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 after 3 years, I continue to see well and am glad with the surgical 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! ;-)

Simulation of my vision - mouseover or click image to see what it looks like through the Cataract in the right eye

cataract vision example
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.

Alek's Left/Right Eye and 10-year old Kyle's right Eye ... all non-dilated and lit from windows

kyle right, alek left right cataract
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

biometry


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

cataract surgery crystalens right eye 2

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

cataract surgery crystalens right eye 1

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 common with cataracts and makes sense as the cloudy lens obscures vision. But it is pretty subtle as it can "sneak" up on you more so than the loss of vision. I used Photoshop to simulate this by applying a +15 with Selective Color (Yellow/Yellow) and -15 on Brightness. The image below gives an idea of how a cataract shifts colors. 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!

Mouseover to see how aging of your natural lens causes yellow hue & general dimness - cataract was doing even more!

cataract vision example color brightness


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.

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

after cataract surgery crystalens both eyes

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

after cataract surgery crystalens both eyes

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

after cataract surgery crystalens right eye


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") simulation - image below is as seen by the right eye with no glasses
Mouseover image to see "resized" in left eye with -7 diopter glasses - yea, that's a problem!

cataract vision example with and without at -7 diopters

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

cataract vision combined with without glasses

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.
heart green blue illusion

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

faa eye charts

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

after cataract surgery crystalens left eye

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! ;-)

after cataract surgery glasses contacts

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 - mouseover image to see overlays

Picture taken in the shade on a sunny day via remote release with a tripod mounted/remote Canon 7D and 17-55/2.8 lens at 1/100 second at F/5.6 and ISO400. I processed the camera RAW file using default settings of Lightroom with White Balance set to shade. Since the camera doesn't "see" Ultraviolet light, I had to use Photoshop to simulate my perception of what I visualize. I selected the "exposed" areas of the Black Light and using Levels, pushed Red to 5, Green to 5, Blue to 9, and RGB to 1.5. Background glow is pushing Blue to 1.15 for the whole image.
The UV bulb is a GE F15T8/BLB which has a peak emission at 368nm and is typically used in insect traps (bug zappers!) and inspection applications - spec sheet here.
While I don't know the filtering characteristics of the glasses or UV filter, I see a drastic difference looking through them at the Black light - others see little/no difference.
cataract ultra violet vision example

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

captain ultra violet vision

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.
Mouseover image to see wide-angle view of setup

cataract vision example color brightness

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

ultra violet monochromator

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.
400nm and 365nm UV flashlight


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 a variety of Emails from people about this webpage and 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.


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                 Paid         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 0 0 1,800.00
Eye Surgeon Premium x2 1,900.00 0 0 0 1,900.00
Pre/Post-op Eye Drops 181.83 0 0 126.83 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 tracked my progress with the Crystalens implants using the FAA Eye charts - the eye doctor actually measured slightly better numbers.
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-
Numbers are Far-20'/Intermediate-32"/Near-16"/Jaeger Scale.
A "+" means I got a few letters on the line below and "-" means I missed a few letters on that line.
Tests done consistently with very good indoor light ... so increased depth-of-field helps.
Intermediate/Near vision gets noticeably worse with less light - a bit disappointing not more accommodation.

Some summary points - remember I'm not a medical professional so consult with your eye doctor about your specific situation. 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've gotten a variety of Emails about this webpage, but this one from AndyG in nearby Fort Collins, Colorado 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 accomodation 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 !!!!