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
leonard67447 deanna81707
Posted
Has anyone had issues with seeing dark spots, (not floaters) reflections and other odd issues that look like your glasses are dirty ? I had this problem after my second adjustment. I was near perfect after surgery and the first adjustment decreased my near vision and the second adjustment added this additional problem. I have confidence the place I am working with will solve the issue, I have also spoke with others who have been thrilled with the results. So far for me it is not going great.
ayassresearch deanna81707
Posted
Thank you for sharing your detailed experience with the Light Adjustable Lens for cataract surgery. It's great to hear that you've had positive results in terms of improved vision and adjusted outcomes. Your insights into the benefits and downsides of the procedure could be helpful for others considering similar options. Keep monitoring your progress and follow up with your healthcare provider as you continue the process.
allie81280 deanna81707
Edited
I have to decide tomorrow if I want to go with LAL as my first cataract surgery is in two weeks. I have -8.0 and -7.50 vision , currently wear multifocal contacts. My criteria for choosing a lens is clear distance and near vision , hopefully minimal halos and open to continued use of reading glasses if necessary. My doctor has an excellent reputation in the area as a cataract and Lasiks surgeon but only started LAL last month. This and the long process of the LAL adjustments ( and need for the UV Glasses for two months ) makes me a bit unsettled. I don't have the technical understanding that many of you on this thread have so i am putting my faith into the doctor. he recommended LAL , with Symfony IOL as the second choice. With a lifetime of high prescriptions I would like to make this cataract endeavor a positive one with the best results possible. If I go ahead with LAL how do I know when adjustments are right ? Any suggestions are welcomed.
laurie30147 allie81280
Edited
Just remember that the LAL lenses are essentially monofocal lenses that can be adjusted. When you say that your goal is "clear distance and near vision," achieving that with monofocal lenses requires monovision, or having different distance targets for each eye. That is different from the multifocal contacts that you use now. Since you are used to wearing contacts, you could try monovision ahead of time to see if you like it.
If you are willing to wear reading glasses, that affects the target prescriptions, too.
Do both eyes have cararacts?
trilemma allie81280
Posted
How much astigmatism in each eye?
RonAKA allie81280
Posted
Keep in mind that LAL primarily gets the range of focus by using mini-monovsion. In LAL speak they call it blended vision, but it is basically the same thing. Mini-monovision can be done with plane monofocal lenses but accuracy in hitting the targets is better with LAL, but at the cost of more appointments, and $$'s. I would pick mini-monovision with LAL or just plane monofocals over Symfony, as the Symfony is more likely to have side effects like flare and halos.
trilemma RonAKA
Posted
Codet in TJ Mexico has been working on EDOF with the RxLAL. I have not seen info on how good the resulting vision is (defocus curve). julie66167 has been seeking and finding info on getting that done in the US.
I don't know if all of the RxLAL providers will start offering that. Right now it seems to be limited to some providers.
RonAKA trilemma
Posted
As best as I can understand it, they create positive spherical aberration to increase depth of focus. The B+L enVista monofocal does the same at a non premium cost.
julie66167 allie81280
Posted
allie81280 - I sent you a private message
allie81280 julie66167
Posted
Hi
I apologize - I didn't receive your message can you send again? thank you !
trilemma allie81280
Posted
To receive a private message, click the envelope icon or the word Messages up top.
martin04875 deanna81707
Posted
From the discussion I've read, I'm guessing there may be some eye care professionals here. I lack the vocabulary to be too specific, but I'm wondering if anyone can help me decide about an LAL. A few details: I'm a 73-year-old male. Going into this cataract journey I had 20/40 right eye and 20/100 left. A small amount of astigmatism in my left eye. My biggest issue is significant vertical strabismus from 4th cranial nerve palsy with double vision as I look in the distance, not close up. Reading is fine. Haven't worn glasses in years. I'll probably need strabismus surgery after healing. Had right eye cataract surgery yesterday with monofocal lens set for distance. Lots of inflammation, so I'm still looking through wax paper. My surgeon is suggesting an LAL for left eye as my astigmatism measurements have been inconsistant and he doesn't think a toric lens is a good option for that reason. Strabismus doctor suggested I try to keep left and right eye as close as possible. Cataract surgeon is suggesting 1/2 diopter myopic in left eye based on measurements. Big concern with LAL is that I was diagnosed with a herpes infection of the eye in 2012 (can't recall which eye and can't get the records). Nothing since that I know of and cornea looks clear. Product literature for the LAL lists this as a contraindication. Cataract surgeon thinks this is just "labeling" and a work-around would be antiviral pills until final lock-in. The idea of triggering infections is worrisome. I'd be grateful for any opinions. I have to decide by 11/20. Thank you!
RonAKA martin04875
Posted
"My surgeon is suggesting an LAL for left eye as my astigmatism measurements have been inconsistent and he doesn't think a toric lens is a good option for that reason."
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One of the challenges in fitting an LAL lens is getting an accurate refraction (eyeglasses prescription numbers) to base the adjustments on. Your inconsistent measurements will be a problem with LAL because you only get three chances to make an adjustment, and then the lens can't be adjusted any longer. But, that said, perhaps 3 chances is better than one chance with a toric. A toric lens however can be adjusted for angular position, and the LAL astigmatism may not be without using up your adjustments.
trilemma RonAKA
Posted
Martin, I have no thought on how strabismus might affect your decisions. Have you had a refraction (sph an cyl) test done on your operated eye? What did your test show? What is measured will affect what you decide to do with your unoperated eye.
A local optometrist can do that for you for maybe $60.
LAL axis (angular position) is adjusted in the same treatment that sph and cyl are adjusted. It goes in with no sph, and thus no axis, and those are all adjusted.
LAL has better granularity for cyl than toric lenses -- 0.25D.
LAL adjustments are based on refractions done with a phoropter (which is better, 1 or 2). So I think the harder-to-predict eye can benefit more from RxLAL.
karen43820 deanna81707
Edited
Thank you for the information. Im scheduled for surgery here on the 15th of January and have started to get worried though everyone here seems to have had good results with the new adjustable lens. I didnt ask the doctor what the baseline will be after the surgery - will i need my glasses until the first adjustment? My vision is - 4.75 in the first eye and worse in the second eye, so i need to have either some correction or the ability to wear my glasses until the first correction. Second eye is being done a week later. Not looking forward to wearing terminator glasses but if my vision corrects the way everyone is suggesting - i will be amazed and more. Have worn glasses my entire life - it will be different
RonAKA karen43820
Posted
From what I understand, assuming you are going for mini-monovision, they will use an initial lens power that leave you at about +0.50 in the distance eye, and -1.0 D in the near eye. Then they will bring the distance eye down to plano and the near eye to nominally -1.50, or what you prefer with the adjustments. It won't be ideal, but probably tolerable without glasses until you get the first adjustment.
trilemma karen43820
Edited
Your existing glasses will not be good for the operated eye. Before correction, expect the vision to be pretty immediately improved. Your brain may tolerate the difference well enough during that week. If not, close one eye, or get a temporary contact in the un-operated eye. The contact should only be tried after measurements have been made.
You are going to like the result. Don't get all joyous about the vision, and ask for lock-in prematurely. Get sphere and cyl tuned to within 0.25D or better of ideal. Don't settle for 20/20 if 20/15 can be achieved.
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I suggest that each time you get a refraction, ask what the numbers are, and log them. We will want to see them.