Light Adjustable ?

There have been many threads on the LAL, so you might be able to search for them. Even though, for the most part, LAL is a monofocal lens it is a premium IOL and as far as I aware not covered by insurance. I say most part because their are some clinical tries using a EDOF feature of the LAL.

One problem is the LAL requires special equipment, so only a few doctors implant them.

But as you point out the surgeon often misses the refractive mark and the LAL allows post operative adjustments without have to do Lasik.

Another good video to watch on this IOL is from summit Eye care titled: The Light Adjustable Lens Live Panel Discussion.

Also I heard the latest version has a UV blocker built in so the required sunglasses might be reduced.

It has been discussed quite a bit here. It certainly is an interesting concept. I determined that it is not available in Canada, so I have not invested too much time in it. For sure it is a big advantage to be able to adjust the lens power after it is implanted, as even with all the most skilled surgeons and sophisticated tools and computer programs, they still miss on power. Only about 70% of procedures result in an outcome of +/- 0.5 D. That is a lot of error that one has to put up with for a lifetime. If this can be easily fixed that is great.

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I am a little more skeptical about the claims of correcting astigmatism. That seems to be kind of a freehand method like LRI, but in this case the lens is adjusted locally. Some seem to claim they can do it, and others not.

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My main worry would be long term durability/stability. These lenses are kind of a lifetime investment in technology. Makes me wonder if sunlight UV over a "lifetime" may end up distorting the lens and cause a loss of vision. Only very long term tests would determine that. @rwbil seems to have invested a lot of time into researching this lens and could probably add much more.

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I have to admit I avoid YouTube when doing research on these technologies. I prefer peer reviewed technical papers which can be difficult to read, but worth it if one is really interested enough. And one has to watch who is writing them and what potential conflicts they may have.

Hi @rwbil and @RonAKA -

Thanks for your responses. Well, it doesn't surprise me that I missed the discussions on here! Ha ha! I've was completely overwhelmed at first and without your help and others on this forum would have been even more lost.

@RonAKA - interesting with regard to UV exposure and how it might distort the lens over time. That makes complete sense. If what @rwbil notes is true, perhaps they've addressed this with a UV blocker.

I, too, read academic papers (I live my life on Google Scholar as a part of my profession -both from a publishing and reading perspective). But, I love eWOM and seeing what others have to say. I watched a guy named Kurt V yesterday and I found his 11-month update (over an hour long) post mulit-focal lens update very useful.

Speaking of academic papers, have you read new JAMS one suggesting a 30% reduction in alzheimer's/dementia for older patients who get implants? Very interesting - not definitive, but an interesting study.

So, right now I am dealing with something I had on the first implant. Sea sickness. Ugh, I guess this is my brain adjusting to the new implants. This second surgery is having a longer impact on my body than the first. I am back in the classroom next week so very much hope I am feeling better. I did some light walking on the treadmill the day before yesterday and that seemed to bring on this sea sickness....UGH

You can get more information about the LAL in this thread:

https://patient.info/forums/discuss/is-there-any-experience-here-with-the-light-adjustable-lens-lal--757608?order=oldest#topic-replies

The LAL is used in Europe for more than a decade. But: It didn't spread. On the contrary. If you have high astigmatism in both eyes, it's hardly manageable to get along for more than three weeks with sunglasses from dawn to dusk, additional readers and a pair of third glasses to correct astigmatism. And: You should be able to tolerate monovision to get more benefit from these monofocal IOLs.

Overall: It's a great idea and a very different approach in refractive surgery. It works well for many people.

Your outcome is a pretty good one. Therefore you shouldn't worry that you have missed something. I don't think so.