Another Cataract Surgery Thread

[Katsmeow]

DW is facing cataract surgery in both eyes. I have not yet gotten all the details of the options (she just received them today and is still nervous about the choices). From what she has told me, she has two surgery options: (a) eliminate the need for glasses or contacts, except for reading, or (b) eliminate the need for reading glasses but require glasses for everything else.

Currently she is very nearsighted. She can read books or work on a tablet without glasses, but for everything else she needs glasses. She reads a lot (one reason we have 5000+ books in our home ), and one concern she has is having to now use reading glasses. She is used to wearing glasses to get around.

OK...this is opinion. I think choice of cataract surgeon is really important. Cataract surgeons are not all alike. Some cataract surgeons tend to use certain brands of lenses and don't offer other brands. Some may not have the equipment needed for particular lenses. For example, the Light Adjustable Lens requires that the doctor have the equipment needed to adjust the power after surgery.

When I was thinking about cataract surgery, I knew I was interested in the Light Adjustable Lens and went to the manufacturer's website and found out who could do the surgery. As it turns out one of the doctors was the doctor who did my LASIK surgery years ago.

Another factor for me is looking at doctors who have been involved in clinical trials for various lenses. My thought was that the doctor who was involved in clinical trials might have more experience than someone who just started to use the lens.

Based upon what others have said on some other forums (more related to health) have said, many doctors don't really adequately explains options to patients. Sometimes people are not really told about options other than standard monofocal lenses or maybe are only told about the lens options that surgeon offers when there might be other options from other surgeons.

Unless your wife knows a lot about this surgeon and has a lot of confidence this is one of those things where getting more than one opinion makes sense (maybe even if she does have a lot of confidence).

From what you said it sounds like the surgeon offered your wife only one type of lens.

It sounds like they offered her only a monofocal lens choice. It sounds like they offered her only the choice of setting the focus for distance (she would wear glasses for reading and probably for intermediate distance such as computer or dashboard) OR setting the focus for near (she would not need glasses to read but would need it for everything else).

That sounds extremely limited. To be clear, some people really need a monofocal lens and can't really use the multifocal lenses or extended depth of focus lenses. For example, in my left eye I had a peel of a macular pucker and a vitrectomy and I need a monofocal lens for that eye. In my right eye, I am not a candidate for multifocal since I had LASIK but I could do the Vivity EDOF lens.

So, your wife may have some sort of eye condition that requires a monofocal lens.

However, even so there are options:

1. She could set one eye for distance and set the other eye for monovision, mini-monovision or micro-monovision. She could see more near with monovision rather than micro but true monovision may be harder to adjust to. It is possible the doctor didn't suggest that because your wife has previously tried monovision and didn't like it or doesn't want to try it now.

2. If you wife needs a monofocal lens, why not try a Light Adjustable Lens. That is a monofocal lens but you can adjust the power post surgery to set each eye exactly as you want. There are some great videos on You Tube about this lens.

The only negatives of the Light Adjustable lens are (1) it costs money and (2) you have to go through the adjustment process. To me, it was worth it to get the adjustment period afterwards. The other downside of this lens is that not all doctors can do it. But, that is solved by finding one who can.

3. Maybe your wife doesn't have any retinal or other eye problems that require a monofocal lens. If so, she might be a candidate for the PanOptix multifocal lens which can give good vision at all distances or a candidate for the Vivity lens which is giving me great distance vision, good intermediate, and what they call functional near vision (I can read my phone without glasses but I don't want to). There are other brands of premium lenses also (those two I mention are made by Alcon).

Maybe your wife does not want to get one of those lenses. That is fine. Everything is a trade off. But, if she is eligible for those lenses, why didn't the doctor discuss them? Again, maybe your wife isn't eligible or she wasn't interested in them.

I mention this simply because I sometimes have seen people have cataract surgery without really considering their options and the trade offs.

 

[RetMD21]

2. If you wife needs a monofocal lens, why not try a Light Adjustable Lens. That is a monofocal lens but you can adjust the power post surgery to set each eye exactly as you want. There are some great videos on You Tube about this lens.

Most people get good vision with a standard monofocal so the LAL isn't going to benefit them, right? Also were you concerned about the higher rate of explant in the study? Only 1.7% for the LAL vs 0.5%. https://www.accessdata.fda.gov/cdrh_docs/pdf16/P160055B.pdf
Maybe better patient selection will help that issue.
There were some color vision abnormalities associated with LAL in the study but these seemed to resolve.

 

[Katsmeow]

Most people get good vision with a standard monofocal so the LAL isn't going to benefit them, right? Also were you concerned about the higher rate of explant in the study? Only 1.7% for the LAL vs 0.5%. https://www.accessdata.fda.gov/cdrh_docs/pdf16/P160055B.pdf
Maybe better patient selection will help that issue.
There were some color vision abnormalities associated with LAL in the study but these seemed to resolve.

The LAL can benefit someone (in my opinion) if you can adjust the power after surgery. If it "misses" a bit from what the patient wants ideally, the ability to fine tune the power after surgery seems really worthwhile to me. A person might get "good" vision with a standard lens, but get even better vision if they can fine tune it later.

Also for people who do want to do some version of monovision (even the milder forms) the ability to fine tune the two eyes to get the refinement seems worthwhile.

And, for people who have had previous refractive surgery that ability to do post-surgical adjustment is of even more importance. With a monofocal lens, if my prior LASIK might make it harder to accurately select a lens power, I really like that ability to be able to adjust later. That wasn't really a factor so much with my Vivity lens on my right eye since that is an EDOF lens. But, I needed the monofocal lens for my left eye.

On the explant issue, the main concern the optometrist at my surgeon's office pointed out was that the manufacturer of the LAL had felt there were too many explants due to patients having unintended vision changes pre-lock in due to not wearing the UV blocking lenses consistently. In fact, when I went in for my initial evaluation, my surgeon's office had just used the ActivShield version of the LAL that day which is meant to alleviate that. In my case, I will be extremely diligent on wearing the UV blocking glasses even if ActivShield is there.

 

[jollystomper]

OK...this is opinion. I think choice of cataract surgeon is really important. Cataract surgeons are not all alike. Some cataract surgeons tend to use certain brands of lenses and don't offer other brands. Some may not have the equipment needed for particular lenses. For example, the Light Adjustable Lens requires that the doctor have the equipment needed to adjust the power after surgery.

When I was thinking about cataract surgery, I knew I was interested in the Light Adjustable Lens and went to the manufacturer's website and found out who could do the surgery. As it turns out one of the doctors was the doctor who did my LASIK surgery years ago.

Another factor for me is looking at doctors who have been involved in clinical trials for various lenses. My thought was that the doctor who was involved in clinical trials might have more experience than someone who just started to use the lens.

Based upon what others have said on some other forums (more related to health) have said, many doctors don't really adequately explains options to patients. Sometimes people are not really told about options other than standard monofocal lenses or maybe are only told about the lens options that surgeon offers when there might be other options from other surgeons.

Unless your wife knows a lot about this surgeon and has a lot of confidence this is one of those things where getting more than one opinion makes sense (maybe even if she does have a lot of confidence).

From what you said it sounds like the surgeon offered your wife only one type of lens.

It sounds like they offered her only a monofocal lens choice. It sounds like they offered her only the choice of setting the focus for distance (she would wear glasses for reading and probably for intermediate distance such as computer or dashboard) OR setting the focus for near (she would not need glasses to read but would need it for everything else).

That sounds extremely limited. To be clear, some people really need a monofocal lens and can't really use the multifocal lenses or extended depth of focus lenses. For example, in my left eye I had a peel of a macular pucker and a vitrectomy and I need a monofocal lens for that eye. In my right eye, I am not a candidate for multifocal since I had LASIK but I could do the Vivity EDOF lens.

So, your wife may have some sort of eye condition that requires a monofocal lens.

However, even so there are options:

1. She could set one eye for distance and set the other eye for monovision, mini-monovision or micro-monovision. She could see more near with monovision rather than micro but true monovision may be harder to adjust to. It is possible the doctor didn't suggest that because your wife has previously tried monovision and didn't like it or doesn't want to try it now.

2. If you wife needs a monofocal lens, why not try a Light Adjustable Lens. That is a monofocal lens but you can adjust the power post surgery to set each eye exactly as you want. There are some great videos on You Tube about this lens.

The only negatives of the Light Adjustable lens are (1) it costs money and (2) you have to go through the adjustment process. To me, it was worth it to get the adjustment period afterwards. The other downside of this lens is that not all doctors can do it. But, that is solved by finding one who can.

3. Maybe your wife doesn't have any retinal or other eye problems that require a monofocal lens. If so, she might be a candidate for the PanOptix multifocal lens which can give good vision at all distances or a candidate for the Vivity lens which is giving me great distance vision, good intermediate, and what they call functional near vision (I can read my phone without glasses but I don't want to). There are other brands of premium lenses also (those two I mention are made by Alcon).

Maybe your wife does not want to get one of those lenses. That is fine. Everything is a trade off. But, if she is eligible for those lenses, why didn't the doctor discuss them? Again, maybe your wife isn't eligible or she wasn't interested in them.

I mention this simply because I sometimes have seen people have cataract surgery without really considering their options and the trade offs.

Thanks, I appreciate the detail, more good stuff to review .

She is very comfortable with the ophthalmologist, she has been with them for years and they have a good record.

I believe that, due to her extreme astigmatism, multi-focal lens are not an option. I did ask her, she said they mentioned something about that but she cannot remember. From my point of view, this situation has DW very nervous, to where she is still reluctant to review the options documentation they gave her ("I can't deal with this right now"). She did say they would be happy to talk more to clarify anything she (or we) did not understand. I am just giving her space to settle down. The main deadline is she would like to get the surgery done before the end of the year. If so this has to be scheduled in the next several days.

 

[Katsmeow]

Yesterday, I had surgery in my left eye. For this eye, I received the Light Adjustable Lens. For a variety of reasons it is hard to compare that experience with the right eye.

One reason is that I had a vitrectomy in the left eye 3 months ago, while I don't have any issues with my right eye (other than having had LASIK).

The other is difference in lens choice. The right eye I received the Vivity EDOF lens. It does have an extended depth of focus so improved my vision from distance to even some near. While I still need reading glasses (expected), I am a able to read my phone without glasses when I need to (better than expected). Essentially, though, my right eye has been stable since 2 days after surgery. I did have some changes in those first couple of days, but no real change since then.

The left eye lens choice is a Light Adjustable Lens. It is a monofocal lens, so won't have that extended depth of focus I get from my Vivity lens. If I got a monofocal lens set to plano for distance I would expect to have really good distance vision and still need glasses for computer and reading. Not much different than what I had with my right eye pre-surgery. The Vivity lens, though, does help me a lot with computer distance and some with near.

In my case, I did not want to set my left eye lens for distance. I want my left eye to help with the computer distance on my right eye. The "target" for surgery was to set it -1 D. That isn't quite enough to get me good computer vision with my left eye. However, the LAL can be adjusted post-surgery. It is easier for them to add power rather than move it. So, I expect the left eye will end up somewhere between -1.25 and -1.5.

Since the left eye was set for -1 D I did not expect 20/20 distance vision even if I hadn't had a vitrectomy 3 months ago. And, with the peel I had done then I am still in the healing stage so my vision has not gotten as good as I hope it will get.

Yesterday after surgery, my left eye was quite blurry the entire afternoon/evening. Everything looked quite hazy and colors were "off" a bit. I could see them but they weren't as vivid as with the right eye. Pre-surgery, my left eye saw everything with a yellow cast due to the cataract. That went away, but still colors were not quite right.

It didn't help that I had to wear UV blocking glasses all the time when awake. Outside they were very dark. Then I had clear pairs for inside. I was given 1 clear pair that had no bifocal in them. Then I was given 2 clear pairs (different brands) that had +1.5 bifocals in them.

I have been told I can also wear the clear or dark power over regular readers or I can put readers over them. It works better to put the readers other. When done the other way the UV glasses tend to easily slip so it is a hassle to deal with.

This morning I could see better and it wasn't nearly as blurry. I went in for my post op appointment. They checked my vision with the clear glasses on and without them. I found that some of the haze was just from the UV glasses. Anyway, I was at 20/40. Given that the target was -1 D I was happy with that.

Pre-vitrectomy I saw 20/60 to 20/70 in my left eye. A month after the macular peel I could see 20/40 which was progress. Then it all started going bad due to the cataract.

Supposedly over the last 2 months my retina has continued to flatten out from the macular pucker and my vision should be improving even though I couldn't see it due to the cataract.

So, the fact I could see 20/40 today was good. The optometrist today said that everything looked good but that I do still have swelling so I should expect improvement.

I go back in 2 weeks to get a check. At that point, we will probably decide when to do an adjustment on my LAL. Normally they wait until vision is stable at 3 to 4 weeks to do an adjustment. I may wait longer. There is a limit to the number of adjustments that can be done so I want to get some more improvement from the peel before I do any adjustment. I tentatively plan to not "lock in" a final adjustment until the end of January (6 months post peel). Of course, some of that is subject to change depending on how things go.

For me, I had 2 primary goals of cataract surgery. Of course, I wanted to get the cataracts removed and to restore vision that was degraded due to the cataracts. But, the nature of modern cataract surgery, is you can sometimes end up with vision better than you started with.

For that, my main goal is to be able to easily use a computer without wearing glasses. I spend probably 8 hours a day on the computer on an average day. I use 3 monitors. I do spend an hour or two reading (usually on my phone or Kindle). The rest of the day is a mixture of intermediate vision (such as in the kitchen) or distance vision (going somewhere, etc). Pre-cataract surgery, I wore glasses in all those situations other than distance. But I used distance vision the least!

If I can eliminate glasses from computer distance then I eliminate most of my glasses time even if I still need glasses for reading. In fact, even if I wanted or needed glasses for night driving, I would still be better off if I didn't need glasses for computer.

So "success" at improving my vision is really binary. That is, if I don't have to wear glasses at the computer, I've materially improved my overall glasses burden. If I have to wear even thin readers at the computer, I haven't. (My surgeon did comment that sometimes a little bit of a miss there can be laser corrected).

Before the left eye was done, I wasn't quite there with the right eye. I could read the computer and use it with no glasses but it was a strain. I didn't want to do it and putting on my +1.25 readers helped.

Now, it is a little different. I am typing this at the computer with only my clear UV lenses on. No readers. I think my left eye is "helping" a little bit so there is a little lens strain. It still isn't totally perfect, but it is a little better.

Of course, the left eye is not yet stable so it may be different in the morning....

Anyway...right now I am cautiously optimistic. I was a little nervous about this surgery since my risk of complications with the left eye was higher (due to the retinal surgery). But, so far, things have been fine...

She is very comfortable with the ophthalmologist, she has been with them for years and they have a good record.

I believe that, due to her extreme astigmatism, multi-focal lens are not an option. I did ask her, she said they mentioned something about that but she cannot remember. From my point of view, this situation has DW very nervous, to where she is still reluctant to review the options documentation they gave her ("I can't deal with this right now").

That is great that they gave her information about options. I understand being nervous about the whole thing. It is very daunting to even think about.

 

[akrono]

I had the Panoptix implant surgery a little over one year ago. I am completely satisfied and delighted with the results. It's like having my 30 year old eyes back again and I have not had to wear any kind of glasses since. I have clear vision at all distances and am so glad to be free of glasses forever. The halo affect has been very minimal and no worse that what I was already experiencing with my developing cataracts. The only thing I have noted is that for reading I need to have good light but. With adequate lighting I can read the back of a pill bottle! It's wonderful

 

[Katsmeow]

I had the Panoptix implant surgery a little over one year ago. I am completely satisfied and delighted with the results.

If I hadn't had prior LASIK surgery I think I would have gone for the PanOptix lens. For me the trade offs would have been worth it. Alas, it wasn't an option for me given my prior surgeries but I definitely would have done it.

And, I will take this to update a bit.

My left eye is really doing well now at 9 days after surgery. My right eye has been very stable although I've noticed in the last week or so that my computer distance vision has gotten better. This is mostly on the right eye. I am actually using the computer without any glasses at all almost all the time, just using the reading glasses for extended reading. I am hoping that I can just get a little more help from the left I will have that great vision at computer distance that I want.

My combined distance vision is fine. If I think about it I can see the difference between the two eyes...but I don't really think about it.

Reading is actually better than I expected it to be. My left eye near vision is not as good as the right. But I am happy that I can read my phone and most papers without any glasses if I have to. I can see my Apple watch easily, etc. I do, however, use the bifocal glasses for extended reading which is fine. If my near vision stays exactly as it is now, I will be very happy with it.

I have a check up appointment on Thursday of this week. I hope that after that they will schedule my first adjustment of the LAL lens, probably a couple of weeks later.

Wearing the UV blocking glasses all the time is sort of a PITA. But, I've gotten used to it. I put a note on the door to garage asking me if I need dark glasses. It is easy to wall out the door with the clear UV blocking glasses on and then have to turn around to go get them. This way I see the note and immediately get them. And, even though it is a bit of a pain to wear them, I've endeavored to be very diligent in wearing them. I even showered with them on (I have a skylight in my shower). And, it is very nice at night to take them off for sleep.

 

[Katsmeow]

Went to post op check up visit on both eyes, 2 weeks on left and 3 on the right.

Not having any problems. Right eye is seeing 20/25 at distance and J1 (20/25) at near and is very good at computer distance. This is the eye with the Vivity lens. The near vision is actually far better than I was expecting from that eye.

The left eye is seeing 20/30 at distance and can be corrected to most of the 20/25 line. This is important to me as pre-vitrectomy and peel of macular pucker I was at 20/60 and 4 weeks after that surgery I was at 20/40. I couldn't see improvement after that because of the cataract deterioration. All of this implies that I have gotten back most of my visual acuity from the peel. I still have some visual distortion (mostly everything slants down to the right) but that is relatively minor.

My biggest goal is to give good uncorrected vision at computer distance. I am almost there. Sometimes I can see see at that distance but sometimes I need reading glasses. They feel some of the fluctuation I see is due to slightly dry eyes so I am now doing some drops to help with that.

I have my first adjustment on my left eye in early December. Two goals for this. First, my left eye does have astigmatism (about -1.25 now) and that will be corrected when they do a light adjustment. The optometrist feels a lot the issues I have in the left will be corrected by that.

Also, they will make me more myopic in that eye to try to give me better computer distance vision. Their "goal" for my left eye lens was for me to be -1 D and then to adjust to about -1.25 or -1.5. Well, I am currently at +.5 D. I guess this is an example of the difficulty of getting accuracy when you have someone with LASIK. However, the beauty of the light adjustable lens is they can adjust. (FWIW, my right eye thankfully came out to match the target which is good since it can't be adjusted).

Anyway -- everything is going well and I am looking forward to that first adjustment.

 

[Turbo29]

Had my first (right) eye done three days ago. Went with a monofocal lens plus laser relaxing limbal incisions for astigmatism. My distance vision seems perfect now, much better than it has ever been. They did a quick eye chart test at my appointment the day after the surgery and said it was 20/30.

I have not yet scheduled my left eye. It is correctable to 20/25 with glasses but the doctor says he thinks it will progress very fast and I will definitely need it within the year. I would schedule it ASAP but I am not sure if it is bad enough for insurance coverage yet. I will ask again at my next appointment.

Because of the way my right eye progressed prior to surgery my current glasses have a very weak lens (-0.5sph/-0.5cyl) with a +2.50 reading addition. I can see through them but as my eye turned out very good they blur my vision The left eye still has a strong prescription at +4.00sph/-1.75cyl with a +2.50 reading addition. I cold tolerate these glasses until I get my left eye done but I am not sure I want to.

I am thinking about ordering a cheap pair of progressives from Zenni now at plano plus a 2.50 reading for the right eye and my current prescription (which is only 3mo old) in the left eye and seeing how that works.

 

[harllee]

I buy my reading glasses from Zenni--each eye has a different prescription. I get them for $8 each and have several pairs all over house and cars. I have had a very good experience with Zenni and I like their frames. In the past they have had surprisingly fast delivery, a couple of weeks, but may take longer now with all the supply issues. Before I found Zenni one time when I was desperate for reading glasses and was waiting to get eye glasses from optician I bought 2 identical pairs at the drugstore but with 2 different strength--one for each eye prescription and somehow popped the lenses out of one and added it to the other so each pair had a different strength and that did me for a while.

 

[Turbo29]

I buy my reading glasses from Zenni--each eye has a different prescription. I get them for $8 each and have several pairs all over house and cars. I have had a very good experience with Zenni and I like their frames. In the past they have had surprisingly fast delivery, a couple of weeks, but may take longer now with all the supply issues. Before I found Zenni one time when I was desperate for reading glasses and was waiting to get eye glasses from optician I bought 2 identical pairs at the drugstore but with 2 different strength--one for each eye prescription and somehow popped the lenses out of one and added it to the other so each pair had a different strength and that did me for a while.

I have a good friend who always loses his glasses. About a month ago he lost a pair of prescription sunglasses and I suggested he order another pair from Zenni. Not only was he very satisfied with the glasses, he was also satisfied that they took less than two weeks to arrive.

 

[Katsmeow]

I have not yet scheduled my left eye. It is correctable to 20/25 with glasses but the doctor says he thinks it will progress very fast and I will definitely need it within the year. I would schedule it ASAP but I am not sure if it is bad enough for insurance coverage yet. I will ask again at my next appointment.

I don't know about insurance before Medicare. However, for Medicare, I was told that what matters is whether there is a visual complaint along with the cataract. There are visual complaints that can be very annoying in the real world, but that do not cause the visual acuity when reading an eye chart to be that bad.

For example, I had a lot of starbursts and halos in my right eye, particularly at night. It was bad enough that before my problems in my left eye (retinal tear, macular pucker, vitrectomy) surfaced, I didn't want to drive at night. I also had some haziness in the right eye and my depth perception was not as good as it had been. That is, I had several visual complaints that had nothing to do with how well I could see an eye chart in the daylight without having to worry about starbursts, halos, haziness or depth perception. Once I had cataract surgery on the right eye, I could see an immediate improvement in these things. And, now I can drive fine at night.

 

[Choosehappy]

Katsmeow, thank you so much for posting your experiences with the LAL lens. I’m scheduled for a left eye (distance) implant on the 16th. I had my surgical consult yesterday and the doc recommended the LAL due to it’s fine tuning capability after surgery. I had planned on the Eyehance, but he’ll do either one, my choice of course. He said that 20% of patient require an additional procedure after surgery. I can attest to this because I had the Symfony implanted in my reading eye back in 2018 and required 2 procedures, one of which was PRK which was not fun. Not sure I want to repeat that.
My concern with the LAL is the color issue (red hues). Did your doctor talk about that at all? At the time I hadn’t researched the LAL so I didn’t know what to ask. The doc did say that he had 3 patients that required explants of the LAL, one was due to not wearing glasses while outside a few times. Thanks.

 

[Katsmeow]

My concern with the LAL is the color issue (red hues). Did your doctor talk about that at all? At the time I hadn’t researched the LAL so I didn’t know what to ask. The doc did say that he had 3 patients that required explants of the LAL, one was due to not wearing glasses while outside a few times.

I just saw this. I have had 2 adjustments of my LAL. The first one was on December 2nd. The second was on December 16th.

To update on this (I will address the color issue below) by early December my left eye was 20/30, reading half the lines on the 20/25 line. I was happy with this. That was before adjustment and indicated I did get improvement from the peel of my macular pucker. My right eye was and is great (Vivity lens). I see 20/20 at distance, can read near although it is a strain and so use light reading glasses. Computer distance is most important to me. Before Adjustments I could see reasonably well but it was a strain at times. I need my left eye to help a bit.

The first adjustment on 12/2 was 2 minutes long (which seemed endless while the adjustment was going on). It didn't hurt at the time but later it did from the suction contact lens they put on my eye for the procedure. That caused my eye to ache and look inflamed for a day or so. Not a big deal. One reason that adjustment took longer was that it also corrected astigmatism.

The first adjustment helped but I still needed to be more myopic. After the first adjustment I was about 20/50 or so in the left eye but could see combined at 20/25. The second adjustment helped a lot. I am typing this on computer not using reading glasses. I really don't have to use them at computer any more at all. I don't know my exact refraction now but they were aiming for -1 in the left eye. This is fairly mild monovision but has been easy to adjust to. My combined distance vision is still great

My retina doctor has recommended I not have my final adjustment until 6 months is up from my vitrectomy which will be end of January. At this point I think I am likely to ask to make it slightly more myopic at the next adjustment. However, that will depend on how my vision is when I go back. I could just stick with what I have.

Choosehappy - I have not had the red tinge to stuff. My understanding is that it happens most often during lock in when they put a lot of UV light into the lens so that it won't change later on. The clinical trial info says that this is temporary is almost all cases.

That said, I seem to have a slight tritan anomaly. Some greens look more blue than green. Some yellow looks more white. This happens especially in dim light. I noticed it a couple of weeks ago and found an online test that identified it. In the clinical trials for the LAL there were some episodes of these although it usually goes away. FWIW, it has gotten milder in the last 2 weeks and I don't notice it except in some very limited situations. With both eyes open together I don't notice it at all. I think it will likely go away completely.

 

[Choosehappy]

Thank you for the update Katsmeow. I ended up having the LAL implant on December 16th in my distance eye and will hopefully have my first adjustment on Friday. Surgery was a breeze and I’m already seeing 20:25. No issues with dryness or flickering. I do have a significant astigmatism which is making white lettering on digital screens a bit fuzzy. Like you, this will be corrected. I agree that the glasses are PIA, but they are much better than having PRK to correct for the astigmatism after surgery. I’m glad things are going well for you.

 

[Katsmeow]

Thank you for the update Katsmeow. I ended up having the LAL implant on December 16th in my distance eye and will hopefully have my first adjustment on Friday. Surgery was a breeze and I’m already seeing 20:25. No issues with dryness or flickering. I do have a significant astigmatism which is making white lettering on digital screens a bit fuzzy. Like you, this will be corrected. I agree that the glasses are PIA, but they are much better than having PRK to correct for the astigmatism after surgery. I’m glad things are going well for you.

Glad things went well for you. You likely had the LAL with ActivShield which will somewhat protect from accidental UV exposure (should still wear the glasses as directed though).

One thing I did not expect with the first adjustment so will warn you just in case. Everything I had read said the adjustments were painless. And, they are. It took awhile to get my eyes dilated enough but none of that was painful.

They put numbing drops in my eye then my surgeon put a contact lens with suction on my eye. This has something to do with helping to visualize the lens when using the light delivery device. This did not hurt (after all, numbing drops).

The 122 seconds for my adjustment seemed forever. The technician held my head to make sure I didn't move. It was all fine though and did not hurt. Then, the surgeon took the lens off my eye. Fine.

About an hour later (I was riding in a car for the 5 hour drive home) that eye starts aching and I look in the mirror and it is very inflamed and red. I was surprised by this but it apparently a known side effect of the contact lens suction. My eye hurt the rest of the evening and was red for 2 or 3 days. Tylenol was fine for the pain (I didn't have any with me though since I hadn't expected any pain so I didn't get the Tylenol until I got home).

The same thing happened to a lesser extent with my 2nd adjustment (only 30 seconds).

Anyway glad it went well for you. Your first adjustment will correct the astigmatism which should help a lot.

 

[Choosehappy]

Glad things went well for you. You likely had the LAL with ActivShield which will somewhat protect from accidental UV exposure (should still wear the glasses as directed though).

One thing I did not expect with the first adjustment so will warn you just in case. Everything I had read said the adjustments were painless. And, they are. It took awhile to get my eyes dilated enough but none of that was painful.

They put numbing drops in my eye then my surgeon put a contact lens with suction on my eye. This has something to do with helping to visualize the lens when using the light delivery device. This did not hurt (after all, numbing drops).

The 122 seconds for my adjustment seemed forever. The technician held my head to make sure I didn't move. It was all fine though and did not hurt. Then, the surgeon took the lens off my eye. Fine.

About an hour later (I was riding in a car for the 5 hour drive home) that eye starts aching and I look in the mirror and it is very inflamed and red. I was surprised by this but it apparently a known side effect of the contact lens suction. My eye hurt the rest of the evening and was red for 2 or 3 days. Tylenol was fine for the pain (I didn't have any with me though since I hadn't expected any pain so I didn't get the Tylenol until I got home).

The same thing happened to a lesser extent with my 2nd adjustment (only 30 seconds).

Anyway glad it went well for you. Your first adjustment will correct the astigmatism which should help a lot.

Thanks again for your updates. I also found a few people sharing their experiences on patient.info. https://patient.info/forums/discuss...ustable-lens-lal--757608?page=1#topic-replies
It’s very helpful (for me anyways) to know what to expect going in to a procedure.

 

[Katsmeow]

Thanks again for your updates. I also found a few people sharing their experiences on patient.info. https://patient.info/forums/discuss...ustable-lens-lal--757608?page=1#topic-replies
It’s very helpful (for me anyways) to know what to expect going in to a procedure.

Yes, I am Very familiar with that page. That is a great page.

 

[Katsmeow]

I had my third adjustment with the LAL (light adjustable lens) the last week of January. Before that adjustment, I was seeing well combined vision at distance (20/25). My left eye by itself was 20/60 and was set at about -1.5 D. My right eye (the one with the Vivity lens) was seeing 20/20 at distance and the same at near (really though that was a bit of a strain, more like 20/25).

My combined computer vision with the 2 eyes are pretty good but still a bit of a strain. So they had my use a trial lens (sort of like a monocle) which I held over my left eye while looking at distance and near. They also let me go to a computer in their office and look at web pages and see if I liked it. This lens would put my left eye at -2 D. (My right eye is plano at distance).

I found that it didn't seem to hurt by distance vision, helped near a lot and helped computer a bit. Most of my issue with computer distance is with the smaller print and also lack of contrast is harder.

Anyway, they did my third and final adjustment (took 60 seconds). I am about 10 days after it and I am pretty happy with it. My distance vision is still very good. Near vision is better than I expected. I can read anything on my phone with no glasses although I definitely need light readers for extended reading. That is fine.

My computer distance vision is good. I haven't used any reading glasses for that for awhile. I do sometimes change to a darker background for web pages that helps with contrast.

I find that my right eye (Vivity eye) sees clearly from 2 feet and out. My left eye (LAL) sees most clearly at 18 inches and a bit closer. I find that if I set my monitor within that 18 in to 24 in distance I see the best.

It has been more than 6 months from my vitrectomy now. It is clear the vitrectomy and macular peel helped a lot to improve my visual acuity. My best corrected vision was about 20/40 before the vitrectomy and is now about 20/25, almost 20/20. I'll take that. I do still have some distorted vision. Slightly wavy lines (not a problem) and lines slant down to the right. That is mostly a problem on near vision in low light. I get some slight ghosting with the combined near vision. But that is OK. It is present a bit at computer distance but really doesn't make it harder so it is OK. I wish I didn't have the distortion but overall it is pretty mild. It is possible it could improve some over time but I am assuming it won't.

I go back to the doctor this Tuesday to have my first "lock in" where they put a lot of UV light in my eye to lock in my current prescription. It is possible I will only need one lock in and 24 hours later I can finally (finally!) remove my UV blocking glasses. After 3 1/2 months I am tired of them. It is possible I will need a 2nd lock in (probably the following week) but I am hopeful I won't. Unfortunately I won't know until I am there. After the lock in the machine tells them if I am done or will need a second session.

 

[Choosehappy]

I’m glad things have worked out well for you. I just want to give you a heads on the lock-in. The light is incredibly bright, a bit unnerving. No pain or issues. I ended up only needing one treatment followed by 2 locks. All Treatments were done in a week and am seeing 20/15 out of that distance eye. I did have erythropsia (red tinted vision) for just under 2 weeks after my initial lock. I was seeing red to pink, especially in low light conditions. It’s wonderful to be seeing clearly during the day and at night without any halos or glare as I do with my right eye (multifocal Technis Symfony IOL). My right eye is my reading eye and I also see 20/30, but I wouldn’t want that lens in my dominant eye. Now the true test is if the locks will hold the shape of the lens for the years to come!

 

[Katsmeow]

I’m glad things have worked out well for you. I just want to give you a heads on the lock-in. The light is incredibly bright, a bit unnerving. No pain or issues. I ended up only needing one treatment followed by 2 locks. All Treatments were done in a week and am seeing 20/15 out of that distance eye. I did have erythropsia (red tinted vision) for just under 2 weeks after my initial lock. I was seeing red to pink, especially in low light conditions. It’s wonderful to be seeing clearly during the day and at night without any halos or glare as I do with my right eye (multifocal Technis Symfony IOL). My right eye is my reading eye and I also see 20/30, but I wouldn’t want that lens in my dominant eye. Now the true test is if the locks will hold the shape of the lens for the years to come!

Thanks so much for the report. That is interesting. I thought the light on adjustment 3 was really bright. My surgeon told me that the light gets brighter with each adjustment. So we'll see how the lock in goes. They did say that since I had 3 adjustments I may only need 1 lock in. I hope so since I've been wearing the UV blocking glasses for so long. I still have a mild tritan anomaly in my left eye (since adjustment 2) that makes green sometimes look blue in low light. I only notice in those situations if I close my right eye so I am not that worried about. I heard about the red tinted stuff with lock in so am prepared for that.

I know what you mean about less glare/halos. I have the Vivity lens in my right eye and the halos with it are not bad (it was much worse before cataract surgery), but nonetheless it is much, much less in the left eye.

Thankfully I have been able to adjust to monovision. I think my left eye is about -2 D while right eye is plano.

And, yes, I sure hope that the changes we get from all this will be permanent.

 

[explanade]

I recently had cataract surgery done. had the first eye done, waited 2 weeks and had the second one done. it has been 4 weeks since the last. just finished the drops in the last eye. the drops i used were a combination of 3 meds in one drop, which was nice not to have to put 3 different drops in. i was very near sighted and did not want to have to wear glasses if possible. i chose to have the premium lenses instead of the monofocal that are covered by ins. extra cost was 2k per eye. best 4k i ever spent. at the suggestion of my MD i had an EDOF (extended depth of focus) lens placed first. name of lens was symfony by J&J. this lens is supposed to have excellent long and intermediate vision but not quite as good near vision. it is supposed to have better clarity and less sensitivity to light. after some research i chose to have a multifocal lens in the other eye rather than the same as the first which the MD was going to do. I chose the synergy lens also by J&J. this lens is supposed to have excellent near vision as well as intermediate and distance. i am happy with these choices. I can read well except for very fine print with the synergy lens and otherwise see very little difference between the two. i have no problems with light sensitivity or driving at night. if you are planning to have this surgery i would recommend doing some research on the available lenses out there. the synergy lens was just approved in the USA this summer but has been used in Europe for a while.

How are you doing with the multifocal and the EDOF lenses now?

Do you still need glasses for distance or reading close up (like phone screens)?


I had cataract surgery in 2017 on my right eye which was changing a lot year to year. They recommended the single-focus distance lenses, saying multifocal lens technology wasn't that reliable then.


I had thought about doing the other eye and possibly re-doing the right eye with multifocal but the pandemic got in the way.

My right eye is fine, though still needs a bit correction for distance. So I use regular glasses, with the left side needing more distance correction.

Great for driving and such and in a pinch I can do fine without glasses.

But I basically have mono vision, which is when they correct for distance in one eye and close focus in the other. So when I look at a phone screen without glasses, the images sometimes diverge.

With glasses, I have to hold my phone at about arm length and then I'm still aware of one side not being as clear as the other side so I just do without glasses.

For computer use, my screen is about arm's length from my eyes so I can use the glasses. But sometimes when I lean forward, often without being aware of it, I tend to take the glasses off, again without being aware.

So I'm considering trying the multifocals or any other type of lens tech.

Also, my opthalmologist did measure my close vision and gave me a prescription but it appeared to be like standard reading glasses?

I've tried those and it doesn't look good at all, since my left eye is fine for close objects.

It's just the convergence problem and having to get weird prescriptions, especially for things like sunglasses.

So has anyone had good recent experiences with multifocals or any other type of lenses which may have come out in the last 2-3 years?

 

[explanade]

I had the Panoptix implant surgery a little over one year ago. I am completely satisfied and delighted with the results. It's like having my 30 year old eyes back again and I have not had to wear any kind of glasses since. I have clear vision at all distances and am so glad to be free of glasses forever. The halo affect has been very minimal and no worse that what I was already experiencing with my developing cataracts. The only thing I have noted is that for reading I need to have good light but. With adequate lighting I can read the back of a pill bottle! It's wonderful

If I hadn't had prior LASIK surgery I think I would have gone for the PanOptix lens. For me the trade offs would have been worth it. Alas, it wasn't an option for me given my prior surgeries but I definitely would have done it.

OK I Googled Panoptix and Vivity after reading your posts.

But I'm not seeing anything specific about these implants not being for people who've had LASIK surgeries?

 

[mn54]

How are you doing with the multifocal and the EDOF lenses now?

Do you still need glasses for distance or reading close up (like phone screens)?


I had cataract surgery in 2017 on my right eye which was changing a lot year to year. They recommended the single-focus distance lenses, saying multifocal lens technology wasn't that reliable then.


I had thought about doing the other eye and possibly re-doing the right eye with multifocal but the pandemic got in the way.

My right eye is fine, though still needs a bit correction for distance. So I use regular glasses, with the left side needing more distance correction.

Great for driving and such and in a pinch I can do fine without glasses.

But I basically have mono vision, which is when they correct for distance in one eye and close focus in the other. So when I look at a phone screen without glasses, the images sometimes diverge.

With glasses, I have to hold my phone at about arm length and then I'm still aware of one side not being as clear as the other side so I just do without glasses.

For computer use, my screen is about arm's length from my eyes so I can use the glasses. But sometimes when I lean forward, often without being aware of it, I tend to take the glasses off, again without being aware.

So I'm considering trying the multifocals or any other type of lens tech.

Also, my opthalmologist did measure my close vision and gave me a prescription but it appeared to be like standard reading glasses?

I've tried those and it doesn't look good at all, since my left eye is fine for close objects.

It's just the convergence problem and having to get weird prescriptions, especially for things like sunglasses.

So has anyone had good recent experiences with multifocals or any other type of lenses which may have come out in the last 2-3 years?

it has been just under 1 year since i had the surgery. i am very happy with the lenses i chose. i can read the newspaper or my phone without any reading glasses. the only time i need those is if the print is very small. my close, intermediate and distance vision is sharp with good contrast. driving at night is not a problem. i have very little dysphotopias. the strength of the EDOF lens is the clarity and less chance for dysphotopias while the MF lens gives me excellent near vision.

 

[explanade]

I recently had cataract surgery done. had the first eye done, waited 2 weeks and had the second one done. it has been 4 weeks since the last. just finished the drops in the last eye. the drops i used were a combination of 3 meds in one drop, which was nice not to have to put 3 different drops in. i was very near sighted and did not want to have to wear glasses if possible. i chose to have the premium lenses instead of the monofocal that are covered by ins. extra cost was 2k per eye. best 4k i ever spent. at the suggestion of my MD i had an EDOF (extended depth of focus) lens placed first. name of lens was symfony by J&J. this lens is supposed to have excellent long and intermediate vision but not quite as good near vision. it is supposed to have better clarity and less sensitivity to light. after some research i chose to have a multifocal lens in the other eye rather than the same as the first which the MD was going to do. I chose the synergy lens also by J&J. this lens is supposed to have excellent near vision as well as intermediate and distance. i am happy with these choices. I can read well except for very fine print with the synergy lens and otherwise see very little difference between the two. i have no problems with light sensitivity or driving at night. if you are planning to have this surgery i would recommend doing some research on the available lenses out there. the synergy lens was just approved in the USA this summer but has been used in Europe for a while.

it has been just under 1 year since i had the surgery. i am very happy with the lenses i chose. i can read the newspaper or my phone without any reading glasses. the only time i need those is if the print is very small. my close, intermediate and distance vision is sharp with good contrast. driving at night is not a problem. i have very little dysphotopias. the strength of the EDOF lens is the clarity and less chance for dysphotopias while the MF lens gives me excellent near vision.

Good to hear it's working out for you.

Do you think you'd have had as good results if you did MF in both eyes?

Is the image from the non MF eye blurred compared to the eye with the MF?


Did you have issues with dry eyes?