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.
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?
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.
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.
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.
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.
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.
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.
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!
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!
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.
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!
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.
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!
are there any issues with the material of lal lenses which arentime induced?
@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?
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. . With a monofocal lens like the LAL you will need about -1.50 D in the near eye for good reading vision.
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.
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.
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.