RxSight Light Adjustable Lens...my current experience
Posted , 27 users are following.
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
redi deanna81707
Edited
Glad to hear your RxSight LALs went well. There are so few real patient reviews around, glad you posted.
I did LALs in both eyes in June 2022, opting for the best distance vision in both eyes due to my desire to support my hobbies that lean to perfect binocular distance acuity.
I ended up with 20/15 or better in both eyes. Anything really closer than computer work requires readers, but I traded that happily. The process from start to finish was no bother and the vision center that did the work could not have been better imo. All that is in the "rear view mirror" now.
donna37035 deanna81707
Edited
I had cataract surgery on my non-dominant eye the 4th of January, 2023. Since I had had Lasik 20+ years ago, my surgeon recommended RX LAL . Vanity and the thought of wearing UV googles for several weeks lead me to decline the suggestion. I had a different lens implanted (Vivity EDOL) with disasterous results. I have double vision and severe glare, halos and starbursts in that eye.
Today they will remove the Vivity and replace it with an RX LAL (I should have listened to the experts to begin with) . I am very apprehensive. My surgeon is not the best at explaining and appears offended when I ask questions. He has told me that I will have great distance vision but will likely require full time glasses for intermediate and close vision. Needless to say, this upsets me considering I didn't need glasses when I started this process. Most articles I have read states LAL is so adjustable that it offers good vision at all distances.
I am so happy to see this article with actual experience by others who have walked this path before me. Thank you for sharing your experience. It has given me hope that I, too, can get there!
donna37035
Edited
@deanna81707 https://patient.info/forums/profiles/deanna81707-1445857
To follow up on my experience - I had the Vivity lens removed and replaced with an RxLAL on 2/15/23. The day of surgery, everything was extremely blurry but I was heavily dilated and pretty sedate from the procedure. When I awoke the next morning, I was absolutely amazed at the brightness and clarity! I think I could see the county line, and, although not as clearly, I could see intermediate distance fairly well. Near vision was not so good. At my day after appointment, I scored 20/40 on the reading chart On 3/7/23 I had a LAL lens implant in my other eye Aiming for better reading vision, we decided to start with -0.75 D so "there wouldn't be a drastic distance spread" should I not be able to tolerate monovision. I am scheduled for light adjustment #1 on March 22nd. I can see a definite difference in my eyes only when I cover one eye. Otherwise, my eyes seem to be working well together My near vision is doable but I'd like a little more clarity. I'm unsure where to go from here or if I even need to be concerned. Are all adjustments based on refractive testing (which is better, 1 or 2) from this point? Would you suggest I come a little closer with distance and move near in to 1.0 or 1.25 D?
RonAKA donna37035
Edited
I would suggest you print out a Jaeger test chart which you can find at the All about Vision. Print is at actual size and view it from 14" in good light. If you can read the J-1 section you have pretty good near vision.
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With a monofocal lens like the LAL you will need about -1.50 D in the near eye for good reading vision.
donna37035 RonAKA
Posted
RonAKA, thank you for your response and advice. I had my first light adjustment today. They set my near eye at -1.0 D for first trial. Dialation has not worn off yet so I'm anxious to see what tomorrow brings. I will print a Jaeger chart tomorrow and use it for my guide for further adjustment.
RonAKA donna37035
Posted
You will likely find lighting is critical to good reading. I can read J-1 in sunlight quite easily, but it does get harder in dimmer light. I would think the objective would be to get good reading vision with the minimum amount of myopia, so you can retain better distance vision with the eye. Based on some studies I have seen, -1.25 D may be an optimum value, and the range of -1.25 to -1.50 is a good target for conventional monovision lenses. With LAL you can personalize the amount to use.
marilyn23061 donna37035
Posted
Donna, I am scheduled for LAL surgery in one month. I have to drive about 1-2 hrs. to Kaiser in Santa Clara, California because that is the only Kaiser facility in Northern California that does the LAL. Are you happy that you chose these lenses? How is your vision after the adjustment? What was the adjustment like? I'd like to know as much as possible pros and cons before surgery. Thanks.
jim09067 donna37035
Posted
I have had one eye done with the LAL. My vision is good with the exception of near/reading. My surgeon is reluctant to adjust my near vision stating it could ruin the distance vision. Does this sound typical? I am not sure if I want him to the second eye now.
RonAKA jim09067
Edited
The LAL is essentially a monofocal lens. If they adjust the power to give you better near, then it will cost you on distance. With the eye that is already done about all they can do is give you some astigmatism. That also will cost some visual acuity in distance but may give you some better near.
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The better approach would be to leave the first eye alone, and set the power for the second eye to give you some near. Instead of say -0.25 D, target -1.50 D. If you don't like it they can adjust it to where you want it.
jim09067 RonAKA
Posted
thank you Ron
jim09067 RonAKA
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Does a setting you listed or one similar typically allow someone to read?
RonAKA jim09067
Edited
I am at about -1.60 D in my near eye and I can see well down to about 8" and read pretty much anything, except very fine print in poor light. It does vary a bit from person to person. That is the big advantage of LAL. You could target -1.50 D and then adjust it to your own preferences.
julie66167 donna37035
Posted
I would like to remove my cataracts and the haveLAL implanted. I still have many concerns and questions. I did not think that the LAL could be implanted with a target and have 3 adjustments left. I assumed they started with 0.00 and worked to myopia! I am trying to understand EDOF. If I am understanding correctly, Deanna81707 saw some EDOF immedialtely as well as after her final adjustment. What has been your experience with the EDOF? Does it feel natural?
What sphere and cylinder did you end up with in both your eyes? What are you able to read and see at distance? Thank your for sharing.
trilemma julie66167
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Initially they have a target. I don't know the range of diopters the RxLAL comes in, but I expect that includes at least 15 to 25D -- likely wider. So the adjustments just adjust from the initial best estimate.
soks deanna81707
Posted
are there any issues with the material of lal lenses which arentime induced?
RonAKA soks
Posted
That is a good question. I would have similar concerns.