Case Study: Refractive Lens Exchange

I had pricked up my ears about laser surgery some years ago, when a friend had had that done. The more I read, I knew I was an unlikely candidate for that but my most recent aggravations with glasses propelled me to find out more about current options and the internet did not disappoint: every path seemed to lead to OCL.

The Consultation

At my consultation in February, they confirmed that, while I wasn’t a candidate for laser surgery, refractive lens exchange (RLE), using multifocal intraocular lenses – artificial lenses implanted inside the eye to correct both distance and near vision focusing errors – would be good for me and should mean that I would be glasses-free apart, perhaps, from a pair of cheap-as-chips, over-the-counter reading glasses for close reading. Another plus would be that I would never develop cataracts or narrow angle glaucoma.

I must have been the most annoying patient – I had endless follow-on questions – but elected for bilateral immediate sequential refractive lens exchange, one eye to follow swiftly on the other and as an outpatient day procedure.

Weirdly, such was my enthusiasm for the near-promise of life without glasses that, by the time I ‘went under the knife’, a good friend and her son and another good friend had already signed up to surgery – and, given timings, the youngest of our ‘group’ went first. Reports of his outcome were very positive and I was emboldened!

The Day of the Surgery

Come the day, the OCL team was was convenient, professional and comfortable. My husband accompanied me and, bang on time on arrival, we were taken in hand. From the easy and faultless check-in onwards, I have never felt so relaxed and confident in any surgical procedure in my life. I went straight up to the ophthalmic day ward, to a very comfy chair and a very good nurse, who talked me through what to expect and timings. During a one hour pre-op period (in my comfy chair), my blood pressure and temperature were taken and dilating, antibiotic and anti-inflammatory eye drops administered regularly. They came to tell me everything was on track and they’d see me in a little while. I gleaned great reassurance from a return patient, arriving for his second eye after a very successful first two weeks before. A recommended Valium pill topped off the morning’s preparations and then I walked with the nurse in the lift upwards, into the ante-chamber to theatre and the good care of a delightful anaesthetist. There, on a very comfortable bed/trolley, anaesthetic was dropped into my eyes and a wimple-like paper attached to the edges of my face. Then in I went, told to keep my eyes shut and to expect bright lights ahead.

What happened next?

As I entered theatre, I saw my surgeon (through slightly hazy vision) and heard his reassuring voice. He swabbed around my eyes and then began his talk-through of the procedure, firstly to warn me of the potentially claustrophobic effect of the lightweight latex/plastic cowl-like covering he put over and around my first target eye (the worse one). It may have been this covering or the Valium but I felt a little nauseous and dizzy, although it soon passed. The covering had an ingenious ‘reservoir’ at the bottom, outer corner, to collect fluid. The surgeon cut a hole in the covering, directly above the eye, and then put in a clip to secure my eyelid open, instructing me to look straight ahead, eyes wide open, at the middle of three very bright lights; the action was about to begin and there was even good music playing.

The lights sometimes ‘swam’, took on bizarre and watery shapes and blue or purple tints, similar to looking into a kaleidoscope, and disappeared at times during the 10-15 minute procedure per eye. Everything was quiet and calm. The surgeon’s recurring request was to ‘open wide’ (shades of the dentist although, as he rightly said, that is not fair as a dentist often causes pain and his tools can be noisy). At one point, I was asked to take a deep breath in and then out. Fluid was often poured over my eye.

When the first eye was done, I rested with the covering off and both eyes closed for about ten minutes, while the surgeon called for the next patient to be lined up. Then he moved onto the second eye, the same procedure but with some slight change to the size of the lens selected. The surgeon then taped a clear plastic ‘shield’ with holes in over each eye and I sat up and got into a wheelchair, for my trip back to the ward. I was grateful for the chair and driver – I felt a bit wobbly.

Following the Surgery

Back in my comfy chair with a welcome cup of tea and sandwich and sporting my eye shields, blood pressure and temperature were again taken and I was again fine to walk around. Antibiotic and anti-inflammatory drops and sachets of saline solution, a sterile pot and gauze swabs were given to take home, with very clear instructions. Everything looked very bright and very blue; when the surgeon came along to make sure everything seemed fine, he explained that that was because my own, old lenses had yellowed and that that accounts for the marked ‘yellow vision’ in Van Gogh’s later works (whereas Turner, who had cataracts, came to paint ‘haloes’). I then set off, some three hours or so after arriving that morning, wearing my old prescription dark glasses against the glaringly bright sunshine, meaning my vision was blurred and my husband was my guide; my first mission on the way home was to buy some cheap, plain dark glasses.

At no stage was there any pain – just as I had been promised. I felt informed and reassured all the time. I think he has a very steady hand although I can’t say how much of the procedure was manual; there seemed quite a bit of high-tech machinery in the theatre. He warned me what to expect next (e.g., I might feel some very slight pressure) and he helpfully let me know when he was two thirds done with each eye. He said that if I was going to sneeze, some warning would be important.

The drops continue for two weeks at four times a day and then for two more weeks at twice a day. I was phoned the next day (which was very kind) and I’ll have a check-up in two weeks.

The Results

Day ten and I’m over the moon: from the first evening post-op, I could see what was on my dinner plate and could confidently have a bath without glasses! I still occasionally reach for non-existent glasses – out of habit, not because of need. I know I must wait for some months to know how my vision has finally settled and what small correction may still be needed by reading glasses but it feels as if I have a new lease of life!

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