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
redi assia99778
Edited
I read through this thread and wanted to thank Jorge and other for posting about their RxSight LAL experiences. There's nearly ZERO end-user feedback I can find and here seems to be the best source. Very few raw testimonials, only adverts from surgery centers... except for here.
I had my right (worst) eye done this week with an LAL, and will go for the left next week. Before, I had a natural monovision going (L had clear distance, R had clear near vision). I will probably opt out of that and go with distance in both eyes as that better fits my hobby and sports needs, putting up with readers for computer work and close work, but the jury is somewhat out on that.
If anyone has recent experiences on LALs and the post-process or long term use, I would be grateful for updates.
Thanks.
**Update: ** Just a quick update now that I am through the post process and have been locked-in for about a month.
Both eyes are now about 20/15 now and my close vision also improved after the first adjustment.
Perfect distance vision (which was my target) is better than I could have hoped, and close vision is good down to about 2 feet now, 1.0 readers for all-day computer work and 2.0 readers for close threading-the-needle work.
Needless to say, I am an RxSight LAL fan. Any post-surgery rituals to support the process was simple and in the past.
Side note: the RxSight UV glasses I received were very well made (appeared to be constructed in Germany of all places) and virtually indestructible. I am making use of the sunglasses even still.
**Update: **6 months post-op. 20/15 both eyes still. Very happy with this vision.
jimluck assia99778
Edited
I had an evaluation at Massachusetts Eye & Ear Infirmary a couple of weeks ago. The doctor said they were getting the capability to do LAL and that LAL is EDOF. I got no further details. I did not know LAL was EDOF so I expressed surprise tinged with doubt. The doctor repeated: LAL is EDOF.
Boston Vision was the only one with LAL in the Boston metro area until now.
I might do LAL in my left eye, if I can't do the IC-8. My right is not a candidate for either -- too much astigmatism. The right will get a non-LAL very toric monofocal.
I'm giving myself a year for research. Targeting surgery for October 2023.
Both Boston Vision and MEEI recommended a toric Eyhance for my left. So that's also on my list.
RonAKA jimluck
Posted
Based on posts here the statement the EDOF status of the LAL is not clear. I have seen posts saying it is, and some saying it is not. Have not seen a defocus curve for LAL to show how much EDOF there really is. A very basic non aspheric spherical lens has about 0.25 D of extended focus compared to an aspheric lens. To be technically an EDOF a minimum of 0.5 D is required. Eyhance for example falls short of that at about 0.35 D.
RonAKA jimluck
Posted
From my quick look at the LAL information I believe they are promoting the extension of depth of focus by using what they call "blended vision" which is really monovision. It requires both eyes to be done with a near eye and distance eye just like monovision. The advantage with LAL is that the correction in both eyes can be fine tuned based on the patient feedback. One slide they show indicates that the majority of patients select a near eye myopia of -1.3 D.
jimluck RonAKA
Edited
"RxSight has developed an EDOF adjustment that could be centered on the visual axis of the near eye postoperatively. '... of enormous value in reducing the amount of myopia needed to provide functional reading ability'"
https://www.eyeworld.org/2021/using-the-light-adjustable-lens-in-practice/ late 2021 date
"RxSight has recently released an EDOF presbyopia treatment for the LAL in Europe, which will further improve depth of focus." https://www.healio.com/news/ophthalmology/20190730/which-emerging-technology-is-more-promising-for-achieving-good-vision-at-all-distances (August 2019 David Change article on that page.)
"The [LAL]
EDOF effect is produced by manipulating spherical aberration, rather
than with a diffractive or small aperture optic"
https://ascrs.org/-/media/files/2021-ascrs-course-handouts/814_9863_135_2019_escrs_article-on-lal.pdf (2019)
So, yes they do monovision or minimonovision, using the ability to adjust power postoperatively to nail the targets. But that's not all anymore. There is a new wrinkle to the product featuring addition of EDOF to the near eye by manipulating spherical aberration. The conflicting information out there is the result of progress over time. It used to be it wasn't EDOF. Now it can be if the new refinement to the RX Sight LAL technology is employed.
RonAKA jimluck
Posted
The LAL strikes me as freehanding the lens design in the eye. I wonder what the accuracy of these freehand changes are and the optical aberrations they create.
jimluck RonAKA
Posted
Why "freehanding?" I think it must be guided by math and physics. The results are not immediate, and they only get 2 to 4 tries, yet the reported results indicate highly precise outcomes. How could you "freehand it" under those conditions and get those results?
RonAKA jimluck
Posted
Perhaps "freehand" is not quite the correct term. But, on one hand you have the Vivity and Eyhance which are carefully designed to extend the depth of focus, extensively tested, and then produced in a factory. LAL on the other hand is made to a basic power and then implanted in the eye. After implantation then you start to design it, and test it on the fly subjectively by the user. To me it does not seem to be as precise of a method. But, the process is not unlike Lasik. Lots of precise measurements but the cornea is sculpted to create a desired effect.
trilemma RonAKA
Edited
I really strongly doubt that. Astigmatism, yes. But initial spherical, no.-- there is not nearly enough adjustment range to accommodate the wide range of spherical needed by different people. I am confident that the doctor chooses a diopter for the RxLAL based on testing, just as is done with all IOLs.
If you search "TABLE. IOL Spec Sheet" page 3 of 4 of the document has a table. There is a DIOPTER RANGE column, but the RxSight row does not really show a range as such. But looking at the wide range of the other lenses, it seems obvious to me that RxSight cannot provide a single strength, and expect the adjustment to get in range for more than a fraction of people. There has to be different diopters for the doctor to choose from after the measurements.
RonAKA trilemma
Edited
From the FDA P160055 SSED pdf the lens is available in these powers:
.
+10.0 to +15.0 D (more myopic than average eyes): 1.0 D steps
+16.0 to +24.0 D (mild myopic to mild hyperopic): 0.5 D steps
+25.0 to +30.0 D (more hyperopic than average: 1.0 D steps
.
I see no mention of availability with cylinder correction. That probably is only done after implantation.
.
So yes, just as with other monofocals you need the IOL measurements with the IOLMaster and a formula is needed to calculate the power required.
trilemma RonAKA
Posted
Good find on that FDA document.
julie66167 jimluck
Edited
jimluck,
I do not understand the EDOF part of the LAL. I have surgery scheduled for the middle of September 2023 to receive this implant and now I have cold feet.
.
The following has is from “The Light Adjustable Lens: Reshaping the Premium IOL Landscape”
"It is indeed a monofocal lens; however, given its aspheric design, it does allow for an element of extended depth of focus (EDOF).
Additionally, patients can elect to add negative spherical aberration to their nondominant eye during the light treatments. This adds an additional 0.50D-0.75D of EDOF, providing a solution for presbyopia and reducing the need for reading glasses postoperatively."
"The surgical target should be set for plano with both eyes regardless of the final refractive target. This allows for re-establishment of eye dominance postoperatively and allows room for the added negative spherical aberration to enhance depth of focus in the nondominant eye."
.
Will I be able to wear glasses to correct my vision, if necessary, with EDOF LAL? I am thinking about the future should my vision change.
Will I lose contrast sensitivity?
Will I lose clarity? I asked my surgeon about visual acutiy with EDOF, and he did not understand my question.
Will EDOF feel natural, or will it be "slow" to focus?
.
Questions for my surgeon that I did not get to ask:
Is EDOF built into the LAL even before adjustment? Do the LDD adjustments add more EDOF?
If the LAL target is nearsighted in both eyes’ vs plano – can EDOF be done on both eyes for intermediate computer vision? Or is EDOF only done with one eye – the non-dominant eye? I might not like mini-monovision?
.
I asked to start with a target, using the LAL, of -2.0 in both eyes and adjust from there because I would like to remain near-sighted with intermediate. I would rather wear glasses for distance than give up being near-sighted. My surgeon explained that if I did not start out at plano, I would miss the EDOF created by the first adjustment. He does not want me to "miss this experience". To my way of thinking, if I start out where I think I should be - there will be more adjustments to fine tune mico and mini monovision.
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I hope you will share what you have learned from your research. I simply do not understand how EDOF works in LAL. I do not understand how the diopters change is possible.
What is your opinion of silicone lenses?
Then I think - maybe I should listen to my surgeon, and I will have the same outcome as Deanna87107.
leonard67447 assia99778
Edited
My vision correction journey has been fraught with challenges to date. The initial stage involved surgeries on my first eye on April 27th and the second on May 9th. Post-surgery, with no further adjustments, my vision dramatically improved to a level better than it had been in years.
I was informed that following the adjustments, my vision would enhance even more, although my close reading ability might temporarily decline. As predicted, this did indeed occur. However, after the second adjustment, I began experiencing discomfort in my left eye, with what I can only describe as cobweb-like visuals entering from the left side. Simultaneously, my right eye developed a light grey film with minuscule bubbles and several dark specks, which I presume are floaters.
To be direct about this, it has been a disaster; wearing these glasses day and night is awful, and I think it impacts my vision and ability to judge how my eyes are doing correctly. My far vision was not bad recently but seems to have changed again, and reading requires me to position objects approximately 14 inches away. A final adjustment is possible, but I've been advised to pause for two weeks while administering prednisone to my left eye.
The provided eyeglasses are not suited for long-term use, but RXsight has been helpful in sending me replacements at no cost. I've meticulously adhered to all the prescribed guidelines. Despite the setbacks, I have confidence in my care team, although I find myself uncertain of the following steps or options available to me. I'm even questioning whether having these implants removed might be a consideration.
Information, advise or other similar experience information would be appreciated
I am adding to my original message. Based on other patients who were having adjustments at the same time I was there; the overall consensus has been positive. I do not know what has gone wrong with my experience, but I would still recommend this solution.
trilemma leonard67447
Posted
julie66167 leonard67447
Posted
I so hope you are doing better. It has been two weeks and Hopefully your targets have been met. Please keep posting. It seems that your vision was better before the adjustments. I wish you healing. I hope your opthomologist can explain what happened.