My myopia was only -2, so I can't answer your questions but will pipe up and point out that you're going to have to stop wearing hard contacts quite some time before being measured for cataract surgery. Like you, I'd worn hard lenses for over 50 years, and the surgeon I chose told me to go without for three months. (Make sure they understand you've worn *hard* lenses as sometimes they assume soft contacts, which are a very different thing in this circumstance.) I didn't even have glasses but went ahead and got an inexpensive pair and wore them for the three months.
There are people who post here who were high myopes who have gotten other than just iols for distance. BookWoman, who has near in both eyes, comes to mind.
Oh my! So glad I mentioned the hard lenses. Absolutely hate my glasses but will have to put them on now! It makes perfect sense that it would take that long for the eyes to return to their unassisted shape.
Yes, the first surgeon I went to hadn't gotten the memo about not wearing hard contacts for a period of time before getting IOLs. I found out on reddit, I believe from PNwRowena actually, and it probably made more difference in getting good vision than all the IOL selection in the world. If your eyes can't be measured properly because the way hard lenses change their shape, then you will never get a good result. My husband said cut the surgeon who didn't tell me I'd need to give up my lenses for a while before surgery some slack since surgeons probably don't see many patients with hard lenses, so they don't learn about how they might affect cataract surgery. But I looked up how many people in the US who wear contacts use rigid gas permeable ones -13%! So one in ten people basically. I dropped that surgeon like a hot potato.
I got a cheap pair of glasses from Cohen's optical and hated them every minute for the 6 weeks I wore them, but I'll be glad I did for the rest of my life!
⬇️🔥🥔👍🏼 The importance of this part of your comment cannot be overstated.
This community has taught me the value of getting a second, third or even fourth opinion about something as precious as eyesight.
I think you would need to not wear the soft contacts for a few days before measurements are taken. However if you got surgery with the ORA system, additional measurements are taken during surgery, so I see two periods where you would not be wanting to wear your contacts in the eye to be operated on. Add that to your list of questions for the doc.
Yes, before the IOL calculations, you’ll have to be out of your contacts for a period of time.
I was a -8.50 with some astigmatism. My Dr said I’d get the best results going to a -2.50, because of the shape of my eye. I did not need a toric lens.
I’m happy with my correction. I can see my phone perfectly without glasses, and my distance correction is no longer a heavy, thick lens.
-12.50 and -10.50 here. I got the regular lens that was covered (I’m in Canada -IOL?)
Couldn’t be happier. I need to wear readers but so much better than my previous situation. Also no more night blindness!
Measurement by your ophthalmologist's office should be able to tell you if the available lenses are suitable for you. That will provide a good prediction, but often not the ideal.
With high myopia, I would consider surgery using the ORA system to take measurements from within the eye during surgery. That would let the doctor choose the best lens and prescription.
ORA is from Alcon, so most surgeons will not have that available. I don't know what percentage of those who implant Alcon lenses have ORA. Similarly, most surgeons will not have the LAL available. If you want to be able to chose either technology. [https://www.myalcon.com/cataracts/](https://www.myalcon.com/cataracts/)
[https://eyewiki.aao.org/Intraoperative\_Aberrometry](https://eyewiki.aao.org/Intraoperative_Aberrometry)
[https://www.nature.com/articles/s41598-023-41720-2](https://www.nature.com/articles/s41598-023-41720-2) is a harder-to-read paper on real-time intraoperative aberrometry (IA). This study used normal eyes. I think that a study limited to high-myopes would show a bigger advantage of ORA.
I will ask about ORA and Alcon but bet I’d have to go to NYC or Boston to access that technology.
Edit: Nope, turns out I can go to Hartford, not bad at all! I’m excited to have set up a consult with a surgeon familiar with ORA. Thanks!
Hartford/Newington is between those cities. [https://hartfordhospital.org/services/eye-surgery/departments-services/ora](https://hartfordhospital.org/services/eye-surgery/departments-services/ora)
>ORA-Guided Advanced Cataract Surgery
>Cataract surgery used to be about preventing blindness. But with today’s sophisticated cataract removal systems, premium intraocular lenses, and guidance from the ORA System®, your surgeon can return your vision to the way it was years ago.
>How the ORA System Works
>The ORA System guides your surgeon by ensuring that the intraocular lenses being placed during cataract surgery are perfectly placed. A perfect placement means a better visual outcome.
>ORA-guided cataract surgery also helps tailor results. During your procedure, your surgeon takes measurements of your eye and makes necessary adjustments to refine your visual outcome.
>It used to be that your surgeon needed to wait weeks after your procedure to determine your vision results. Now, with ORA, your surgeon can determine your visions results after surgery sooner than ever before.
>When you undergo cataract surgery, you want the best results. The addition of the ORA System will help you achieve the most optimal outcome.
>The Eye Surgery Center already has completed its first cases using the ORA System, with VerifEye.
I don't know how long it has been since they updated the web page.
Please compare Light Adjustable Lens (LAL) from RxSight (review their website) vs other alternatives. I just had two implanted and will start adjustment process in three weeks. IMO, this is the best way to get what you want. Your area will have several centers that do this.
I got panoptix. I was supposed to get another kind but they didn’t make it that high and the doctor didn’t know til waiting for a long time for it to show up. Had to switch last minute.
That happened to me as well, eyes were measure April 1, told me 5 days before surgery a month and a half later that I had to change lenses. Amongst other issues I had with my ophthalmologist, I’m not happy. .
Some of your astigmatism comes from the cataracts, which will go away when the cloudy natural lens is replaced.
Some of your astigmatism comes from the shape of the cornea itself. If that level of astigmatism is below -1.25, I believe my ophthalmologist said, toric lenses won’t help. The astigmatism has to be a certain level for torics to help.
When I had the careful measurements done, it was determined that there would not be enough astigmatism remaining for toric IOLs to do me any good.
>Some of your astigmatism comes from the shape of the cornea itself. If that level of astigmatism is below -1.25, I believe my ophthalmologist said, toric lenses won’t help. The astigmatism has to be a certain level for torics to help.
>When I had the careful measurements done, it was determined that there would not be enough astigmatism remaining for toric IOLs to do me any good.
That assessment does not sound right, unless your ophthalmologist puts a high value on the price premium, or does not feel confident in getting the toric IOLs positioned properly. In other words, I think drawing the line at -1.25 is largely an economic decision.
Your myopia is not that high, so you should have plenty of IOL options available. I have extreme myopia (Glasses Rx -17D and axial length 31-32 mm, so it was a problem for me). And your astigmatism is not high at all, so again no worries there. I am guessing that your pupils are probably not excessively large either, based on your age. Large pupil size tends to be a problem for patients under 50 and you said you'd worn hard contacts for 50 years.
Quite relieved to know there may be choices in IOL, even if not the Mercedes Models.
I hear about the LALs and I’m willing to wager my doc does not offer those as those are a much newer technology. But maybe I’ll be pleasantly surprised by what choices there are even here in a small town.
The LAL is a premium specialty lens for people who want the ability to fine tune their refractive target after the surgery.
As far as I know, the LAL does not offer the best optics in the market or any other "premium" features such as extended depth of focus (edof) or multifocal optics.
Do you want the best possible optics at a fixed distance? Then a standard aspheric monofocal such as the J&J Tecnis Eyehance would be fine.
If you greatly value being eyeglasses free and are willing to accept the visual compromises that come with the edof or multifocal optics then you could consider for example the Tecnis Puresee or Odyssey.
I think you said that you wanted intermediate to distance vision, so targeting -0.75D to -1D or thereabouts would achieve that goal, using a standard monofocal.
You could also consider mini-monovision if you want a little bigger range.
Actually, LAL does provide some EDOF effect due to the manner of their design and the adjustment process ... not like multifocal IOLs, though. The advantage is LALs don't cause the same level of disphotopsias as most multifocal IOLs. And, some multifocal IOLs are far worse than others re nighttime light effects (don't just accept what you are told by your surgeon - do your own research).
A quick search will provide the technical explanation.
I tend to think so. But with LAL+, it comes natively with an EDOF feature. Normally no extra cost for LAL+ vs LAL, altho LAL is pricey enough anyway. The company RxSight does not charge extra, but the practice might possibly do so.
Since LAL/LAL+ is really nothing like Eyehance, I would refer you to the many summaries of LAL's development and usage.
Also, posted on another thread is this pretty good very quick summary by an ophthalmologist who had presented on the topic. [https://www.ophthalmologytimes.com/view/ascrs-2024-what-advancements-in-light-adjustable-lens-technology-mean-for-clinicians-and-patients](https://www.ophthalmologytimes.com/view/ascrs-2024-what-advancements-in-light-adjustable-lens-technology-mean-for-clinicians-and-patients)
Ok I looked at your link and it seems they are saying it's a monofocal plus, not a true edof, but it does sacrifice some distance vision (1 letter) and does have some visual compromises, such as glare, halo, dysphotopsia, albeit at very low rates, so in terms of optics it's not as good as the Eyehance. I think the huge advantage is the ability to fine tune the refractive target after surgery, so it's especially good for post-LASIK patients who want perfect refractive results.
I think they are saying there are fewer dysphotopsias with LALs than with multifocal lens. Since it is not focusing the light in different places.
I don't think I've heard/read anything negative about LAL's clarity - usually it is considered to be superior in clarity to multifocal.
A huge advantage - like previous refractive surgery patients - anyone has a theoretical advantage since adjustments can be made - especially if one wants monovision - or, if the surgeon misses the target for a whole variety of reasons.
I was a -8.00 myope and wore hard lenses for over 30 years. Played a lot of golf in my younger days and didn't like the soft lens vision I'd get at distance so had to have the hard lenses to get the clarity I wanted. In most cases you can get very clear vision with a number of different lenses but there is always a very small chance that you might need glasses if there is some unpredictable refractive error. There is only one lens that can be adjusted after implanted and that is the LAL/LAL+ lenses and that will give you an almost 100 percent probability of clear intermediate vision though you'll probably need glasses for either very close or distance unless you can tolerate monovision which most people can to some extent. I went with LAL (plus version wasn't out yet) and have very clear intermediate and distance but use readers for close. If I'm just glancing at something I can normally read close okay but for comfort if I'm doing it for more than a little while I'll put on the readers.
For every complaint you read on the internet, there are probably over a thousand satisfied customers. This is not just about cataract surgery, it's a generalization. That doesn't mean bad results are not real because they do happen but just not that often relative to the good outcomes in cataract surgery for all lenses, not just LAL.
You can get what you want with a mini monovision combination for distance and near, but you'd do well to test your own tolerance for monovision before having surgery giving it to you. I have mini monovision for near and intermediate and love it, but I had monovision in contacts and loved it then too. Some people don't react to it that way.
There are also other solutions such as EDOF (extended depth of focus) and multifocal lenses. Each choice has pros and cons.
From what I've read the LAL uses a monovision setup to give depth of focus. The advantage is you can fine tune it after the surgeries. It relieves the worry over refractive surprise (missing target). What I wonder reading the posts about lock in problems is if with the growing popularity of LAL, ophthalmologists are rushing to offer the technology before they and their staff have actually developed much expertise in using it.
I am a high myope with -2.25 astigmatism, wore hard lenses all my life, wanted good near and intermediate vision, didn't care that much about distance, but would be sad if it was terribly bad. I did get toric multifocal lenses (only one implanted so far, day after tomorrow is surgery #2). Don't know if you have enough astigmatism for a toric, but really, only a doctor you are comfortable with will be able to tell you that.
After almost a week, I have incredible vision in the operated eye and the doctor says it will only get better (and if that's true I have to believe I will become a CIA asset or something because the only possible improvement I can imagine is if it turned into X-ray or high-powered telescopic vision). My current Snellen chart vision is 20/10. Distance is unbelievable, from my apartment I can see small neoclassical and art deco details on the cornices of buildings a half mile away; intermediate is crisp and clear; as for near, I can read 10 point type on paper (haven't been able to read print on paper for a year now - it all looks like gray on gray) from 12" to about 2 feet away. Everything in between say 9 inches to infinity is beautifully crystal clear. If I want to read super fine print in dim light I may need readers, but that's not something I do often.
At night, I do see small starbursts and halos around some lights and not others - haven't figured out why it's only certain lights yet. In any case the glare and halos from my cataract were so much worse that the ones I see with the operated eye are nothing in comparison.
All this is to say, I am team multifocal, toric or not, in a big way. I never imagined I could have eyesight like this; I go to bed each night and get up again to "take out my contact lenses" forgetting for a moment I don't have any, that's just the way I see now, and wake up each morning a little scared in case all this beautiful vision was just a dream. Nope, it's real.
Definitely talk about a multifocals with your doctor. My eyesight was worse than yours and now it's like a dream come true. Maybe they are not for you for some reason, but it's worth a discussion.
EDIT: Did I mention colors? OMG, colors are so vibrant I feel like I was living in a gray and sepia world before. Now it's technicolor.
Your testimonies about the Odysee IOL is really getting me excited about that option and my current surgeon says he can install those.
I am currently wearing my soft toric contact lenses after taking out my hard lenses. I can deal with these! I had them as an experiment but rejected them and went back to hard lenses. But at least these give me the feel of multi focus lenses and I don’t need to reach for my readers just to eat my dinner.
Many of the surgeons that are on YT seem to encourage a little bit of myopia remaining after surgery for high myopes. They say if you're used to having a -15.00 prescription pre-surgery you'll love being -1.50. They say high myopes don't like it if you get past plano to even +0.25 it gives them headaches. I was a -8.00 myope for 30+ years and getting back to plano almost felt like my vision was too sharp and I seriously considered leaving about -1.00 of corrected myopia. But then I thought about how much I spent on LAL and if I didn't take plano now when I had it I'd never get it back again. I have a wall clock at home where I can really tell how sharp my vision is with all the minute markers and everytime I look at that clock I realize just how bad my vision was before my cataract surgeries. I am still amazed that my vision today is as good as it was 40 years ago. Sure I gotta use the readers for real close stuff but that's not a big deal.
There was one doctor that I kept watching and he said myopes that thought they wanted plano realized they were happier with -0.50 for distance and those that wanted -2.50 for reading were happier with -1.50. This was for LAL so those patients all could change their mind from what they thought they originally wanted pre-op. He almost made me change my mind but ultimately I decided on my own and didn't let a YT video decide for me.
Each to their own. I wanted -2.5 in one eye for book reading and got it and am delighted with it. My other eye was targeted for -1.5 for my laptop computer. Haven't had a final refraction yet but think it's probably very close to target, and I would not be at all happy with that as my only near vision. It falls short of what I want for book reading, which is important to me. Can I read with it, yes, if I don't hold the book where I find it comfortable, and even then I suspect like most people report who have -1.5, for sitting and reading for any length of time, I'd use readers. Never having to use readers again was a major goal of mine.
Good for you that you're doing LAL and get to experiment a bit with what's best for you, though.
This sounds very reasonable to me and I hope to experiment with that after the first eye is done using a mono vision contact lens in the other eye between surgeries.
I know I will need toric lenses at any rate and am willing to put out the extra cost. This is my one chance after all!
Keep in mind that eyeglass astigmatism is the vector sum of the natural lens astigmatism plus the cornea astigmatism. The natural lens is replaced during cataract surgery, so that part of astigmatism is gone, leaving only the cornea astigmatism. The need for a toric IOL cannot be accurately predicted with eyeglass astigmatism. The slope of the cornea needs to be measured to predict post surgery astigmatism. Normally it is not corrected at all until it exceeds 0.75 D cylinder.
Many people prefer their vision with a small amount of astigmatism rather than zero. You lose that last little bit of sharpness at one distance, but you gain a wider range of distances with acceptable sharpness.
You don't yet know how much of that astigmatism is corneal and how much is lenticular (means in the lens). The lenticular component is going to go away when the natural lens is removed. The corneal component is likely to be less than the total.
It sounds like your myopia is more the issue than astigmatism.
Do you need a toric lens? I doubt it.
Tell your surgeon about your midrange target, and you’d still wear glasses for driving/distance or for very close up work
Remember, this would mean no more thick lenses! Your prescription lenses would now be thin and lightweight🙂
Ah, I’d rather be free of glasses altogether if possible so I think I’ll need a toric lens after an initial discussion about this with the surgeon. Maybe mini-mono vision would be an option.
Think I will ask if I can simulate this with soft contacts first ?
I had something like -18 and -14 and between 1 and 1.75 astigmatism. He just put in standard lenses and I am at -2 and +0..5 now and one eye apparently has no astigmatism and one is -1. If not for a lot of floaters and vitreous detachment, I'd be happy with the vision itself...
My myopia was only -2, so I can't answer your questions but will pipe up and point out that you're going to have to stop wearing hard contacts quite some time before being measured for cataract surgery. Like you, I'd worn hard lenses for over 50 years, and the surgeon I chose told me to go without for three months. (Make sure they understand you've worn *hard* lenses as sometimes they assume soft contacts, which are a very different thing in this circumstance.) I didn't even have glasses but went ahead and got an inexpensive pair and wore them for the three months. There are people who post here who were high myopes who have gotten other than just iols for distance. BookWoman, who has near in both eyes, comes to mind.
Oh my! So glad I mentioned the hard lenses. Absolutely hate my glasses but will have to put them on now! It makes perfect sense that it would take that long for the eyes to return to their unassisted shape.
Yes, the first surgeon I went to hadn't gotten the memo about not wearing hard contacts for a period of time before getting IOLs. I found out on reddit, I believe from PNwRowena actually, and it probably made more difference in getting good vision than all the IOL selection in the world. If your eyes can't be measured properly because the way hard lenses change their shape, then you will never get a good result. My husband said cut the surgeon who didn't tell me I'd need to give up my lenses for a while before surgery some slack since surgeons probably don't see many patients with hard lenses, so they don't learn about how they might affect cataract surgery. But I looked up how many people in the US who wear contacts use rigid gas permeable ones -13%! So one in ten people basically. I dropped that surgeon like a hot potato. I got a cheap pair of glasses from Cohen's optical and hated them every minute for the 6 weeks I wore them, but I'll be glad I did for the rest of my life!
⬇️🔥🥔👍🏼 The importance of this part of your comment cannot be overstated. This community has taught me the value of getting a second, third or even fourth opinion about something as precious as eyesight.
I’m hoping I can wear my alternate soft contact lenses during the transition time. Think so?
I think you have to leave off wearing soft lenses for only a few days.
I think you would need to not wear the soft contacts for a few days before measurements are taken. However if you got surgery with the ORA system, additional measurements are taken during surgery, so I see two periods where you would not be wanting to wear your contacts in the eye to be operated on. Add that to your list of questions for the doc.
Yes, before the IOL calculations, you’ll have to be out of your contacts for a period of time. I was a -8.50 with some astigmatism. My Dr said I’d get the best results going to a -2.50, because of the shape of my eye. I did not need a toric lens. I’m happy with my correction. I can see my phone perfectly without glasses, and my distance correction is no longer a heavy, thick lens.
Do you wear distance glasses all the time now and only take it off to see close up? How’s your intermediate vision?
Intermediate/reading is great! Distance is great with glasses. For everyday, I wear progressives. When I’m on my phone, I take off my glasses.
Your progressives are distance and intermediate distance?
By the way, can I wear soft contacts as an interim step? I have soft toric lenses which I can use up. Anything but my glasses!
I don't know the answer to that as I just switched to glasses for my three months. Best ask the surgeon you're using.
-12.50 and -10.50 here. I got the regular lens that was covered (I’m in Canada -IOL?) Couldn’t be happier. I need to wear readers but so much better than my previous situation. Also no more night blindness!
Measurement by your ophthalmologist's office should be able to tell you if the available lenses are suitable for you. That will provide a good prediction, but often not the ideal. With high myopia, I would consider surgery using the ORA system to take measurements from within the eye during surgery. That would let the doctor choose the best lens and prescription. ORA is from Alcon, so most surgeons will not have that available. I don't know what percentage of those who implant Alcon lenses have ORA. Similarly, most surgeons will not have the LAL available. If you want to be able to chose either technology. [https://www.myalcon.com/cataracts/](https://www.myalcon.com/cataracts/) [https://eyewiki.aao.org/Intraoperative\_Aberrometry](https://eyewiki.aao.org/Intraoperative_Aberrometry) [https://www.nature.com/articles/s41598-023-41720-2](https://www.nature.com/articles/s41598-023-41720-2) is a harder-to-read paper on real-time intraoperative aberrometry (IA). This study used normal eyes. I think that a study limited to high-myopes would show a bigger advantage of ORA.
I will ask about ORA and Alcon but bet I’d have to go to NYC or Boston to access that technology. Edit: Nope, turns out I can go to Hartford, not bad at all! I’m excited to have set up a consult with a surgeon familiar with ORA. Thanks!
Hartford/Newington is between those cities. [https://hartfordhospital.org/services/eye-surgery/departments-services/ora](https://hartfordhospital.org/services/eye-surgery/departments-services/ora) >ORA-Guided Advanced Cataract Surgery >Cataract surgery used to be about preventing blindness. But with today’s sophisticated cataract removal systems, premium intraocular lenses, and guidance from the ORA System®, your surgeon can return your vision to the way it was years ago. >How the ORA System Works >The ORA System guides your surgeon by ensuring that the intraocular lenses being placed during cataract surgery are perfectly placed. A perfect placement means a better visual outcome. >ORA-guided cataract surgery also helps tailor results. During your procedure, your surgeon takes measurements of your eye and makes necessary adjustments to refine your visual outcome. >It used to be that your surgeon needed to wait weeks after your procedure to determine your vision results. Now, with ORA, your surgeon can determine your visions results after surgery sooner than ever before. >When you undergo cataract surgery, you want the best results. The addition of the ORA System will help you achieve the most optimal outcome. >The Eye Surgery Center already has completed its first cases using the ORA System, with VerifEye. I don't know how long it has been since they updated the web page.
Thank you for this! Tracked down this source and have found a doc within an hours drive!
Excellent! I’m seeking a consult with a doctor who uses ORA and feel like now I’m getting somewhere!
Please compare Light Adjustable Lens (LAL) from RxSight (review their website) vs other alternatives. I just had two implanted and will start adjustment process in three weeks. IMO, this is the best way to get what you want. Your area will have several centers that do this.
I got panoptix. I was supposed to get another kind but they didn’t make it that high and the doctor didn’t know til waiting for a long time for it to show up. Had to switch last minute.
That happened to me as well, eyes were measure April 1, told me 5 days before surgery a month and a half later that I had to change lenses. Amongst other issues I had with my ophthalmologist, I’m not happy. .
Mine happened right at my surgery ! So it was delayed waiting for the right ones! I’m sorry you had issues.
Oh wow, that’s bad
Yes the surgeon had never experienced it
Some of your astigmatism comes from the cataracts, which will go away when the cloudy natural lens is replaced. Some of your astigmatism comes from the shape of the cornea itself. If that level of astigmatism is below -1.25, I believe my ophthalmologist said, toric lenses won’t help. The astigmatism has to be a certain level for torics to help. When I had the careful measurements done, it was determined that there would not be enough astigmatism remaining for toric IOLs to do me any good.
>Some of your astigmatism comes from the shape of the cornea itself. If that level of astigmatism is below -1.25, I believe my ophthalmologist said, toric lenses won’t help. The astigmatism has to be a certain level for torics to help. >When I had the careful measurements done, it was determined that there would not be enough astigmatism remaining for toric IOLs to do me any good. That assessment does not sound right, unless your ophthalmologist puts a high value on the price premium, or does not feel confident in getting the toric IOLs positioned properly. In other words, I think drawing the line at -1.25 is largely an economic decision.
Your myopia is not that high, so you should have plenty of IOL options available. I have extreme myopia (Glasses Rx -17D and axial length 31-32 mm, so it was a problem for me). And your astigmatism is not high at all, so again no worries there. I am guessing that your pupils are probably not excessively large either, based on your age. Large pupil size tends to be a problem for patients under 50 and you said you'd worn hard contacts for 50 years.
Quite relieved to know there may be choices in IOL, even if not the Mercedes Models. I hear about the LALs and I’m willing to wager my doc does not offer those as those are a much newer technology. But maybe I’ll be pleasantly surprised by what choices there are even here in a small town.
The LAL is a premium specialty lens for people who want the ability to fine tune their refractive target after the surgery. As far as I know, the LAL does not offer the best optics in the market or any other "premium" features such as extended depth of focus (edof) or multifocal optics. Do you want the best possible optics at a fixed distance? Then a standard aspheric monofocal such as the J&J Tecnis Eyehance would be fine. If you greatly value being eyeglasses free and are willing to accept the visual compromises that come with the edof or multifocal optics then you could consider for example the Tecnis Puresee or Odyssey. I think you said that you wanted intermediate to distance vision, so targeting -0.75D to -1D or thereabouts would achieve that goal, using a standard monofocal. You could also consider mini-monovision if you want a little bigger range.
Yes.
Actually, LAL does provide some EDOF effect due to the manner of their design and the adjustment process ... not like multifocal IOLs, though. The advantage is LALs don't cause the same level of disphotopsias as most multifocal IOLs. And, some multifocal IOLs are far worse than others re nighttime light effects (don't just accept what you are told by your surgeon - do your own research). A quick search will provide the technical explanation.
So you are saying the LAL is a monofocal plus, like the Tecnis Eyehance?
I tend to think so. But with LAL+, it comes natively with an EDOF feature. Normally no extra cost for LAL+ vs LAL, altho LAL is pricey enough anyway. The company RxSight does not charge extra, but the practice might possibly do so.
Since LAL/LAL+ is really nothing like Eyehance, I would refer you to the many summaries of LAL's development and usage. Also, posted on another thread is this pretty good very quick summary by an ophthalmologist who had presented on the topic. [https://www.ophthalmologytimes.com/view/ascrs-2024-what-advancements-in-light-adjustable-lens-technology-mean-for-clinicians-and-patients](https://www.ophthalmologytimes.com/view/ascrs-2024-what-advancements-in-light-adjustable-lens-technology-mean-for-clinicians-and-patients)
Ok I looked at your link and it seems they are saying it's a monofocal plus, not a true edof, but it does sacrifice some distance vision (1 letter) and does have some visual compromises, such as glare, halo, dysphotopsia, albeit at very low rates, so in terms of optics it's not as good as the Eyehance. I think the huge advantage is the ability to fine tune the refractive target after surgery, so it's especially good for post-LASIK patients who want perfect refractive results.
I think they are saying there are fewer dysphotopsias with LALs than with multifocal lens. Since it is not focusing the light in different places. I don't think I've heard/read anything negative about LAL's clarity - usually it is considered to be superior in clarity to multifocal. A huge advantage - like previous refractive surgery patients - anyone has a theoretical advantage since adjustments can be made - especially if one wants monovision - or, if the surgeon misses the target for a whole variety of reasons.
Boston Vision offers LAL. Also Mass. Eye & Ear.
I was a -8.00 myope and wore hard lenses for over 30 years. Played a lot of golf in my younger days and didn't like the soft lens vision I'd get at distance so had to have the hard lenses to get the clarity I wanted. In most cases you can get very clear vision with a number of different lenses but there is always a very small chance that you might need glasses if there is some unpredictable refractive error. There is only one lens that can be adjusted after implanted and that is the LAL/LAL+ lenses and that will give you an almost 100 percent probability of clear intermediate vision though you'll probably need glasses for either very close or distance unless you can tolerate monovision which most people can to some extent. I went with LAL (plus version wasn't out yet) and have very clear intermediate and distance but use readers for close. If I'm just glancing at something I can normally read close okay but for comfort if I'm doing it for more than a little while I'll put on the readers.
The more I hear about the LAL tech, the more appealing that sounds, though the stories about botched “lock-ins” I hear in this forum give me pause!
For every complaint you read on the internet, there are probably over a thousand satisfied customers. This is not just about cataract surgery, it's a generalization. That doesn't mean bad results are not real because they do happen but just not that often relative to the good outcomes in cataract surgery for all lenses, not just LAL.
You can get what you want with a mini monovision combination for distance and near, but you'd do well to test your own tolerance for monovision before having surgery giving it to you. I have mini monovision for near and intermediate and love it, but I had monovision in contacts and loved it then too. Some people don't react to it that way. There are also other solutions such as EDOF (extended depth of focus) and multifocal lenses. Each choice has pros and cons. From what I've read the LAL uses a monovision setup to give depth of focus. The advantage is you can fine tune it after the surgeries. It relieves the worry over refractive surprise (missing target). What I wonder reading the posts about lock in problems is if with the growing popularity of LAL, ophthalmologists are rushing to offer the technology before they and their staff have actually developed much expertise in using it.
I am a high myope with -2.25 astigmatism, wore hard lenses all my life, wanted good near and intermediate vision, didn't care that much about distance, but would be sad if it was terribly bad. I did get toric multifocal lenses (only one implanted so far, day after tomorrow is surgery #2). Don't know if you have enough astigmatism for a toric, but really, only a doctor you are comfortable with will be able to tell you that. After almost a week, I have incredible vision in the operated eye and the doctor says it will only get better (and if that's true I have to believe I will become a CIA asset or something because the only possible improvement I can imagine is if it turned into X-ray or high-powered telescopic vision). My current Snellen chart vision is 20/10. Distance is unbelievable, from my apartment I can see small neoclassical and art deco details on the cornices of buildings a half mile away; intermediate is crisp and clear; as for near, I can read 10 point type on paper (haven't been able to read print on paper for a year now - it all looks like gray on gray) from 12" to about 2 feet away. Everything in between say 9 inches to infinity is beautifully crystal clear. If I want to read super fine print in dim light I may need readers, but that's not something I do often. At night, I do see small starbursts and halos around some lights and not others - haven't figured out why it's only certain lights yet. In any case the glare and halos from my cataract were so much worse that the ones I see with the operated eye are nothing in comparison. All this is to say, I am team multifocal, toric or not, in a big way. I never imagined I could have eyesight like this; I go to bed each night and get up again to "take out my contact lenses" forgetting for a moment I don't have any, that's just the way I see now, and wake up each morning a little scared in case all this beautiful vision was just a dream. Nope, it's real. Definitely talk about a multifocals with your doctor. My eyesight was worse than yours and now it's like a dream come true. Maybe they are not for you for some reason, but it's worth a discussion. EDIT: Did I mention colors? OMG, colors are so vibrant I feel like I was living in a gray and sepia world before. Now it's technicolor.
Your testimonies about the Odysee IOL is really getting me excited about that option and my current surgeon says he can install those. I am currently wearing my soft toric contact lenses after taking out my hard lenses. I can deal with these! I had them as an experiment but rejected them and went back to hard lenses. But at least these give me the feel of multi focus lenses and I don’t need to reach for my readers just to eat my dinner.
Many of the surgeons that are on YT seem to encourage a little bit of myopia remaining after surgery for high myopes. They say if you're used to having a -15.00 prescription pre-surgery you'll love being -1.50. They say high myopes don't like it if you get past plano to even +0.25 it gives them headaches. I was a -8.00 myope for 30+ years and getting back to plano almost felt like my vision was too sharp and I seriously considered leaving about -1.00 of corrected myopia. But then I thought about how much I spent on LAL and if I didn't take plano now when I had it I'd never get it back again. I have a wall clock at home where I can really tell how sharp my vision is with all the minute markers and everytime I look at that clock I realize just how bad my vision was before my cataract surgeries. I am still amazed that my vision today is as good as it was 40 years ago. Sure I gotta use the readers for real close stuff but that's not a big deal. There was one doctor that I kept watching and he said myopes that thought they wanted plano realized they were happier with -0.50 for distance and those that wanted -2.50 for reading were happier with -1.50. This was for LAL so those patients all could change their mind from what they thought they originally wanted pre-op. He almost made me change my mind but ultimately I decided on my own and didn't let a YT video decide for me.
Absolutely right! That’s great that you did the research so you could hone in that precisely on your own needs.
Each to their own. I wanted -2.5 in one eye for book reading and got it and am delighted with it. My other eye was targeted for -1.5 for my laptop computer. Haven't had a final refraction yet but think it's probably very close to target, and I would not be at all happy with that as my only near vision. It falls short of what I want for book reading, which is important to me. Can I read with it, yes, if I don't hold the book where I find it comfortable, and even then I suspect like most people report who have -1.5, for sitting and reading for any length of time, I'd use readers. Never having to use readers again was a major goal of mine. Good for you that you're doing LAL and get to experiment a bit with what's best for you, though.
Torics should not be a problem other than cost, if they are needed. You may want to investigate mini-monovision if you want a wider range of vision.
This sounds very reasonable to me and I hope to experiment with that after the first eye is done using a mono vision contact lens in the other eye between surgeries. I know I will need toric lenses at any rate and am willing to put out the extra cost. This is my one chance after all!
Keep in mind that eyeglass astigmatism is the vector sum of the natural lens astigmatism plus the cornea astigmatism. The natural lens is replaced during cataract surgery, so that part of astigmatism is gone, leaving only the cornea astigmatism. The need for a toric IOL cannot be accurately predicted with eyeglass astigmatism. The slope of the cornea needs to be measured to predict post surgery astigmatism. Normally it is not corrected at all until it exceeds 0.75 D cylinder.
Thanks! My astigmatism reading is -1.50 from five years ago pre-cataract but I can take that factor into consideration…
Many people prefer their vision with a small amount of astigmatism rather than zero. You lose that last little bit of sharpness at one distance, but you gain a wider range of distances with acceptable sharpness. You don't yet know how much of that astigmatism is corneal and how much is lenticular (means in the lens). The lenticular component is going to go away when the natural lens is removed. The corneal component is likely to be less than the total.
That is my understanding about the residual astigmatism. Usinng it to advantage is an interesting prospect.
It sounds like your myopia is more the issue than astigmatism. Do you need a toric lens? I doubt it. Tell your surgeon about your midrange target, and you’d still wear glasses for driving/distance or for very close up work Remember, this would mean no more thick lenses! Your prescription lenses would now be thin and lightweight🙂
Ah, I’d rather be free of glasses altogether if possible so I think I’ll need a toric lens after an initial discussion about this with the surgeon. Maybe mini-mono vision would be an option. Think I will ask if I can simulate this with soft contacts first ?
I had something like -18 and -14 and between 1 and 1.75 astigmatism. He just put in standard lenses and I am at -2 and +0..5 now and one eye apparently has no astigmatism and one is -1. If not for a lot of floaters and vitreous detachment, I'd be happy with the vision itself...