Trifocal Lenses Implant Operation Diary

Trifocal lens ends need for glasses for Sandra
Trifocal lens ends need for glasses for Sandra
18 Jan 2017

Before deciding on my consultant and clinic for my cataract operations, I researched extensively e.g. types of lenses available. I liked the idea of Trifocal lens. Hopefully, they would provide me with near, intermediate and distance vision without having to wear glasses.  

Finally, I selected Mr Daya as he is both a leading eye surgeon and an innovator with ethical attitudes towards his patients.  

I thought Centre for Sight’s website was excellent. It was very informative and had both depth and width in its content.  The administrative staff (particularly Vivien) provided further help and reassurance in my contact with them. 

Eventually, I chose East Grinstead because it appeared to be a flagship location - purpose built.  Additionally, I wanted a venue outside London situated in a peaceful setting so that I could combine having surgery with a short break.

As it transpired the centre was only 3 minutes away by car from the excellent Alexander & Utopia Spa Hotel which I had selected from a list sent by administrative staff.

Initial Consultation

Internally, the Centre’s design created a light and airy feeling. Everyone was welcoming including receptionists Lorraine and Lyn. 

The consultation was very thorough and extensive. I think I was there for approximately 4 hours. 

After meeting Lisa (Patient Coordinator), I watched videos which explained the procedure and went through the pros and cons of Trifocal lens.

Thankfully, the carefully animated video imagery was informative and sensitively presented so that it was suitable for all viewers.  Indeed, the videos could have included Mr Daya’s comments within them, thus, making them personal and specific to Centre for Sight.

In addition to reading tests, Cristia (senior ophthalmic technician) assessed my eyes on approximately 11 different machines.

Various eye drops were then administered by another member of the team (Jette).  My eye pressure was also taken for the first time with an instrument which directly contacted the eye.  I was told it provided a more accurate reading.

Eventually, I met Mr Daya. He went through all the extensive test results and said I was suitable for the trifocal lens but that my right eye might be a problem because I had Pseudoexfoliation in it.

Furthermore, he didn’t know how fragile the zonules might be.  Therefore, he suggested he would incorporate a ring around the lens which would help centre and reinforce the capsule.  

He advised me to take Omega 3 eye capsules and eat green vegetables like spinach, asparagus for my dry eyes.  As I am very interested in alternative approaches to health, I also located a section on eating healthily on his website. 

A few days later, I wanted clarification on some of the issues before I went ahead with the procedures, so I emailed several questions to him. His response was prompt, clear and concise. Consequently, I decided to go ahead with Mr Daya and the trifocal procedures.

Left Eye Procedure

I arrived at the clinic for the procedure on my left eye in the afternoon. Some of my apprehension was reduced when I was taken into a room where I sat on a chair whilst Wendy (ophthalmic technician and nurse) explained the pre op process.

For example, I was to have several drops inserted into my eyes, at timed intervals, so that they would be fully dilated and anesthetised. She then gave me a pillow for my back and neck plus a blanket.

This pre-op area seemed to be divided into small spaces specially designed for the various stages of the process.  In the next space, I could see cubicles with relaxing chairs in them.

On returning I walked, instead of being wheeled, into the theatre.

Once in there, I remember a male nurse (Matt) being very kind and bringing me a special gel pillow for my neck and a pillow under my knees so that my back felt comfortable.

My feet were then just covered with protective covers. His touch was very comforting and I recall joking with him re he could hold my feet during the procedure.  Humorous exchanges with the staff helped me to relax. Seeing Mr Daya was also reassuring.

I felt a strong pulling/pushing sensation from Mr Daya. Although I had been prepared for this action, I was surprised that it hurt. (In retrospect, it was not unbearable and didn’t last very long.) It helped that Dr Lam, the anaesthetist, was holding my hand throughout; I remember squeezing it at that particular moment.

I then recall Mr Daya telling me the procedure was over and that it had been successful and that my zonules were fine. As he had decided that he would use reinforcement rings in both eyes, I now wondered if I had actually needed one in this left eye.

Then, I returned to the hotel (5pm) and went to bed for 4 hours (9pm) in my lovely garden suite with its relaxing view visible from my bed. (During this time, a member of staff from the Centre telephoned to check all was well.)

On arrival at the Centre for Sight next morning, I had my dressing removed on my left eye prior to it being bathed. I could see immediately. Drops were then inserted into my left eye. Everywhere felt bright and I noticed the flickering on the outer edges of my vision.

I was given a reading test and my eye seemed to perform well. It was then reassessed on three machines. The intraocular pressure was taken in both eyes.

Adenay (ophthalmic technician) was very efficient and we had lots of fun together.

Eventually, I saw Mr Daya’s wife (Marcela Espinosa-Lagana) for a consultation.  I thought she was a very empathic and warm person. She said my eye was doing fine but there was some inflammation in there.  The flickering, she explained, was just my eye getting used to the new lens.

Right eye procedure - 2 days later

I arrived about 9am. It was a similar procedure to the left eye.

Only this time I had to see Mr Daya for a further consultation, prior to surgery because he wanted to double check the measurement for my right eye. He again advised me that it was problematic because of the Pseudoexfoliation. As the intraocular pressure was high (23 in the left eye and 27 in the right), he prescribed eye drops (Combigan) to lower it.

This time, I didn’t seem to be in the seating area for very long before I was transferred to a cubicle with the much desired comfy chair in it. There was reassurance, humour and banter again between staff and patients. The camaraderie between everyone was very evident and comforting. It helped to create a friendly almost akin to family atmosphere.

As Tom (another male theatre nurse) inserted a cannula into my arm, he joked that it was time for a gin and tonic. Remembering that Vivien had said that the sedative had a similar effect to having a champagne breakfast, I replied in similar humorous vein that I preferred something sparkling. After the sedative was administered, I was wheeled into the theatre on the comfy chair which had now converted into a bed.

The next thing I remember was seeing the laser, this time it was more like Posterisation with even less colour than before. Again I remember Mr Daya pushing and pulling at my eye. It hurt even more than previously but in retrospect was still bearable.

Dr Lam again held my hand throughout the procedure. Everything else seemed hazy but I do remember Mr Daya asking me to look at a light to my left which I couldn’t see very clearly and saying that I had to help him.

My overall thoughts during both procedures had been that I was in very capable hands – Mr Daya’s.

I had a further sleep in the cubicle followed by a healthy sandwich (on brown bread) and a peppermint tea in the private seating area.  Before I left the nurse said as my consultation the following day was in the afternoon, I could take off the dressing myself the following morning so that I could begin the eye drops in the right eye.

Next morning, knowing that the procedure was more difficult in my right eye, I felt very anxious as the dressing was removed.  My husband assisted me.  I was pleasantly surprised therefore, to discover that I could see clearly.

Adapting to trifocal lens

Post operatively, I felt very tired and very slightly downcast (which lasted a couple of days) – I couldn’t understand why - when it was obvious from day one that my eyesight was so vastly improved.

Maybe it was the trauma of the procedures or the drugs in my eyes plus the sedative and the fact that our journey back took 9 instead of 5 hours.

Initially, inserting eye drops 4 times a day seemed a nuisance. But after establishing a routine e.g. drop order (always left eye first), regular times, creating a computer chart for recording and using a timer to ensure the 5 minute intervals – it was no longer a problem. It also ensured a resting time for my eyes particularly as I simultaneously palmed them.

As the anti-inflammatory drops sting and burn, I experimented with the drop order to minimize this effect. I found using them first sometimes helped.

My eyes hurt inside sometimes when I moved them e.g. turning round to check traffic whilst driving. This started to disappear after 3 weeks.

Initially, there were aches round my eye sockets, also forehead, back of head, sinus area, teeth and gums. Maybe the aches were due to operation trauma. After 4 weeks they had almost disappeared. 

Sometimes there is a pricking sensation in my eyes, an itch in the corners and very occasional stabbing.  I think this might be part of the healing process or possibly due to my dry eyes.  (I must ask Daya about the new laser treatment – Intense Pulsed Light - for dry eyes.)  When the corner of my left eye became slightly pink, on one occasion, the post-operative eye drops cleared it immediately.

At first it was difficult to remember I mustn’t bend down – so I have started bending my knees slowly in a squat position whilst keeping my back straight so that my neck avoids the 90 degrees angle - I intend to continue doing this, several times a day, as I feel it is a good exercise to do.

Sometimes, the brightness continues to make my eyes feel tired creating a feeling of eye strain. At first I wanted to close them often. Wearing old faded sunglasses in the house and anti-glare sunglasses outside helped to soothe them and counteract any glare. The feeling that my eyes were not secure continued for a few days.

From time to time, it feels as if there is something in my eyes particularly the left one. At night it can feel like there is a delicate thread or hair in the left eye. I have also noticed a slight reflection on part of the bottom of the vision in my left eye - like a sliver of light. It appears to be reflecting from my lower lashes but after 6 weeks it is less obvious.

I phoned the Centre for Sight helpline on 22/08/2016 to report the continuing symptoms in my left eye. They were very helpful and Adenay talked me through it and also asked me further questions.

She then telephoned me back within an hour to let me know that Mr Daya had been consulted and he had said to reassure me that all was well and it was nothing to worry about. (But she didn’t say what it was.)

She also suggested I resume my dry eye drops as that might help and added that it would help my eyes from watering too much when outside which it did.

Occasionally, I have to concentrate on re-focussing when looking at small print and print on certain backgrounds/colours and when the spacing is too close.

After 6 weeks, my ability to read small print is still improving.

It was such a thrill to be able to read a book without glasses although as yet I have not done any intensive reading.  

It was also an incredible experience going to art exhibitions. Seeing the paintings and text close, intermediate and distance without glasses is an indescribable joy.

The whole journey and experience of looking through my trifocal lens is a slowly unfolding revelation in particular at the wonder of what my ‘new magical’ eyes can reveal.

For example, I can’t get enough of looking at nature and art - colours, shapes, textures, and fine lines - specifically the individuality of detail – every blade of grass is visible even when viewing it from a distance. There is clarity of vision which I haven’t experienced for a long time.  

Before the operation was performed on my right eye, it was amazing to see the difference in looking at colours when using the left eye only – they were so intense and vivid in comparison.

After finishing the Combigan eye drops, I went to see Mr Doyle (an Optometrist located on Centre for Sight’s website) to have my intraocular pressures checked.  The pressures were 18 in the left eye and the average pressure in my right eye was 22.  I also had a Humphrey visual field test.  (This appointment was 5 weeks after the procedures.)  

Mr Doyle thought my sight was very good both distance and near and there was no evidence of any astigmatism.  Unaided, he said my distance was 6/7.5 in both eyes and my reading N5 in both eyes.  

He suggested I used Viscotears (without preservatives) at bedtime in addition to resuming Hylo tears (also without preservatives) during the day for my dry eyes and advised Maui Jim sunglasses to help with the glare but suggested that I try to avoid wearing sunglasses inside.

I was surprised how long he spent with me including answering all my questions.

As my eyes are still adjusting to the new implants, Mr Doyle suggested another eye test in 6 months’ time to monitor my eye pressures and check my eyesight particularly in relation to small print and reading at night.  I thought he was very empathic and an expert in his field.  

His assistant was also very pleasant and clear in her instructions e.g. testing my intraocular pressures and operating the various tests.

Final consultation after 10 weeks

Everyone at the Centre seemed pleased to see me and there were plenty of greetings and hugs.

I arrived at 4 and left at 8pm approximately. 

I was thoroughly assessed on 4 machines including eye scans, tests for reading, astigmatism and quality of vision.  My intraocular pressures were very good - 15 in the left eye and 18 in the right.

Adenay and the new optometrist then provided me with a further consultation in order to respond to some of the 20 questions I had prepared for Mr Daya.

Mr Daya was very pleased with my results and said they had exceeded his expectation. His response to the problems I am experiencing with my left eye, and the halo effect, was that they were nothing to worry about and just to forget about them (but I would still like to know what was causing the former).

I think a positive attitude and not allowing my mind to dwell on these problems might help me to forget them.

In response to my journal, Mr Daya asked me if I had ever done a blog. When I replied that I had written obituaries e.g. for the Guardian, he seemed very amused but indicated that it was a very different approach. He then suggested that I might like to use the journal as a blog on his website.

I felt very sad when I realised, I wouldn’t be seeing any of the staff again.

Post consultation, I have decided to request a copy of my file for future reference.

With reference to my halo and left eye problem, I am going to apply the following words to them (from a poem entitled Tonight I write sadly by Christopher Logue about a lover’s lament):

A day will pass in which I shall not think about (you)
Even once
And this
The last line I shall write (you)

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