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Question about RxSight Lighjt Adjustable Lens

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melodyNYC
melodyNYC

Hello. I had a cataract removed from my non-dominant eye last June -- and had a PanOptix lens put in. At the time, I chose PanOptix because I really wanted to be able to read without glasses. This lens has been excellent for reading - but not great for medium or distance. But I don't want the doctor to make PRK lasik adjustments as I would some of my reading ability..... So, the original plan was to put a Vivity in the dominant eye, so that I'd have that for distance. .... However, when I went to talk to my doctor today about getting the dominant eye done, he was suddenly pushing really hard for me to use "Rx Sight Light Adjustable Lens." This was a lens he never even mentioned to me when we discussing all of my options last year before my surgery on the first eye.

When I read about the Light Adjustable Lens, it talks about multiple adjustments being done after the surgery - and how you can't be exposed to light during those weeks. (You have to wear special glasses all the time both indoors and outdoors). And it just all seemed strange. Even if they "lock" in a particular adjustment - wouldn't the eye be vulnerable to unplanned changes as it's exposed to light over time? It just seems risky to me. ... But when I asked about the Vivity lens again, my doctor said he'd still prefer the Light Adjustable lens. ..... I'm a little confused -- as last year he thought the vivity or another panoptix would be best for the second eye. So, maybe I'm being cynical - but I'm wondering if he's pushing it because he gets paid more (it's more expensive than the PanOptix and Vivity lens. And he'd also get paid more from my insurance every time he made an adjustment).

So, does anyone have experience with the Light Adjustable Lens? If so, what was the result like? And how did it last over the years. Did exposure to light everyday change it from when you had the final adjustment? Any info would be greatly appreciated.

0 likes, 5 replies

5 Replies

  • RonAKA
    RonAKA melodyNYC

    Posted

    As I mentioned in another post, it sounds like your surgeon had a "miss" or "surprise" as it is sometimes called with your PanOptix first eye. You could confirm that and determine how much the miss was by getting an eyeglass prescription for your PanOptix eye. From what you describe it may require a -0.5 or -0.75 D eyeglass lens for best corrected distance. If so, you were left myopic.

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    As I suggested in the other thread, I would suggest considering a monofocal like the Clareon in your second eye, but set for distance (-0.0 to -0.25 D) this time. It should make up for the lack of good distance in the PanOptix eye. It will also avoid any of the potential optical side effects which are common with the PanOptix. The trick of course is that this time you want the surgeon to hit the distance target, and not miss again.

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    And that is where the LAL can come in. It is still basically a monofocal lens, but it is adjustable for a limited amount of time until you are happy with it. If there is a miss again the surgeon can correct it in your eye.

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    However, if it were me I would avoid the expense and extra trouble, and just go with a monofocal. Your surgeon should have learned on your first eye, and get it more accurate in the second eye.

    • melodyNYC
      melodyNYC RonAKA

      Posted

      Thank you Ron! You are a fountain of knowledge and I appreciate it!! .... I realize my doctor "missed" on the first eye, but I actually love the way I can read with it. He offered to adjust it with PRK and YAG - but I worried that this would mess with my ability to read and I LOVE being able to read without glasses. (I've consulted two other doctors - and both said the placement of the lens is perfect). So, I've left it alone. ...... And now I'm focusing on the other eye - to choose a lens that will improve my distance. ..............................

      I'm not sure why there was a miss on the first eye-- I had an astigmatism in that eye and he didn't give me a toric lens - so that might be it. Also, nobody told me not to wear my contacts in the week leading up to the final measurements - so that might have contributed to it too. Also, the machines in his office - they had to repeat one of the tests 15 or 20 times to get the measurement, which didn't leave me feeling confident about their accuracy.

      ...... When I went this week for them to measure for the surgery for the other eye - the staff had the same issue with trying to get a measurement on this one machine. They repeated it 20 or 25 times. Have you ever had this happen before? ... When I told the doctor about my concerns, he blamed my dry eye for the difficulty in getting the measurement and thought it would be fine. ......

      My other question: Are you familiar with the RxSight Light Adjustable Lens?

      ... Also, if most of my reading ability is in the non-dominant eye - and most of my distance will be in the dominant eye -- will this give me headaches? or problems with depth perception? Could I still play a game of tennis?

      ......... Any insights on these questions would be appreciated.

    • RonAKA
      RonAKA melodyNYC

      Posted

      If you want to find where you really stand with your first eye, the only way is to get an eyeglass prescription for it. That will tell you by how much the miss was, and if there is any astigmatism. But, if you are happy with the reading, then it would be best to just take it as it is.

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      I have run into the measurement issues when I went for a Lasik consult with one clinic. I have trouble getting my eye wide enough open, but I really think it was inexperienced staff. The best machines for cataract surgery eye measurement are the IOLMaster 700 and the Lenstar 900. If you are considering another surgeon you could ask to see if they have either of those two machines.

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      Yes, I am aware of the Light Adjustable Lens (LAL). It is still just a monofocal but since they can adjust it after implantation, your are assured that you will not have a miss. But, keep in mind it can't deliver close and distance vision. It is one or the other.

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      It is normal when doing monovision to get your distance vision in your dominant eye and close vision in the opposite eye. I would expect with a MF lens in one eye and a distance monofocal in your dominant eye you should have no trouble with tennis. A distance monofocal should give good vision down to about 2 feet, so you should be able to see the ball hit your racket with both eyes.

  • maura04015
    maura04015 melodyNYC

    Posted

    I have no experience with the LAL but it's in the back of my mind that in the event I get a "surprise" with the first lens, before just getting a second lens in the same way and hoping, I'm going to investigate LAL in depth. I'd rather pay the extra and go through the extra process and be sure it wouldn't happen again. We all stress over what lens to get, but from what I see here and in other sources, the biggest problem in cataract surgery, regardless of lens choice, is the lack of surety of getting the target desired. You're happy with the result of your miss, but most people aren't and you wouldn't be if it was in the other direction. The LAL is new in the U.S. so there aren't years of data, but I wonder if like other lenses it was used in Europe first and data from there would answer some questions.

    • RonAKA
      RonAKA maura04015

      Posted

      One of the ways to potentially avoid a "surprise" is to get a little more involved in the IOL power selection process. The best eye measurement instrument to determine power is likely the IOLMaster 700, with the Lenstar 900 being a close second. A good starting point is to select a surgeon that has the latest technology instrument like the IOLMaster 700. The next thing you can do is ask for the IOL Calculation data sheet after your measurements are taken at your consult. It will have the details of your eye measurement and the lens options to achieve your target outcome. The surgeon will likely have their favourite calculation formula which will be programmed into the IOLMaster. But, you can use these measurement values to enter your data into one of the formulas that are on line. You can run those calculations and see how it compares with what the surgeon wants to do. Hopefully all you will be doing is confirming what the surgeon wants to do. If it does not confirm the surgeon's selection then you will need to discuss it... The two formulas that are probably the best for determining the accurate power are the Hill RBF-3.0 and the Barrett Universal II. My eyes were done with the Hill RBF-2.0 and the outcomes were very accurate. The 3.0 is a further improvement over the 2.0 formula. The Hill formulas are based on an AI analysis of data submitted by surgeons and is based on thousands of eyes. You can find the formula by googling this:

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      Hill-RBF Calculator Version 3.0 - IOL Power Calculations for Cataract Surgery

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      You can find a little more about the V3.0 here:

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      CRSTG Hill-RBF Calculator: More Data to Further Refine Outcomes Warren E. Hill, MD and Adi Abulafia, MD

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