It has been decided: Iridotomy

Reasoning:

Like many others, I have decided to begin documenting some of my experiences in my journey toward getting ICLs (Implantable Contact Lenses or Intraocular Collamer Lenses). Felt I should give back after "taking" in all of everyone else's experiences, both good and bad. I too feel that there isn't a lot of information out there about ICL experiences in particular: we're a small population of people, since most choose LASIK or PRK.

I'm 31, male, about -6/-7 (ish) in each eye with moderately high astigmatism. Thin corneas, dry eyes, high myopia made me not a candidate for LASIK. My severe dry eye has also lead to corneal abrasions while wearing contacts and so I am no longer allowed to wear contacts either (or else I would consider forgoing refractive surgery completely, given all the risks). Reading about ICL's theoretical reversibility (though it's meant to be permanent unless there is an extenuating circumstance, while the iridotomies are permanent) and lack of removal of existing, otherwise healthy (corneal) tissue convinced me more that this would have been the right procedure for me even if I was a candidate for LASIK. I don't think I could handle even drier eyes - or the higher risk of returning to glasses after a few years. I admit, it took me a couple of years to get over the fact that something was going to be shoved into my eye - but after watching some videos (which should have scared me off), it didn't look as bad as LASIK if you really thought about what both procedures actually involved (tucking a removable soft lens just under the surface of your eye via a tiny incision vs. a laser permanently burning off your healthy corneal tissue irreversibly).

I'm based in Toronto, Canada, so I have access to the Toric (for my astigmatism) Visian ICLs as opposed to some of the unfortunate American experiences of not having access to FDA-approved Toric lenses (from what I can tell). I found out about the new Visian V4C ICL with CentraFLOW technology, which is available in CE Mark European countries up two years ago. The great thing about this lens is that an iridotomy is not required - a small opening in the centre of the ICL allows for fluid to pass through. However, it is a new lens that is not available or approved outside of Europe at the moment - nor have there been many studies on the effectiveness of this lens. I wish it was available so I wouldn't have to take the risks of going through an iridotomy, but I do want to start enjoying my $7K investment in glasses free vision ASAP. At my age, I probably still have 10-15 good years left before I need bifocals and have to begin being more concerned about age-related things like cataracts. Given how unpredictable and slow government approvals processes can be (toric ICLs still not approved in the US?), I have no idea when the V4C may or may not be available in Canada. So I decided to go with the tried and trusted existing version - one that conveniently also preempts potential narrow-angle glaucoma in the future. Still, I'm a little disappointed that it isn't available to me - and i'll have to go through what may become an unnecessary + permanent iridotomy procedure, but at least the toric ICL is an option! I can't wait to be rid of my glasses.

Iridotomy Procedure:

Had my iridotomy done two days ago. The experience was really fast, not painful at all (contrary to what I read). The machine looked like any other eye measurement / observation ophthalmology tool: put your chin on the rest, forehead against the concave bar and voila! It begins. Two drops in each eye to freeze & constrict (I guess?). A red light appears, the Doc asks you to look at one spot and don't move (no other assistants in the room). Super nervous that if I move, he'll miss the spot. Many clicks in my right eye (the sound of the laser shooting) - I lose count. Less than 10 in the right eye probably. Only maybe 4 in the left. Your eye is held open by a circular tool designed to help the Dr aim the laser at the right spot. It is coated with a cool gel substance that sticks to your eye. It was hard to focus on a spot while doing the second eye, since the first was coated in gel. So I just focused on one of my floaters haha. :( The whole process took maybe 5 minutes. Two more drops in each eye after it was all over. Gel was left in (kind of a cooling affect). Didn't feel anything in the first eye - and just mild tapping feeling in the second. Eyes stung after, but just a mild discomfort. Unlike others, I only had drops in my eyes: no pills, painkillers, sedation -  no nausea, fainting, etc. They didn't even check my eye pressure after, which I was surprised and somewhat disappointed about. Just a green light to go home. But apparently since iridotomies are inherently pressure-reducing (though that's not what I read about regarding potential risks), they just sent me home. No drops to go home with me either! Went home, closed my eyes & listened to podcasts, but couldn't sleep. All was clear after a few hours when the eye gel disappeared.

Reflections & Side Effects:

I was pretty nervous about the iridotomy. Based on my extensive reading of other people's blogs, I was more afraid of the purported side effects of the iridotomy than the ICLs themselves (which I am getting in a few weeks). White lines, glare, ghosting/double images, etc. Well, after 1 day, I started to notice what one blogger described as seeing his "eyelashes." After reading more blogs, I unfortunately realized that it was not my eyelashes: I am one more victim of the white line side effect. I'm extremely disappointed by this as I specifically asked about this and was told that it was "rare" and not to listen to all the bad stories online. Being Asian and having almond shaped and smaller eyes made me think that I might avoid some of the complications of others since my eyelids sit pretty low over my irises. I have to say that it is not as bad as I had read though. It is not as if there is a giant, thick, solid and permanent white line across/blocking the centre of my vision field. Rather, it is more like seeing a bit of dust or a snowflake caught at the end of your eyelashes. It is stronger in my left eye, especially the bottom corner. Most importantly, it only happens under certain lighting conditions (haven't fully tested all scenarios - but in front of a computer is one situation): when I raise my eye lid, a faint, translucent, semi-disjointed shadowy white line moves up with my lid from the bottom of my visual field up to the centre (presumably as my lid moves above the iridotomy holes). It is a little distracting, but not the life-altering experience some have made it out to be (at least for me). One blogger noted that his went away after 6 months and he went to the same place I did, so I'm hoping it will fade away or my brain adapts and removes it from my perceptive senses. If not, there is nothing I can do (other than consider corneal/iridotomy tattooing or suturing as others have noted) so I am accepting it and moving on, since I need to pretty much be still and silent and focused on it once I notice it, in order for me to be truly annoyed by it. Still, I am a bit annoyed that this has happened to me after I read so widely about it in advance. Reader beware! It is not as rare as they make it out to be: it can definitely - and likely - happen to you. That being said, I have terrible vision and astigmatism and have always seen starbursts, haloes and floaters with glasses/contacts and so this isn't any more distracting than any of those experiences, which I have gotten used to as being normal. So what's done is done: I have nothing I can do, but look forward to my ICL procedure. Hopefully, I won't have any further side effects with the ICLs (though after the iridotomy side effects coming true, I feel a little naive having this hope)! Will report back soon.