Is there anyone who has chosen intermediate focus with cataract surgery

The accuracy in predicting outcomes with IOL power calculation formulas is improving though. A recent study found that the AI based Hill-RBF 3.0 D formula is 95% accurate in predicting outcomes the fall within plus or minus 0.5 D. Yes, I know that 0.5 D off is a lot. But when you look at the 95% confidence limits on a normal distribution graph you can see that the odds of actually ending up right at the limit of this +/- 0.5 D range is very low. Yes, you do roll the dice to some degree, but the odds are stacked much more in your favour of landing closer to the target than to the limit of the range. See this graph for illustration. Keep in mind though that this study on the Hill formula accuracy excluded higher risk eyes like those at the extreme limits of myopia or hypermyopia, and those having previous refractive surgery.

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It's good to hear about some recent data on accuracy. Is this based on Tsessler et al?

This info could be reassuring for some, and unsettling for others. For me, with my excluded "higher risk eyes", I am imagining (based on no data whatsoever) a 10% chance of an error greater than 0.75 D. Or perhaps it's a 20% chance. Who knows?

It is indeed a roll of the dice to some degree, as is much of life. Perhaps I should reconsider using loaded dice - the RxSight Light Adjustable Lens...

There is that one, and also this one from Dr. Adi Abulafia.

https://eyewire.news/news/study-shows-highest-iol-prediction-accuracy-for-hill-rbf-30?c4src=article:infinite-scroll

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If the cost and time are not an issue there certainly are some upsides in accuracy with the LAL.

Thanks RonAKA. It appears that is the same study - Tsessler and Abulafia are co-authors, and members of the same medical team in Jerusalem.

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Would you offer any thoughts comparing the LAL vs the enVista MX60E? Aside from the obvious differences, that is. I was just about ready to sign up for the enVista, based on its aspheric uniform power design, balance between good depth of field and good acuity, reputed resistance to glistening and maybe also to PCO, rapid unfolding and stability in the eye, and especially the general tolerance for corneal imperfections like mine. But it's hard to swallow a substantial chance of a substantial refractive error. I have no problem with the hassle or the cost of the LAL - if it materially improves the likelihood of a good outcome, it's definitely worth it to me.

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Any other thoughts would be greatly appreciated.

That is a hard choice. I think the enVista may be a better lens and made from a better material than silicone used in the LAL. However, you take the risk of them not hitting the target with the enVista. If you are up to more Lasik, you could target more myopia than you want to end up with and reduce it to target with Lasik on the cornea. My experience with investigating Lasik is that they can reduce myopia, but increasing it is difficult and not so predictable.

Here's my plan as of today:

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• Ask my surgeon to target -2.25 D myopia with enVista lens
• If he gets me anywhere between -1.50 D and -2.50 D, I'm done
• If I end up more myopic than -2.50 D, get a LASIK targeting -2.00 or -1.75 D
• If I end up less myopic than -1.50 D, either live with it and buy some reading glasses, or consider exchanging for a weaker lens, targeting -2.00 to -1.75 D.

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  I don't know. I might get lucky and get a good outcome. Or I might end up pretty far away from my goals, or risk a second surgery. The LAL could reduce some of these risks -- maybe I'll change my mind again tomorrow... 😃

I think you have a very good plan. If practical I would get measurements from at least two different optical biometers, and use a surgeon that has experience and confidence with refractive surgery eyes. It probably would be a good plan to consult with the Lasik specialist before surgery to get their input on what they can and cannot correct. They may be willing to measure your eyes pre cataract surgery and give you their thoughts on a target they can work with.