lights, mostly at night. Headlights, Christmas lights, exposed filament bulbs, they all show some "lens flare" (vs the "smeary" glare of my cataracts. My doc thinks most of this is due to remaining uncorrected astigmatism. We'll have to see once i get a final glasses / contacts prescription after my LE is done.

For my LE, we're planning on doing a Tecnis lens (the original plan for my RE before we had to change to the 3-piece Acrysoft lens due to a tear in my capsular bag (details above). My surgeon offered to match me but said she rarely has seen challenging outcomes with mixed lenses, and since the Tecnis lenses have such good reviews and aren't subject to developing glistenings like the Acrysoft lenses, it feels lime a good choice. It's also a newer lens design than the 3 piece Acrysoft in my RE so hoping it produces less glare at night.

I am slightly farsighted in my RE now (.5D to 1D), so were going to aim for 1 step in from plano to provide me with mini-monovision. I strongly suspect I'll need glasses/contacts after I have both eyes done for computer & reading usage, but I think the mini-monovision will give me the most freedom to avoid glasses for other things. I'm fairly nearsighted in my LE now and while its a bit weird having monovision now, I'm tolerating it well. I think at this point with how close my near focus is in my LE (probably 6-8 inches from my face), this "mini-monovision setup will bee less dramatic than what I'm seeing st the moment with my non-operated LE but still give me enough near vision to go shopping, cook a meal, etc. without glasses.

Am strongly considering contacts after surgery (and CooperVision has a multifocal toric contact) as I do quite a bit of distance shifting in my day. It's fun to actually have reading glasses and such make a difference in my vision, but I do think I may prefer contacts to glasses. We shall see! It's just fun to know that glasses/contacts finally can correct my vision for the first time in my life.

I am now 1 day post-op on my LE (second eye). Yesterday I was implanted with a J&J Tecnis ZCB00 lens (+28.5D power) at the Mass Eye & Ear Infirmary here in Boston.

I just came back from my first day post-op check in with my doctor. I was successfully able to read 20/20 clearly on distance (for the first time in my life! Which is exciting). All in all, things with my LE are looking good - I'm still a bit dilated, but my near vision is coming in better than my RE (we were targeting a step in from plano for my LE). So far it looks like I should be able to do things like use my cellphone and even a laptop without glasses, which is what I was aiming for (Also cooking - was weird to have the stove stop be out of focus with just my RE done). I was able to read to a J3-4 with a bit of squinting today and I expect that to improve.

On my RE side, which is now a month post-op, I'm reading 20/25. With a slight power adjustment I can get to 20/20 but I do have some moderate PCO which is fuzzing up my vision a bit. We'll likely treat that in Jan/Feb.

All in all, I'm really pleased so far! My only complaint with my LE surgery vs my RE was I had a different anesthesiologists and he only did local anesthetic with no sedative (whereas the gas passer for my RE gave me a mild something). So I was a bit more anxious on the table while my doc was doing the surgery, but we made it through and I was bouncing around yesterday 2-3 hours after my surgery like nothing had happened (whereas the sedative from the RE knocked me on my butt for about a day). So I guess you take the bad with the good?

Looking forward to seeing how my near vision continues to come in over the coming weeks.

So I'm 1 month post-op on my LE and 2 months post-op on the RE, so figured it was time for an update.

Overall I'm really pleased with my vision, but of course, this being eye surgery, we all know is all about tradeoffs - you just can't get back healthy, 22 year old eyes any more (at least not with today's technology!).

General feedback on progress

My distance vision is the best I've ever had in my life. Since I've always had congenital cataracts, the best vision I remember ever testing to was 20/35 (and that may have been a stretch). I could always see well enough to pass a driver's exam, but that was sort of my limit. Now, without glasses, I can read 20/25 in my RE (which is slightly hyperopic) and most of the 20/20 in my LE. My "walking around vision" is really phenomenal, and I regularly tease my wife who's highly myopic that I have better vision than she does (which was definitely true for distance until she got a new contacts prescription - now she's back in the game).

Besides the "walking around" vision, my intermediate vision is okay. I can read my cellphone (I'm a Millennial after all) at close to arm's length. It's workable - if tomorrow was the end of the world and I had no glasses, and cellphones still worked, I could make it work (especially with the fonts punched up a size or two). Close in than arms length though and I do not have my near vision anymore. I can read most small labels at arms length, but getting down to the size of font on the back of most shampoo bottles is a bit of a trick.

The other thing that I also get, having large pupils, and I also have a falloff in focus in my peripheral vision where you get to the edge of the lens. I think I've used the example above that when I'm driving, everything from the dashboard forward is really sharp, but my wife in the passenger seat in my peripheral vision is blurry. Sort of weird to get used to. I do notice this more in certain lighting conditions (depending on how dilated my eye is), and when there's lots of action in my peripheral vision (like running on the treadmill at the gym when you have someone on either side of you). If I'm wearing glasses (sunglasses or readers), it's much less noticeable since the glasses frames cover much of that area and you're looking straight through your glasses which is the sharp area of focus.

So far, I've been getting by with a pair of +1.5D readers (which I somehow found a stylish pair at CVS that I keep getting compliments on). I wear them a lot inside since I'm doing lots of intermediate distance stuff - use the computer, pick up a tablet/book, cook food, chat with my wife at the kitchen counter, read in bed, etc. We live in a cozy condo so very few distances are further away than what's in focus through the readers (though it does make everything look bigger!). I did see the optometrist today and will talk more about what we're doing below.

Observations on my IOLs

As a reminder, I have an Alcon Acrysoft 3 piece MA60AC of a 26D power in my RE (sulcus implant) and J&J Tecnis ZCB00 of a 28.5D power in me LE implanted in the capsular bag.

In my RE, I did develop PCO and I had a capsulectomy on Jan 2 to clear it up. This eye came out +1D farsighted. All in all, the vision is good but I do get some "lens flares" at night. It's pretty minor, and is much much better than the glare my cataracts gave me prior to my surgery. My ophthalmologist said the lens glare may be related to uncorrected astigmatism, but I have a hunch that some of it is related to the older optics design.

In my LE, no PCO so far. This eye is targeted closer in and based on my latest optometrist catchup. I think it's come out +.5D (based on glasses prescription so fairly close to plano. Compared to the Acrysoft, I think the vision (in the focal range) is just a tad sharper and crisper. I don't get any lens flares or halos with the Tecnis when I'm not dilated (when dilated, I'd get concentric circles around point lights due to the optics of the lens). If I could have gotten two of these implants, I would have, but due to complications in my RE I had to get the Acrysoft as it's one of the few that can be implanted in the sulcus.

Every implant has a large field of sharp vision, and then falls off as you move into your peripheral vision, due to the size of the implants (varies from person to person depending on the optics & shape of various parts of your eye). I do feel that the sharp field of vision in my Acrosoft lens is slightly larger. That is a purely subjective observation, and my Acrysoft lens has had another 30 days implanted than my Tecnis. To be fair, when I only had the Acrysoft in my RE and my LE still had its natrual lens (with cataract), I found the field of view of the Acrysoft lens annoying until I had my LE surgery, and then suddenly it didn't seem as bad anymore (i.e. brain started readjusting to what it could see out of two new eyes). I think time will tell how this evens out.

Current Status Post-Op, Post-Optometrist Check-in

So now that I'm 30 days post-op on my second eye, I went to the optometrist to get fitted for glasses to clear up my residual refractive error. My plan at the moment is to do glasses for now, and get to know my new vision a bit better, and then later go get fitted for some form of contacts solution. More on that in a minute.

Where I am at the moment is that my RE is slightly farsighted, and my LE is effectively plano. I have a bit of residual astigmatism in both eyes (I had some astigmatism before my surgery, but was on the border of treating it with toric implants - since your eyes will continue to adjust over time, and your astigmatism may shift, my surgeon and I made the choice to not use toric implants since I'd been living with the astigmatism all my life and could easily be treated with glasses / contacts after).

So the glasses prescription I have now is:

• RE +1 Sphere, -.5 Cylinder, reading 20/25+ with a +2.5 add for near
• LE +.5 Sphere, -1 Cylinder, reading 20/20 with +2.5 add for near

I'm going to get a pair of standard progressives as an "everyday" pair of glasses as they'll adjust the slight distance refractive error I have and give me correction for intermediate & near. Since I work in technology and spent 8+ hours a day in front of a computer, my optometrist suggested a pair of Hoya computer glasses on top of the regular progressives, which are basically a 60% intermediate, 40% near progressive designed for sitting in front of a computer all day. He made the point that the intermediate focus on a standard progressive is a fairly small part of the optic, so you spend a lot of your time tilting your head around to get the various parts of a monitor in focus, whereas with the Hoya lens you can see the whole thing at the right focal length, plus you have near add at the bottom for reading phones / notes / paperwork. You could also do single distance glasses for intermediate but then you'd need to swap glasses for near (phone, notes, paperwork, etc). So I got both sets and we'll see how they work out.

I also spoke with him about a contacts option - I'm fairly young and active. I go to the gym and run 5-6 days a week, I snowboard in the winter, my wife & I hike extensively, etc. I get very sweaty so in these instances I don't think I want to deal with glasses with all the sweat (it already drives me batty juggling readers as is now and in the past every time I tried glasses I couldn't stand wearing them during active pursuits). He has a few options for me using either multifocals, multifocals + a monofocal (my RE has some peaking in my iris, which could impact how clear a multifocal is in that eye), or monovision. I'll be going back to see him for a fitting for that in March, which will give me a month+ to get used to the new glasses.

Overall - How am I feeling with this whole process?

I'd say generally I'm really pleased with how everything has been turning out. I always found dealing with my vision with cataracts growing up as an exercise in frustration as my vision wasn't "that bad", and I could usually compensate by sitting at the front of a classroom, or near a projector screen during presentations. However, especially in the last 2-3 years, I've felt my vision degrade and especially once the fogginess & glare from the cataracts really set in over this summer, I knew my time was limited before I had to do the surgery.

I do find the loss of near vision without glasses frustrating. I think your usual cataract patient in their 50s, 60s, 70s has already gone through that loss, so adjusting to that after cataract surgery is less of an adjustment. There's obviously a big interest in mult-focal IOLs, as you can see in these forums, but unfortunately I was a bad candidate for those due to existing amblyopia and, during my RE surgery, a tear in my capsular bag which made my surgeon pivot to a 3-piece IOL in my sulcus (so multifocal would have been out anyways).

However, for the first time in my life glasses actually help my vision. I can see 20/20 for the first time ever, which is amazing. I think most of the visual side effects of the IOLs such as the peripheral vision and other bits will become less noticeable with time as my brain adjusts to how it sees the world, and new glasses & contacts will help as well. Especially given that there are options for contacts, I'm very excited that I shouldn't always have to wear glasses (and probably north of 50% of people do wear glasses & contacts every day, so I should just get used to joining their ranks).

So that was a long update on where I'm at now. I hope this is helpful for anyone with congenital cataracts who's starting their journey, or just anyone else in general who's early on in their research of life after cataracts.

I'll post some more updates as time goes on to help answer how people adjust to glasses post surgery, as well as observations on how I continue to "break in" my new eyes and IOLs.