Wow, I can see now I was lucky, I too had congenital cataract and I had uncomplicated surgeries.
But good to hear your surgery went well, it is really fantastic to see the world without cataracts, I am 4 month in, and I am still blown away by the colors and the contrast I have now 
Related article. Great coffee/tea read!
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Christopher Kent, Senior Editor
Published 11 July 2018
The IOL in the Sulcus: When, Why & How
When you need to place a lens in the sulcus, it pays to be prepared—and to know what not to do.
Fours days post-op now, a quick update.
I’ve had two post-op check ups so far. Initially it looks like I’ve come out a bit farsighted in my RE - I measured +2D on my 1 day post-op, but it improved to +1.5D at my 3 day (usually it would be a 1 week, but Thanksgiving throws off the scheduling).
So while its weird to be farsighted (I’ve always been slightly near sighted and could always pull things close to my face to see them), my overall distance vision is awesome. I’m reading to the 20/30-20/25 line uncorrected (20/25 is a stretch), but 20/25 is clear with some alight correction (primarily for astigmatism) and i can also read 2-3 letters on the 20/20 line. In my adult life, I don’t think I’ve ever read better than 20/35 overall, and likely worse in that eye, so to me this is pretty life changing.
Compared to my still-cataract non-operated eye, the world is much crisper, colors are cleaner, contrast sensitivity is better - it’s all the things people say it will be but you’re unsure of until you actually see it with your new eyes. Driving (daytime) is super, and my intermediate distance has come in enough where i can read my dashboard without glasses (tested by closing my non-operated eye). The distance vision was so good that when i pulled out of my street, I unleashed a stream of expletives because it was so amazing (I really don’t think I can say “Holy sh!t” enough times).
Since we did monofocals, my intermediate is definitely not what I’d desire, but we’ll see how it evolves over the coming month, I can use a cellphone or tablet without glasses but favoring my non-operated eye, Doc had me pick up a pair of 1.5 readers which helps (2s probably would have been better, because I’m used to holding things closer). Depending on how the intermediate comes in over the coming month will determine how we do my LE - I’d be a big fan of aiming for a blended vision approach. Right now I think I’m naturally in a mono/mini-monovision state (+1.5D operated RE, -1D natural LE) and am tolerating it well (though it’s a bit weird at times).
Overall though, and this is the thing I’d emphasize to anyone with congenital cataracts, is while I’ve so far lost some accomodation by having to use the monofocal lenses, it’s amazing to finally be able to be corrected to something approaching 20/20. In the past, I’ve been given glasses to correct for a slight astigmatism, but to be honest, I could barely notice a difference. But since you can’t correct for cataracts with glasses, you’re mostly stuck with what you see. But now when the doc spins the dials, I can actually see clearly! To 20/20! That is something amazing.
I was sitting next to an older gentleman (probably 65-70) at my one day post-op and i heard him tell his wife that this surgery is almost a miracle - I’d have to agree with that sentiment so far.
More updates to come as this settles in. LE scheduled for Dec 16.
Sorry if don’t remember, were you not going with Trifocals?
Your sight will improve even more hopefully. 4 days is way too early
Today my wife started seeing the sharpest far far away, at exactly 4 weeks!!!
Takes 2-6 weeks on average for vision to settle.
So nice to hear!
I had congenital as well, and I was to blown away by the colors, contrast and depth perception that comes with removing the cataracts, so I can relate to your experience.
W-H - Trifocals were the original idea but we had to go to monofocals for two reasons.
One - I’m amblyopic and apparently that counterindicates the multifocals
Two - during my operation, they found iI had a tear in my capsular bag after removing the cataract, so they made a game time switch to an Alcon Acrysoft lens to implant into my sulcus instead of the planned Tecnis lens. This is because its a better design for sulcus implantation. I don’t think they could have put the Panoptix trifocal there so if we had planned on the trifocal and I was wheeled out of the OR with a monofocal I think I would have been a but bummed
Thanks Danish - exactly. I was driving yesterday and doing the eye comparison A-B test and thought to myself “I really need to clean the windshield” and then i realized with my new eye that the windshield is clean, its my remaining cataract thats dirty!
The way I’ve been explaining it to people is its like gaslighting - the change has been so gradual that i hadnt realized how icky my vision had gotten.
Boston sorry to hear about the capsule rupture 
Looks like you are doing well. Healing will make things even more better. Keep you eyes lubricated and follow the drops as advised by the doc.
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What is the long term outlook for sulcus implanted IOLs? Maybe ask your surgeon about it and if you need to be careful or watch out for any warning signs?
W-H - great Q. That’s on my list for my next post-op checkup.
From the small bits I can find on the internet (it’s not the most common procedure), I think the main concern is shifting or dislocation of the lens. Since its not held in place by the capsular bag, it has the haptics tucked into the iris I believe. So its stable but doesn’t have the bag to cradle it per normal.
Update now that I’m 2 weeks post-operative on my right eye.
Vision has come in really well. My distance vision is the best I think it’s ever been. I’m still pretty amazed at how vivid things are, the details I can see, etc. My wife (who is very nearsighted and has a very strong prescription) and I keep playing the “I can see it, can you?” game and I’m consistently beating here which is fun.
Intermediate vision is mixed. I can see things out to about arms length really well. Once it gets closer than that, things start to blur out. It’s no where near as bad as I dreaded it would be (if I saw like this with both eyes, I could still do just about everything short of read and use a computer), but it’s not as close in as I’d perhaps like. However a pair of +1.5 reading glasses make quick work of things, especially with font sizes pushed up just a bit on my phone / tablet / PC. Honestly, I could probably use less power but my non-operated eye is fairly nearsighted so +1.5 for now is a good balance.
I have my second eye scheduled for Dec 16, and will see my doc next week for a 3 week follow-up and to plan for the next surgery. I’d likely to ask her for more intermediate vision so I can mostly get by without glasses where I can. I’m also considering trying out multi-focal contacts after surgery as the glasses are great, but I hate carrying them with me constantly for certain tasks.
Sounds like the surgeon have hit the target very well
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.
Nice to hear things have turned out well, even that things are not perfect, but really, things never are…
Yes, go with the Tecnis if possible, I have two different lenses as well, no problem at all.
And you are right, pco is likely to come fast with young age, I consider it as part of the package as well…
Yeah, someone here had mentioned that many of the manufacturers were basically saying “assume and treat PCO in everyone” so I wasn’t surprised to hear that news.
And thanks for the vote on mix & match Danish. Good to know I’m not doing something whacky!
And yes, I think it helps to have a positive attitude about the change in my vision . I was at the airport today and for the first time in my life I could read the arrivals and departure boards (the ones on LCD screens) from far away. I’ve never been able to do that - I’ve always had to walk up close to read them. Knowing that there are many types of options in terms of glasses and contacts for the things that I’ve lost a bit is also encouraging - I always found glasses frustrating before because with my cataracts they didn’t really do anything to help and now they do! Very exciting
I have Alcon in one eye and B&L in another. Both monofocals. I think Tecnis is a good choice. Alcon has yellow tint so you may notice slight color differences if you compare individual eyes. With both eyes open it should be fine. No big deal to me. Going mini mono should give you a little glasses independence. Good luck!
Thanks Deb!
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.
Good to hear, sounds like you will end up with quite good vision
Feeling pretty optimistic about things Time will tell with neat vision, but signs point to good things