Is there any experience here with the light adjustable lens (LAL)?
Posted , 38 users are following.
The light adjustable lens (LAL) received approval by the FDA in 2017. I'm now offered this IOL as an alternative to a monofocal one. Is somebody here with experience - referring to treatment and outcome?
There is a thread in the forum introducing the LAL but it's three years old. They discussed the question whether the LAL is able to correct far, near and intermediate vision, achieving to be spectacle free at best. One member denied saying that you can only correct one distance like a monofocal lens. What is true?
Because I had rotation and unsucessful trifocal IOL treatment I very much appreciate the LAL with the possibility to correct the refraction several times after surgery when the lens is in place. Nighttime issues because of trifocal halos like concentric rings and spiderwebs around point light sources are not possible.
Sure there is the inconvenience to wear special sunglasses for several weeks from morning till dusk to protect the eyes from sunlight - even indoor and during showering but if it's worth the outcome I wouldn't mind.
0 likes, 131 replies
amar51707 assia99778
Edited
This forum helped me in deciding which lens to choose (LAL) and I want to contribute back my experiences to date so far. I was diagnosed with posterior subcapsular cataracts in both eyes from steroid eye drop use late last year. At the time of diagnosis my vision was 20/15 at all distances (essentially perfect). Unfortunately, this type of cataract is very fast growing and I was told I essentially had a year before going blind. I saw 5 different cataract surgeons and to my surprise every single one recommended a different lens.. LAL, PanOptix, Vivity, Symphony, and Tecnis Low Add. While there was no commonality in recommendation there was commonality that there where going to be side effects with the multifocal lens and that since I had LASIK the side effects could be more pronounced. One surgeon shared that he recently had to explant a PanOptix lens because the glare and halos was too overwhelming for the patient. There was also commonality (although not explicitly said) that my vision would not be as good as before no matter what lens I chose. Net Net there where going to be compromises 1) Stereo vision with likely life long side effects, 2) mono vision with no side effects but needing glasses, and 3) LAL with no side effects, no glasses, but with mini monovision. I went with the ladder (LAL) to be side effect free and figured I could also enhance my vision with glasses or contacts when/if needed. Below is my experiences so far that you will likely not hear anywhere else.
Surgery - The process starts with putting in a contact lens for an hour that has been soaked in dilation fluid. You get an IV for a conscious sedation cocktail. If you picked Laser assisted (in my case LENSAR) you will be awake for that procedure. Tons of numbing drops, a suction ring with water is put on your eye and you hold very still and look at the light for 60 seconds. The laser corrects astigmatism, makes the incision, and breaks up the lens. After this you are given conscious sedation and will not remember anything after where they further break up the lens, suck it out, and put in the new lens. The most painful part is probably the IV followed by the awkward feeling of the Lensar ring around your eye.
Post Surgery - You get 3 pair of glasses 1) tinted for outdoor, 2) clear for indoor, and 3) clear with a bifocal in it. You need to wear these at all times as any UV light can change the lens. You can take them off for showering in a dark room and sleeping. When you get home and are fully awake your eye will still be dilated and you will see rings around lights. I freaked out and thought the surgeon put in the wrong lens. Turns out it's called edge glare that disappears when the dilation goes away, but will return anytime you are dilated. There will be some aches and pains on and off that can be managed with Tylenol and Advil. Also dryness will likely be an issue for 2 months and plays a role in some of the pain. Oasis and Refresh Relevia are good.
LAL Post Surgery - The LAL is set to distance only after surgery and it will be up to 4 weeks before you start light adjustments. This means you will need readers as the bifocals in the clear glasses are too small to see through. Also you will need to put the readers over the provided UV protecting glasses. I found some good clip on readers on Amazon that worked well as I could flip them up and down as needed.
Pre Light Adjustments - You will meet with your Dr and select your dominant eye for distance and non-dominant eye for reading. The Dr will work with you to decide you initial prescription.
Light Adjustment Procedure - Your eyes are dilated and then numbing drops are applied. An eye patch is applied to one eye to cover it and a suction ring is place on your other eye. You place your head on the machine. The surgeon holds the ring on your eye and the nurse holds your head while you look into the machine for up to 90 seconds depending on the correction. The process is reversed for the other eye. The UV light is intense, but it is painless. It takes about 72hrs for the correction to happen and peaks around 48hrs.
Getting to Final Results - For at least a month you will be going in every week for adjustments. The right has good range of focus from 3ft to 300ft. The left eye has very little range of sharp focus, maybe 1 ft starting 1ft out. After my first treatment I pushed the right lens out to 20/15 for distance and my left eye further in for a 1.75 diopter spread. The range was too much and the gain you get with sharpness is lost with disorientation. In the office I could read J1+ in left eye and had 20/15 distance in right eye. The result was a blurry zone where your computer screen is or where you see items on the stand at a grocery store. So I pushed the left eye .25d out further for 1.5 spread which definitely helped.
Lock-in - The lock-in is the same as the adjustment, but the light intensity is double. It is painless, but intense. I did notice a rose tint to everything after the lock-in for up to 3-4 days which did go away. I also suspect the lock-in isn't an exact lock-in as there was some vision change. I lost a little distance and a little reading, nothing major, maybe .25d in total.
Pro's - I have zero side effects. No rings or halos. I have good range of vision. I can read my phone, computer screen, and see decently far. In the dr office my right is about 20/15 and I can read J1. It is impressive that the brain can cancel out the distorted image in the other eye at all distances. If you have less than perfect vision today, this lens will likely be an improvement.
Cons - The quality of vision is not as great as stereo vision. While the EDOF in the right eye is good I still cant see as far as I could before cataracts. The 2 month process is rough. Wearing glasses all day with clip on glasses was mentally taxing and at times claustrophobic. It is difficult to balance maximizing the best vision while balancing the distortion effect. I may have over done it with 1.5d difference and would recommend 1.25. Time will tell here if I can fully adapt.
Long Term Results - TBD. I completed my lock-in this week and will be glasses free soon. I will post a follow up on adjusting to mono vision in a couple weeks and if I decide to complement the mono vision with progressive glasses or contacts to get closer to stereo vision. Still too soon to say if it was worth it in the end. However, I am leaning toward Yes. I did notice that my vision changed during the healing process about 4 weeks after surgery (probably a little shift). I suspect that if I had put in another lens that this would also have occurred which would require a vision correction that can only be done with glasses, contacts, or Lasik. More to come...
assia99778 amar51707
Posted
Hello amar!
Thank you very much for your detailed report! I'm sure it will help those who are interested in the LAL.
How is your vision at the moment? Do you need glasses to feel more comfortable? Are glasses needed to read small print like pocketbooks (medicine bottles I don't ask - that's too demanding and not possible with a monofocal lens - even if monovision is used).
I wonder if I tolerate monovision. Did you try it before the surgery? What you gain near you will obviously loose far. That's how it works. How does this monovision affect stereovision? I can't imagine it. Problems during driving, sports (catching a ball ...)?
I'm not sure if high astigmatism (3 D) can be really and fully corrected during the UV light treatments. They say it's possible - theoretically. But in practice? Have you been far- or shortsighted? Any astigmatism?
In my case I must wear three glasses all the time for several weeks during the healing period: UV protection glasses, readers plus astigmatism correction. As you said: two glasses are already tough. But three ...?
Looking forward to hearing from you and hope you're doing well.
amar51707 assia99778
Posted
Hi Assia! At this point, I am for the most part spectacle independent. However, I do foresee needing some glasses for day and night time driving. My distance vision may be 20/20 in the dr office, but it's definitely not in the real world. If I put on a -.5 contact in my right eye my distance is amazing, but the difference between the 2 eyes is 2d which is annoying to say the least (and you loose some intermediate focus). I can read fairly small print (i.e. medicine bottle), but it is a struggle with monovision. My dr said it can take up to 3 months for your brain to fully adjust. I will admit there are days that I wish I had done multifocal iol's... but I still hear of people having hard time with either reading or seeing far (not to mention the side effects). I am not sure if the LAL can correct for astigmatism.. when I did the procedure the LENSAR machine that made the incision did any correction. Overall, as I said earlier, if you required a vision correction prior to surgery then I think you will be pleased and see an improvement. If you don't, as in my case, I think you will be disappointed no matter what iol you choose. I may explore multifocal contacts or some progressive glasses to offset the times when I need the extra boost... likely driving for sure. Vision around the house is good and glasses are not needed. I may also explore PRK or a piggy back lens to improve distance in the future as well... but there is my frustration... as I did the LAL to avoid that and I pushed my right eye out as far as the machine would let me. One other thing that I noticed that impacts your vision is dry eyes and tear drops. Dry eyes cause blurriness as well as many drops after you put them in. With monovision, this creates problems because if one eye is blurry the other eye cant cover for you. So far the drops that I have helped the most and are least blurry are Refresh Relieva. Anyways, I hope all of this helps. Did you have the procedure? How is it going? Happy to answer more questions. Hope you are doing well.
assia99778 amar51707
Posted
I've got trifocal IOLs since Oct. 2020. Both off-axis, causing significant residual astigmatism, therefore several glasses needed - for computer work to at a time (readers on top of the far specs). Large spiderwebs/up to 12 concentric rings around point light sources. Night driving is a nightmare. I'm living in a big city, so many lights ... it's awful.
The LAL was suggested as alternativ IOL after explantation. But I'm cooling off.
Concerning dry eyes: In my case dry eyes after the surgery and using eye drops returned to normal after three months. I think you shouldn't worry about that - it will improve, but as you said: With monovision one eye can't cover for the other.
Please let us know if the neuroadaptation will manage the challenging monovision. Your doctor is right: It can take at least three months. I think you haven't tried monovision with contacts before the surgery. I can't do that because it's no longer possible with trifocal implants. I had multifocal contacts before the surgery. Never wore glasses since my childhood. With the LAL or any other monofocal lens progressive glasses or multifocal contacts are possible - not with trifocals. I didn't know that before the surgery. I'm struggeling hard with the situation I'm in.
hhunt assia99778
Posted
I'm a RK veteran (around 16 incisions on the left eye & I've been told the scarring is stable). This eye is due for cataract procedure.
During one consult I received a strong sell for the LAL. Another option is to go with standard mono lens and do PRK adjustment down the road.
As I'm medicare dependent the second option is more appealing financially.
Suggestions anyone?
assia99778 hhunt
Posted
I would prefer the LAL in your situation because you can adjust them after healing. They are often used to address difficult cases and with successful results. PRK is a painful, invasive procedure. Another advantage with the LAL: You can try different sorts of monovision.
But: I'm not an eye surgeon, just a patient myself. Your doctors should discuss the options with you. Maybe you have already made a decision. Take your time, if you are unsure.
assia99778 amar51707
Posted
Hello Amar,
how you are doing? Was the doctor right with three months wait for neuroadaptation? I'm sure you found solutions that work best for. Any dysphotopsia or other strange things?
Regards, Assia
Songirl amar51707
Posted
Hello
can you tell me where you had LAL done?
zer33674 assia99778
Posted
I'm having a lot of trouble finding information about the LAL/RxSight. I'd love it if anyone could toss in their two cents:
I'm in my early 50s so I (hopefully) have a long time to live with my IOL choice, and I've been agonizing over it. I thought I wanted the Vivity, however my opth. said I'd be much happier with Panoptix and said to wait until later this year when it's on Clareon... but I want to be able to stargaze without halos. I've got dry eye now, but back when I could wear contacts I was content with monovision (maybe mini monovision? I had a 1.0 difference between eyes).
I've got a second opinion appt next week with a doctor who is on the RxSight list so I'd like to have my ducks in a row before then.
assia99778 zer33674
Posted
Sorry for late reply. I hope you received the necessary information about the LAL during your second appointment with the surgeon who is familiar with the LAL. Therefore you now know that it is basically a monofocal lens. You are lucky to be able to use monovision (I can't use it) which improves the range of visual acuity with the LAL and can be adjusted during the UV-light treatments. An advantage that no other lens provides.
I have trifocal IOLs myself which are similiar to PanOptics but the whole experience is a nightmare. I don't recommend this diffractive trifocal IOLs for people who are doing night driving and who have higher amounts of astigmatism. If you have high visual demands in the near and intermediate range, PanOptics may cause problems or won't be sufficient.
What information did you get so far? Have you made a decision yet? All the best!
zer33674 assia99778
Posted
Thank you so much! I did get a good deal of information. Both doctors that I've seen about cataract surgery seem a little tired of all my questions, LOL.
What I've found is that the LAL costs about $6000-6250 per eye out of pocket or $1000-2000 more than other premium lenses . Ouch. In addition, I do have a fairly high amount of astigmatism, so it might not even be an option for me (it's approved for up to 2.0 and I have at least 1.75). We won't know until I go to a pre-op visit and get all the measurements taken. If the LAL won't work, she said she'd recommend the Eyhance.
I considered multifocal lenses but I already have so much trouble with night time double vision and streaks that I decided I wanted to be able to stargaze again without a chance of issues.
Currently I'm trying out monovision again with contact lenses. It's been 10+ years since I had to stop wearing them due to dry eye, but some of the new lenses are much better for that condition. (I'm the wrong kind of astigmatic for dailies, though - wah!) I've been thrilled about not having to swap between computer glasses, readers, and distance glasses. So much so that I've kind of put the cataract surgery on the back burner for now!
RonAKA zer33674
Posted
I just finished nearly two years of doing a contact lens monovision trial. J&J Moist lenses were the worst contacts that I tried. I found them impossible to handle and I could not get through a whole day without them becoming uncomfortable. J&J Oasys 1 Day toric ones gave me the best vision as I had -1.25 of astigmatism before surgery. However in the lenses available at Costco Optical I found the Kirkland Signature daily the most comfortable and that is what I used. They are actually CooperVision My Day lenses, and are available in a toric, but Costco at least here do not carry them. If you can find them the Oasys and MyDay may be worth a try for torics.
robert80020 zer33674
Posted
I had the LOL with edof enhancement in April 2021.
Edof takes away a little crispness at distance but gives about 1.5 D of add. No halos or light show. I didn't notice any contrast loss, but my macula's are not good anyway.
My lenses started opacifying at 6 months and need to be replaced badly. After having to wear bifocals or carry around reading glasses for a while, I'm going to try to get these replaced with the Panoptix. Now that the Clarion version is available, that 3.2 D near add is what I want. I'll put it in my left eye first and try it for 6 months and see if i can get use to the halos. If I don't like it I'll put a Vivity in the right eye and call it a day. I hate wearing glasses
Bottom line: If you want a monofocal lens to do monovision or whatever, get the Clarion or Eyhance. If you want some intermediate vision with no light shows, go with the Clarion Vivity. I think it wil make the Edof LAL obsolete.
assia99778 robert80020
Posted
Thank you, Robert, for getting back to us. I'm a bit shocked about this opacification of the LAL, and that you are facing lens exchange because of that. What did they say at CODET? Is the opacification linked to the new material used with EDOF?
The original LAL without EDOF is used in Europe for more than a decade and I have never read about opacification.
Now I think you already had your exchange with the PanOptix. How are you doing with that IOL? Did the exchange procedure went well?
r46250 assia99778
Posted
I have a question for those who have had a lal iol implanted already and been through at least one adjustment When you get the light treatment, which I’ve read takes from 1 to 2 minutes, do you have to hold your eye perfectly still that entire time? i don’t know why but i have a hard time holding my eye still for anything more than 10 seconds or so althoughi think it’s just nervousness and I think I can learn to hold still longer. just wondering and thanks in advance.