Decision on LAL prescription
Posted , 5 users are following.
I had a light adjustable lens implanted about three weeks ago and all is going well. I absolutely hate the heavy u.v. glasses so I won't do this for the second eye. Second eye doesn't need surgery for a while. I had lasik surgery, which is why I chose the LAL; I have needed reading glasses for close reading. Right now I can read with second eye, albeit blurry; can't read with LAL eye. I haven't had an adjustment yet. I have two questions: first, should I have the LAL eye adjusted for slightly less than optimal distance vision to help with the reading issue, or just go for the best distance vision I can get (right now, before adjustment, it's really good)? And second would an enhanced focus lens work in the second eye, or should I just do a regular lens. I'm thinking I won't need that surgery for a while.
0 likes, 8 replies
RonAKA anne31252
Posted
The normal practice with monovision or hybrid monovision is to get the best distance vision you can in the dominant eye. Then in the non dominant eye you can go for mild myopia (-1.25 to -1.50 D) with a monofocal lens. Or, you can use an EDOF like the Vivity and go for a little less myopia.
rwbil anne31252
Edited
The fact you do not need the other eye done for awhile is great news as new IOLs are always coming out. Heck the Juvene might be out by the time you need cataract surgery or new trifocals. In fact the LAL is doing clinical trials on other features like EDOF.
Right now the only way to get really great distance and close vision is to use a diffractive IOL. Of course it comes with its tradeoffs like dysphotopsias. Some folks are OK with the tradeoff and others are not.
I have the Synergy, which IMHO provides the best close vision of any IOL out there, but also IMHO is the highest risk IOL out there.
You can also gain close vision with monovision. The greater the monovision the greater the close vision. But also the greater the monovision the greater the issues arise from presenting 2 different images to the brain. Again some people want great distance vision with both eyes and are not OK with monovision, while it works great for others. I would suggest mini monovision, but that will not get you great close vision.
You can also combine monovsion with the new premium refractive IOLs such as Vivity or Eyhance or RAY one.
I suggest you look at defocus curve for the various IOLs. That will give you an idea of the vision quality you can expect and you can also see how various monovision settings will effect your vision. So you will get a rough idea if you get IOL X and do Y monovision I will be able to see 20/40 at 16".
The point is all the options come with tradeoffs. Luckily you have time to research and decide which tradeoffs you are willing to take.
But again I advice procrastinate as long as possible as you might be able to wait on a new adaptive IOL. And my guess is just like any new technology once one is approved there will be a flood of new adaptive IOLs which will be the future and make the fixed plastic IOLs I have look like something from the dark ages.
RonAKA rwbil
Edited
I would just add that if you are considering mini-monovision and you can still see well in the second eye that will be used for the close vision, then you should do a simulated trial of monovision using a contact lens. Say for example if you have an eyeglass prescription for this eye of -3.0 D, then you would use contacts like -1.75 D or -1.5 D to leave you with -1.25 D or -1.5 D myopia respectively. This will give you some estimate of what close vision you will get, and whether or not you can adjust to seeing distance with one eye, and seeing close with the other eye. I am currently doing this simulation and really like it. I can read everything but the very finest print. For those situations I use +1.25 D readers. But for all other things like driving, watching TV, using my computer, reading my iPhone, and reading books or paper documents I am eyeglass free.
Jennifer_Guess rwbil
Posted
Hi @rwbil,
I wonder if also in the future if lens exchange will be more manageable for surgeons. As I am now 49 and have two implants - I wonder if I will be able to get new fancy ones in the future as a result of improvements in surgical procedures like nano surgery, etc.? What do you think?
rwbil Jennifer_Guess
Edited
I have seen article from surgeons developing new techniques to make lens extraction less risky. But it is still digging a piece of plastic out. Who knows what new capabilities might exist in the far future, but I have not read anything in the near future that will make it an easier surgery.
This is one of the things that makes the new Juvene so interesting in that it has a modular base that keeps the capsule bag open and "supposedly" makes lens exchange mush less risky minor surgery.
Sadly we developed cataracts to early.
So we will have to wait until the new revolutionary IOL that mimick the actual natural lens become available and have been time tested and decide if the risk is worth it or not.
RonAKA Jennifer_Guess
Edited
Lens exchange has a long way to go to become routine. There seems to be two basic methods of getting the old lens out. These new plastic materials cannot be broken up and sucked out like a natural lens. Some cut the IOL in half and pull one piece out at a time, while others if the lens is thin and flexible fold it back up again and pull it out in one piece. It all sounds gruesome with lots of room for improvement with new technology. Lets hope!
Jennifer_Guess RonAKA
Posted
Hi @RonAKA - I think Wong shows cutting these up in one of his videos. He had a patient who did not do well with one of the premiums (I don't remember which) and had them switched for the Panoptix. Very interesting.
Jennifer_Guess anne31252
Edited
Hi there,
I am not as informed on the options as @RonAKA and @rwbil. I would only add to have a very good discussion with your ophthalmologist/ surgeon about the options you have. Sometimes, it does not matter what the patient thinks and/or wants - it is a case of the actual eye and what the surgeon assesses in terms of risk. I would start there for the 2nd eye - ask what the results of the assessment are (which lens can your eye actually take safely and the surgeon is willing to implant) and then make the choice (you may have only one or even two options).