RxSight Light Adjustable Lens...my current experience

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I read so many helpful threads while researching my recent cataract surgery, but didn't see many with actual experience with the Light Adjustable Lens so I thought I'd share mine. I chose the LAL because it seems that around 25-30% of cataract surgery patients don't get the results they're hoping for, prior refractive surgery makes it even harder for the surgeon to hit the target choosing a lens power, and I'm picky about my vision. I had old-style LASIK about twenty years ago, and I wasn't a candidate for a LASIK tweak due to thin corneas. I don't wear contacts any more due to dry eyes, and have never gotten great vision with glasses, so the stakes were high and I wanted to maximize my chances of getting good vision at all distances.

My surgery was just over a month ago and I got some good improvement immediately; I still had pretty decent distance vision and gained a lot of near vision (I could easily read my laptop with only -.25D myopia in near eye, which speaks to the EDOF.) I'd still have needed some help from glasses and light readers, but was glad to have no glare or halos and none of the visual issues that some have with multifocal lenses. I had my first light adjustment day before yesterday; I woke up the next morning with amazingly crisp distance and mid-range vision, and able to read the tiniest of tiny print.

Besides the fact that it's adjustable, I was drawn to the fact that the LAL acts like a monofocal lens in the beneficial ways...crisp vision, lets in all the light so doesn't have the compromises in low light conditions some multifocals do, doesn't have the dysphotopsias (halos, glare) that some others do. It does have some extended depth of focus built into the lens even before the light adjustments. I kept seeing that when they first started using it, many surgeons were shocked at how much near vision their patients got with only a little anisometropia...basically mini or micro-monovision. That helps with stereoacuity and depth perception, then making adjustments toward myopic unlocks some more EDOF. I was also reassured by the fact that though it's only been in commercial use in the US for a few years, it's been used in Europe for over 12 years and there is over two decades' worth of data and studies.

Downsides are the need to wear the UV-blocking glasses for several weeks and 3-5 extra appointments to do the adjustments and lock in procedures. The wraparound glasses are comfortable but not attractive and I won't pretend it hasn't been a bit annoying to wear them for these weeks. There is a UV shield on the lens now, so it's not as critical to wear the glasses indoors, and there's hope this will at some point remove the need to wear the glasses at all, but for now they're still prescribed.

I know I sound like a commercial but for me, being adjustable absolutely trumps these relatively minor inconveniences! I was prepared for more than adjustment but it appears we may have hit it with the first one. I go back next week for refraction and either another small adjustment or the first lock in procedure. I'll let you know how it goes.

9 likes, 55 replies

55 Replies

  • Posted

    Sounds like a good outcome. I am assuming you had both eyes done with a mini monovision? If so what was the resulting refraction in each eye?

  • Posted

    Ron, yes I did both eyes a week apart. Target in distance eye was plano, and I ended up at +.25 with -.75 cylinder. Near eye target was -.75 as a starting point for adjustment and I did end up there with -.25 astigmatism. The adjustment two days ago targeted just the astigmatism in distance eye, leaving the decision whether to stay a little hyperopic or adjust for plano until next time. Near eye was targeted for -1.25 and I'll find out next week how close they got. Obviously with a good surgeon and luck, I ended up close enough to target that for me it wouldn't have been tragic if the lenses weren't adjustable...that aspect would have a much higher value to someone who ended up farther from target. Even the minor adjustment completely removed the need for glasses at any distance, though, and that was my hope.

    • Posted

      It certainly is a good feature to be able to adjust the refraction after it is implanted. Should let you get to target or very close to it. I think the ideal for mini-monovision is -1.50 D in the near eye, and 0.00 D for the distance eye, with no astigmatism in either. I would think once you get to the 6 week post surgery mark, the eye should be stable and what you get for refraction then should be stable over the long term.

  • Posted

    Agreed...everything I've read seems to say that -1.5D is about ideal for monovision in general. With the EDOF in this lens it seems pretty common to end up reading J1 with -1.25 or even less, so it'll be interesting to see what I refract next week. I'll probably go ahead and take that distance eye to plano and then see how my reading vision looks.

  • Posted

    There is no toric version of this IOL is there?

    Thats what prevents it from being a choice for me since I have around 2D cylinder in my left eye.

    • Posted

      The ability to correct astigmatism after the surgery is a strong point for RXLAL. If you use a toric lens, which has the astigmatism correction built in, then the surgeon has to get the axis correct. I think that can be hard. The RXLAL lets the doctor set the axis and strength after the surgery.

      Also, the toric lenses have a granularity in how much cylindar is added/subracted.

    • Posted

      True that the LAL may be better than a toric IOL in the hands of a skilled surgeon for mild astigmatism. Keep in mind they are eyeballing the correction on the fly. On the other hand the cylinder comes built into the toric IOL. The angle is set by the surgeon and will be accurate at the end of the surgery. The question is how long does it stay at the correct angle. The same issue exists with LAL if the lens moves in the eye, the correction angle changes.


      I believe the LAL correction for astigmatism is limited to 2.0 D, while an IOL can correct double that amount or more with specialist lenses.

    • Edited

      The setting of the astigmatism adjustment, including axis, is done during the light adjustment -- not before or during surgery.

      The first adjustment is 3 weeks after implant, so hopefully any rotation would have happened. But there are further adjustments-- maybe a total of 4 a week apart. Four is probably seldom needed.

      "The IOL can be modified up to a total of 3 D of cylinder". That info is https://www.reviewofophthalmology.com/article/adjustable-iols-lights-lasers-and-lockins and is likely a change from the first specifications.

  • Posted

    I asked a couple of US surgeons about the light adjustable lens but neither had the equipment to do it. You could probably find someone in a larger metro area but I'm not sure how you'd go about finding a surgeon with the equipment in other areas of the US. In my area, most surgeons tend to have strong preferences for either the Alcon or J&J platforms which don't include the light adjustable lenses.

    I have good results with the Eyhance so far but my surgeon hit intermediate targets with virgin corneas. The light adjustable lens would be a great option for those less likely to hit targets or who want to try different targets. I probably would have gone for it if I could have found a surgeon with the equipment.

    • Posted

      I asked a couple of US surgeons about the light adjustable lens but neither had the equipment to do it. You could probably find someone in a larger metro area but I'm not sure how you'd go about finding a surgeon with the equipment in other areas of the US.

      You can go to the RxSight website, and click "PATIENT INFORMATION". Then click "FIND A PHYSICIAN" near the top.

  • Edited

    Night-Hawk, the LAL can correct anywhere from .5D up to 3D of astigmatism, any axis, so your 2D wouldn't need a toric lens. I think one of the advantages here is that toric lenses have a pretty good chance of rotating or tilting as they heal, which messes things up but good...with the LAL you let the lens heal and settle first, then adjust.

    greg59...I think more and more practices are offering it, but as you found it's not on every corner since there is the initial investment in the light delivery device for adjustments, training, and extra appointments. I found options for a couple of family members near surprisingly rural areas but I'm sure it just depends. The RxSight website doesn't work well for locating a provider, so I had the best results just googling a certain town and the terms. I know you already have your lenses, just replying for anyone else who is interested in it.

    • Edited

      Cylinder in an IOL is not equal to cylinder in glasses for the same amount of astigmatic correction. The ratio isn't constant, but it can be as high as 1.5 diopters of IOL cylinder needed to equal 1 diopter cyl of spectacle prescription, assuming none of the astigmatism is in the lens. So, the maximum cylinder that the LAL can do of 3 might be just barely enough for someone who has 2 cyl in their eyeglass prescription, but it should be enough.

      In the US, most toric IOLs are available up to 6 cyl, which means if your glasses prescription has more than about 4 cyl, you are out of luck, unless some of your astigmatism is lenticular and the corneal components is 4 or under.

      My glasses prescription for the left is 2.25 and my doctor says the LAL could handle it, because a tiny bit of it is lenticular. My glasses prescription for the right is 8.25, all corneal, and my doctor says I need about a 10 cyl in the IOL; so I have to either go to some other country for surgery on the right or accept I will still have very bad astigmatism after surgery. The estimate of 10 cyl apparently comes from studying the corneal topography. More measurements and calculations will be needed to hone that number. I don't think my spectacle cyl prescription is even an input to the calculations.

      I tried scleral contacts, which automatically eliminate all corneal astigmatism without being toric themselves. They completely eliminated the right-eye astigmatism (according to subjective refraction) and nearly all the left eye astigmatism, confirming my astigmatism is in the corneas not in the lenses, except for a tiny bit in the left. That tiny bit in the left lens puts my corneal astigmatism in the left under 2, and, as I said, that's why the LAL would work for me in that eye. But I doubt I will go for the LAL. I'm leaning toward Eyhance. I have an appointment in 10 days. I'll grill him on the EDOF potential of the LAL vs the Eyhance. Surgery is at least a year away, so I got time to mull it over.

      One thing I was struck by with the scleral contacts in, was the lack of depth of focus. It felt like zero depth of focus monocularly. I was trying different refractions in each eye, so I got some depth of focus that way binocularly. But wow, I have so much more depth of focus with my irregular corneas being the refractive surface than when the perfectly spherical scleral contacts were. It makes me think I have natural higher order aberrations that give me some EDOF.

  • Edited

    My final results with LAL:

    Yesterday was the second lock-in and the end of my LAL journey. I feel so fortunate to have excellent vision at all distances and to be collecting all my old progressives, multifocal "computer" glasses, and reading glasses to be donated.

    Final results are:

    Dominant eye from plano to -.25, 0 cylinder

    Reading eye from -.125 or -.150, with -.25 or -.50 cylinder at 180 axis

    The numbers were always the same with the autorefractor, the variances from the lenses I chose on the "better at 1 or 2?" part of refracting. It's normal for refraction to vary a bit on different days or even from morning to evening and if the difference is less than that quarter diopter it will get rounded up or down to the closest .25D. I obsessed a little bit over whether to go for correcting the last little bit of astigmatism in near eye on the days they called it as -.50 cylinder, but knowing that small amount is frequently not detectable or corrected, and that multiple studies have shown a small amount of myopic astigmatism to enhance near vision, made me decide we were done.

    Bottom line is I see 20/15 distance with some of the letters on the 20/12 line, and read at J1 and smaller so I guess that gets me to better than "20/Happy" as the doctors call it.

    It's a lot of near vision for such a small difference in power between my eyes, which means no monovision issues. The extended depth of focus in the lens and the additional EDOF gained when doing the myopic adjustment to my reading/near eye helps give that, plus a smooth range of continuous good vision through near, intermediate, and far.

    Highly recommended!

    • Edited

      Being able to fine tune the sphere and cylinder is a big advantage. The issue with monovision is getting an accurate sphere value as with just IOL power selection and surgery one is only about 75% sure of being within +/- 0.5 D. Being able to fine tune down to +/- 0.25 is a bonus. You obviously got a good outcome. Well done!

    • Edited

      Thank you for posting. I have had both surgeries (1 month apart) and still need to wear 1.0+ readers (inside the UV glasses) for computer use at work. I've had one adjustment on the first eye and go in for the 1st on the 2nd eye in 6 days . Much of the terminology on here is above my pay grade. Hopefully I can post more so others can benefit as you have done when I have the lenses locked in. Initially it was difficult but only because my doctor had not prepared me for what to expect. I am an accountant and had payroll for over 70 people to run the following week. Fortunately the receptionist overheard my difficulty and gave me a set of UV glasses that my computer glasses would fit inside. That allowed me to function with one lenses removed. After the 2nd surgery and 1st adjustment to the first eye I switched from my prior glasses to the 1.0+ readers that I have on now and the bifocal UV glasses that came with the surgery.

      For those still trying to decide, I am happy I made the choice to spend more and get rxsight adjustable.

      Thanks again for posting.

    • Edited

      I wasn't quite prepared for how many weeks the process would take; all the literature makes it sound as if you're done in about a month or less, but my surgeon's practice is very conservative and prefers to wait for a longer healing time to begin adjustments. Like you, I layered reading glasses with the clear UV glasses at first. I'm glad you got improvement with the first adjustment and think you'll be very happy once you're done!

    • Edited

      Hi Deanna81707,

      Is the prescription or Target correct for your near eye? I think the decimals may be off. Since it has been several months, is it possible for you to give an update?

    • Posted

      Hi Bruce, I am hoping that you received this and will give us an update of your outcome. thank you.

    • Posted

      It's a lot of near vision for such a small difference in power between my eyes, which means no monovision issues. The extended depth of focus in the lens and the additional EDOF gained when doing the myopic adjustment to my reading/near eye helps give that, plus a smooth range of continuous good vision through near, intermediate, and far.

      Do you think that your ability to get good vision over a wider range of distances than you expected involved the adjusting optometrist to do anything beyond dialing in target sph and cyl ? In other words, do you think the adjusting optometrist did anything else to enhance EDoF specifically? Or is it just that the combination of mini-monovision, and the inherent characteristics of the lens, and leaving some astigmatism, and the characteristics of your eye, gave this great result?

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