Avatar universal

Light Adjustable Lens Experience

I had started to discuss my experience with the Light Adjustable Lens in http://www.medhelp.org/posts/Eye-Care/adaptive-IOLs-outside-the-US/show/2076228 but found it was closed today.  I've just had my second adjustment and wanted to give the many interested folks in the community an update on my experience.

I had the second adjustment yesterday afternoon.  As with the first adjustment the appointment began with the optician working with me to look at where I was with my visual acuity and also getting an update on my intraocular pressures.  After being dilated and waiting an hour or so, I went in with the ophthalmologist and had the UV irradiation.  As before, they used topical anesthetic, a contact lens and eyepiece were applied, and the UV light turned on.  This time I didn't find the experience as uncomfortable.  It may be she used less irradiation this time or perhaps I still had part of the lingering washed out vision from the first adjustment still present.  After, I was essentially unable to see out of the treated eye because of a large, intense red/pink distorted area covering most of my visual field.  As the afternoon and evening went on it faded only slightly but I did seem to be able to have more sharpness with some distant objects than before, again, very hard to tell.

This morning still a lot of redness and pink hues especially noticeable when looking at white objects.Green LED lights look white.  But my acuity is returning and I feel that there was definitely an improvement with the second treatment.  The plan is for me to return in a few days for the first lock in and then the second lock in a couple days after that.  It is hard to really know just how well the lens is working at this point as I haven't recovered from the UV irradiation and I'm wearing the dark UV blocking glasses.  But I'm feeling optimistic that my intermediate vision is much better and reading vision also significantly better than my untreated presbyopic eye.  

Unless they close this forum or the moderators delete this post I'll put a couple follow ups on and some observations as I get the lock ins done.

This discussion is related to adaptive IOLs outside the US.
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177275 tn?1511755244
These are Dr. John Doane's answers:

Thank you so much for your answers.   I do appreciate it.
psbpsbpsb  was a person who posted on this site earlier his experience with the lal lens implant.  That is the person who reported having very red vision following lock in procedures and the green washed out look.  He also mentioned that over several months the color perception issue resolved itself.  
JFD:  I answered yesterday on the red vision or erythropsia.  It is not a long term issue but is noticed immediately after adjustment and lock-in but not after a few weeks at most.  One can also experience this without the LAL. Specifically, if a case goes long enough light exposure on the retina will lead to same symptom that may last several days to a week or so.  It does resolve.

One final question, if this lens were FDA approved would you be utilizing this frequently at your clinic?  

JFD:  Absolutely, it would be first line lens for anyone that wanted to have the best unaided vision.  It is the best option ever designed for this desired endpoint.  It will be magical for anyone that has had prior corneal refractive surgery.

I guess my biggest concern would be with getting an IOL is creating a bigger dry eye problem than I have now, which I would consider to be somewhere between mild and moderate.

JFD:  Having cataract surgery should not affect this issue positively or negatively if standard small incision surgery is completed.



46 minutes
I have been to Durrie Vision in Kansas City and they had recommended I get an IOL for my RK and most likely have PRK on top of that. I just feel like the LAL would save me from having the PRK.  I do understand my case is tougher than a virgin cornea, but I am hoping that having 6 incisions in each eye that my case isn't extremely difficult to fit the LAL IOL between the RK incisions.

JFD: I also practice in Kansas City.  Even if I didn’t surgeons are analogous to Chef’s – each has his own recipe.  If LAL were available now there would be no question I would recommend LAL for you.  It could take care of astigmatism up to 2 Diopters and any residual refractive error.   I personally avoid laser vision correction on prior RK as it tends to not be stable long term.  Simply not a great foundation for more corneal surgery.  In the face of RK  you may continue to get effects of the RK even after 20 years so your foundation even with LAL may still not be static.  That being said I still believe LAL is the best option for someone in your situation. Again, I expect LAL to be available in the US in the 2nd half of 2017.
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Any form of prior corneal surgery would be ideal for LAL, ie RK, LASIK, RK, PKP as long as the residual error after surgery is 2 D less of cylinder, myopia, hyperopia.  It is possible with further iterations that the treatment amount may go up.  This would be especially helpful with astigmatism.  

My first LAL cases after commercialization will likely be these folks that are very hard to predict outcome.  LAL will make it a cake walk.
I like the sound of that !  I am patiently waiting for it to be approved in the US   I really dont want to travel to Tiajuana for this type of surgery.  Have you performed a lot of traditional cataract surgery on many RK people?  Is it quite a bit more difficult than a virgin cornea as far as the procedure itself goes.?  I have 6 incisions in each eye.    
177275 tn?1511755244
JFD is our Discover Vision Centers internationally known cornea/cataract/refractive surgeon. He answers your questions below

Well I do not have any irregular astigmatism.  I am wearing readers for near and far vision.  1.75 left eye, 2.0 for the right eye.   Did any of the patients in your clinical trial experience color perception issues that did not resolve over time?

JFD:  no.  There is some concern with “ red vision “ or erythropsia but if present this was transient.  An issue to be concerned about for sure but in practice was a non-issue.  We see this with regular lenses especially if a case goes long.  Always is a transient phenomenon.
  Are they happy they had the LAL implant?
JFD:  Universally yes.
Would you say that cataract surgery causes less dry eye symptoms than Lasik?
JFD:  Yes.  Anytime one undergoes surgery anywhere on the body and traumatizes a nerve which is anytime someone has surgery there can be symptoms. One of the these is neuralgia which can be experienced by patients after lasik or cataract surgery.  Tends to be transient in nature as well.

Sorry for all the questions, but these are considerations I need to take into account.  Most importantly, do the trial clinics use the latest "version" of the LAL lens.

JFD:  The FDA trial is complete.  No cases being done in the US.  If a case is done outside the US it is the latest technology in all likelihood.  Calhoun only wants the latest most advanced surgery to be performed.
  In other words, as Calhoun Vision tweaks the lens for various reasons is that what gets dispensed to the surgeon for use?    

JFD:  Yes.
For example  psbpsbpsb stated that the color red was very pronounced after adjustments and lock in procedures, also that the color green looks washed out.  Is Calhoun working on lessening those affects and if so are those generation of lenses being sent to the Drs. in the approved countries and to the clinical physicians?

JFD:  Not sure what psb is?  PBS??  What you cite in first sentence is transient.  Even within the study we modified the optics to minimize the erythropsia.  I never had a complaint nor heard of a single patient from the other centers having a green desaturation.  Not saying it didn’t happen in US or OUS but I have never heard this mentioned in any setting ie investigator conversation or meeting.

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Thank you so much for your answers.   I do appreciate it.
 psbpsbpsb  was a person who posted on this site earlier his experience with the lal lens implant.  That is the person who reported having very red vision following lock in procedures and the green washed out look.  He also mentioned that over several months the color perception issue resolved itself.   One final question, if this lens were FDA approved would you be utitlizing this frequently at your clinic?  I guess my biggest concern would be with getting an IOL is creating a bigger dry eye problem than I have now, which I would consider to be somewhere between mild and moderate.
I have been to Durrie Vision in Kansas City and they had recommended I get an IOL for my RK and most likely have PRK on top of that. I just feel like the LAL would save me from having the PRK.  I do understand my case is tougher than a virgin cornea, but I am hoping that having 6 incisions in each eye that my case isn't extremely difficult to fit the LAL IOL between the RK incisions.
177275 tn?1511755244
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177275 tn?1511755244
This is from the surgeon in our Discover Vision Centers that did the experimental work on LAL in the USA:  "LAL is ideal for prior corneal refractive surgery including RK, minus the irregular astigmatism.  LAL at present is not treating irregular astigmatism but may have an opportunity at some point but not in the short term.  LAL hopefully will be available in the US in late 2017 or early 2018."  
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Well I do not have any irregular astigmatism.  I am wearing readers for near and far vision.  1.75 left eye, 2.0 for the right eye.   Did any of the patients in your clinical trial experience color perception issues that did not resolve over time?   Are they happy they had the LAL implant? Would you say that cataract surgery causes less dry eye symptoms than Lasik?
Sorry for all the questions, but these are considerations I need to take into account.  Most importantly, do the trial clinics use the latest "version" of the LAL lens.   In other words, as Calhoun Vision tweaks the lens for various reasons is that what gets dispensed to the surgeon for use?    For example  psbpsbpsb stated that the color red was very pronounced after adjustments and lock in procedures, also that the color green looks washed out.  Is Calhoun working on lessening those affects and if so are those generation of lenses being sent to the Drs. in the approved countries and to the clinical physicians?  
Avatar universal
Hi, how close to planar are you in the LAL eye?

The most compelling reason to go for a LAL in my opinion is because of a better optical outcome - a result closer to planar than normally obtained using conventional monofocal IOLs - which do get pretty close anyway without the  additional problems you encountered.

Out of interest would you have another LAL or would you prefer a monofocal lens for the next eye?
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Please comment as to the state of your eyes now.   I am seriously interested in this surgery, and have read and re read every paragraph of your detailed experience.   Thank you so much for posting your thoughts about the lens, it really is beneficial to those out there considering this innovative lens.  
Our practice has done some of the FDA investigation research in the USA and our patients are very happy with the LAL.  This includes the mother of one of our ophthalmologists.
Well that is certainly great to hear, do you know if any of them have color perception issues?  I had RK 22 years ago, 6 incisions in each eye.  I have had no procedures since, but my right eye has deteriorated and I am more than ready to have good vision again.  I am nearly 52 years old.  I realize I would have to go to Tiajuana to have the procedure, due to the slow FDA.  Do you have any information as to when the FDA might approve it for use in our country?
  I figure it is better to have cataract surgerk with the LAL lens and hopefully have a lasik like outcome, than to have traditional cataract surgery in the US with the surgeon estimating the correct lens and then most likely having PRK over the top to correct residual error.  
By the way, my original prescription before having RK was -2.25 and -1.75  What are your thoughts Dr. Hagan?  
The RK is a wild card and puts you into a high risk category for any kind of IOL except a standard monofocal aspheric.  The research protocol for LAL did not allow for any RK patients and I don't think most surgeons would feel  you were a good candidate.  I will forward this to the surgeon that did the research in our group to see if he has comments.
Thank you for asking others for opinion, I had read where a surgeon in Spain had implanted the LAL in a RK patient with success.  http://www.calhounvision.com/articles/article_29.pdf      I do not know if Dr. Chayet in Tiajuana has implanted any or not in a RK person.  I really do not want to have standard cataract surgery with probable PRK on top of that.   That would be two surgeries, where I could get by with just one with the LAL, I realize I may have to wear the UV glasses longer, to allow my eye to settle down after surgery.  Prior to any lock in treatments.  But, that seems a small price to pay for not having to endure two surgeries
Avatar universal
Oops, one more comment.  After lasik many years ago I remember having problems with dry eye for a year or two after.  I notice that I continue to have intermittent problems with this since having my surgery last year and hope it will get better over time as it did with lasik.  I think my eyes are just very sensitive to being cut on.  I also do get annoying floaters from time to time but I think they are getting less over time too.  Crossing my fingers.
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Try taking a lot of different krill oil, flax oil, or fish oil pills.  Name brand isn't real important, just a couple of different kinds to help lubricate your eyes from the inside out.   I get a few different ones from Amazon.com and it seems to help me out.  
Avatar universal
Well here we are in 2015 so I thought I'd give a long term follow up.  First the color vision issue.  It has taken months and months for gradual improvement of the blue/green issue in the treated eye.  I'm pretty sure the UV caused damage that has just taken a while to heal but there is also some color effect in my untreated eye from the cataract there which gives things a slight hue that I was unaware of until getting the lens replaced with the LAL.  So for example, , when I look at the 'post a comment' button on my computer screen with the LAL eye the color is not so much green, more of a very pale blue unless I get very close to the image.  The closer I am and the brighter the green, the less difficulty I have seeing the color.

Overall I'm pretty happy with the results, I have a sort of mini monovision with good overlap with the treated and untreated eye, particularly of intermediate vision.  I don't normally wear glasses unless I'll be driving or going to the movies and this is significant because I'd been wearing progressive lens glasses over the last ten years.  I still am getting used to the mini monovision even some months later but mostly I'm not aware of the discrepancy in focus between eyes and go about my business without problems.  While I'm sure the results were as good as could have been possible I do have a slight bit of astigmatism on the treated side, correctable with glasses, that I wish would not have been there.  

Another comment - there is an odd kind of focus I get from the LAL eye that seems to be related to depth of focus and is different from the normal accomodation I had before.  If I look at a distant set of letters it can come into focus and it seems different than how I'd focus on things in the distance before (my LAL is set for near/intermediate).  I think this helps make the monovision work better that it otherwise would become there is some sort of pseudoaccomodation at work.

Will I get an LAL for the right eye when the time comes?  Well, first I'm in absolutely no rush to do so and will put it off until it is clear my vision is suffering.  At 53 my hope is that additional options and experiences with the LAL will occur that will help guide my treatment.  I definitely will try to get the treatment done in an English speaking clinic as working with the clinic in Berlin had some difficulty due to language and because my needs were different as a foreign patient.  I liked the clinic where I had it done and would recommend it but be aware of the logistical difficulties.  Hopes this helps.
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Avatar universal
So did you go to the Dr and confirmed that the lens was reshaped after lock-in? Bottom line: If you would decide once more,  would you do with normal lens or the light adjustable one?  
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Avatar universal
The good new is: I have no problems at all now (11/13/2014) with my color vision. I don't know at what point all pinkness was gone, but it was quite awhile ago.

The bad news is: The vision in my one treated eye has seemed to change abruptly. It seemed to shift about .5 diopters in a nearsighted direction during a 1-week beach vacation. (I could give a few more details, but the  bottom line: my strong suspicion is the bright sunlight has reshaped the lens - which was not supposed to be possible, given that the lens was 'locked-in' as the final procedure.)

This theory of mine is unconfirmed, but as I say, it seems the likely reason from what I understand about the lens. (Not good). I am trying to contact the Dr. to attempt a correction and re-lock-in to verify and fix (or not) but have not heard back yet. Will attempt to keep you posted.

Also of some note: I have read absolutely zero reports of this on the web. However, I have met a second patient who is having similar problems with both eyes implanted with the lens. So in real life I only have knowledge of 3 eyes, and they all appear to be unstable after lock-in.

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Ken if this comes to you I'd be interested in an update. My wife had both eyes done in 2011 and has never received the major benefits this approach purports to give ?In particular she wears glasses and the vision in her distance eye has worsened such that she sees better long-distance with her  with her near sighted eye which has also become her dominant eye !!
Avatar universal
I just saw the forums and very impressed with your detailed updates.  
I was wondering about the outcome of your color vision of the LAL eye now.
Has it recovered to almost 100%?   And what is your score of it?
Can you give us more updates?

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Avatar universal
Long version Part III

Saturday AM 5/24

I had the usual tests again, examinations and a final lock-in. This one took about 30-45 seconds of UV light.

I had a few final questions for Dr. Chayet. How long till I can exercise?

    - 1 month  from surgery  to jog (Though I could use a stationary bike now)
    - 2 months from surgery to lift weights.

We discuss experimenting with mini-monovision in anticipation of correction of the second eye at a later time, and Dr Chayet gives me some samples of contact lenses to try, with a prescription to purchase more. If I can tell that works for me, I would be more likely to try something like this with the second eye when that time comes.

My vision was very reddish in the right eye for several days. Even green traffic lights appeared as a reddish amber.

One slight unexpected effect: When I removed the goggles, I had a slight cross-eyed feeling, or something like seeing underwater. With reading glasses or sunglasses I don't notice it much, but when they come off it is very noticeable, especially for a minute or two. It seems to interfere with depth perception. I've tried to analyze it; at first I thought maybe it was just that my left eye had been better and I had been giving it priority, and now my brain was having trouble making sense of the reverse situation: After all, the difference in vision was greater between the eyes now than before, and in the opposite direction.

Later I thought maybe the lens is sitting in a slightly different position in my eye, so that the image is shifted on the retina slightly from what I am used to.

But I now think what it is most likely is, is that the image in the right eye is a little larger than the image in the left. For example, it seems that cars in the distance are 'shorter' with my left eye than my right. This is not something I have discussed with the doctor. It is a little annoying, but even if it does not go away, my overall vision is much improved and more useful - i.e., this is a second order effect/defect. I also notice that, with not needing to strain to see something, the left eye is also staying relaxed and unfocused most of the time; this may make the left/right difference even greater. I feel like I have something in my left eye now as though I need to rub it out.

I hope that the image size is the overall reason for the temporary cross-eyed feeling, and for the feeling of not great depth perception (like if the sidewalk is a little raised it is hard to notice, and I believe I have scuffed  these with my shoes more than would normal). If that is true, then I would expect it to go away when the second eye is done later.

What else: 1 week later,  I do not really notice a pink shift in the daytime unless I 'test' for it, but in the mornings especially I still interpret my clock radio green LEDs an digits as red.

6/19 2014
There has been no noticeable reddish/pinkish shift for some time; I didn't notice when that stopped, but probably a week or more ago.

I have noticed in this time that I can place a 1 diopter lens only over the left eye, and the cross-eyed feeling and depth perception problem seems lessened significantly. (for now, I tried popping out the right lens in a dollar store pair of reading glasses and wearing them sometimes). (This does not improve the vision in the left eye; but it somehow seems to make it 'match' the right eye better.) I have not tried with a contact lens in the left eye yet.

I suspect my vision may be sharper at distance again; I plan to visit an optometrist soon to find out. My close vision has I think moved out a little. The computer screen seems sharp at about 4.5 feet (I can read this Times New Roman 10 point font at that distance (24 inch 1920x1200 display), though just barely, as it is small at that distance)


Late notes: I see some excellent recent posts from psbpsbpsb in these forums from this year I had not noticed before. The only comments I would make are where we had some different experiences or concerns:

For me, the scheduling was not too difficult, given that Codet gives a 'canned' schedule out for consultations, surgerys, and post-op exams and you can schedule these for consecutive days to make that fit into one Airflight. After two weeks you must be there Monday through Saturday to allow for adjustments, so that can be fit into a second trip.

Codet issued me two pairs of goggles (LAL "Coolview" Post Op Spectacle"), one that was clear (to visible light; 100% opaque to UV of course) to wear indoors. The dark ones looked cool, but the clear ones looked a little goofy, and I endured some light teasing over them. :)

I did not wear the googles while sleeping or in the shower, but did at all other times. I kept my right (operating) eye closed while in the shower, so no problems here.

I had no pain or itching, except for a significant soreness if I grazed my eye while soaping up in the showers.

Sorry for filling up the forum! But I hope it is as useful for someone as previous posts were to me!.
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Avatar universal
Long version Part II

Here's how that went:

CONSULTATION Saturday 5/3/2014 at 9:30 AM
After some measurements and examinations by others, Dr. Chayet examined and consulted with me.
He was very pleasant and patient and I felt much more at ease following our discussion.
We discussed dominant eyes, possible options of increasing the asphericity to increase depth of field.
After locking in the lens, would my eye stay stable? I asked.
Dr. Chayet said he had examined patients who had the lens implanted 4-5 years ago, and he had found typically there was a .25 diopter shift (always in the same direction); now he takes that into account and locks the lens in .25 diopters in the opposite direction, so that vision should get a little better, rather than worse, over time.
Could I have this lens explanted (removed) if a higher-tech option was available in the future?
No, probably not, it will be so tightly attached at that point, removal probably would not be an option.
How soon would I likely need some treatment for POC (Posterior Capsular Opacification.)
From his experience, this lens has a 15% POC rate per 5 years.
Crisp answers, no waffling. Very likable doctor.
Surgery was set up for Monday morning.

SURGERY Monday 5/5/2014 at 7:30 AM
Payment (credit card in my case) was made prior to surgery  (denied by Visa at first, requiring some phone calls)

I leave all my belongings in an office (which is just my backpack - as I'm walking to and from here from my hotel just across the U.S. Mexico border). I'm led to a room to remove all my clothes except briefs and socks. I put on a hospital gown and am led to the waiting/prep room for surgery.
(Folks in this area of Codet don't speak much English, and I speak no Spanish, but we get by. They all seem to be sweet people.)

A pill goes under my tongue, an IV gets started. Shortly I am led into the surgery room where I lay down.
The anesthesiologist places some plastic tubing around my neck so two tubes slightly enter my nostrils to give me oxygen(?).
("keep your eyes open, don't talk, don't move" they said)
My right eye is propped open, and the rest of my face is draped. I am awake and reasonably alert. I try to watch what is going on inside my eye.
But I only see two bright objects near the center of my field of view that don't seem to move. I had expected to see some movement of instruments inside my eye, but didn't. (or at least, I don't recall it).

Maybe 10 minute pass? The doctor says everything looks good, and they wheel me back out to the prep room.
Soon I am ok to be transferred back to an easy chair. Then I get some juice. Shortly I am myself again (maybe a little slower and not so coordinated), and I am led back to the closet where I change back into my street clothes. I have a hard plastic eye patch taped to my face; it is to remain on for 3 hours, when it is time for eye drops again. At that point I am to switch to a pair of UV-blocking goggles. (which must be worn until final lock-in 2 weeks later, except for sleeping and showering).

They say eat something, take it easy, don't put your head down, don't do anything strenuous.
I am free to go when I have something to eat and feel ok. I stop in the cafe across the hall and take care of that and then start walking back to my hotel across the border  to come back the next day for a post-op check. I need to put drops in every 3 hours and with the typical wait at the Mexico-US border, I'm a little concerned I will still be in bright daylight beyond that time and unable to remove the goggles to do that. Codet personnel arrange a ride across the border for me.

Already, I can see my distance vision is very sharp. It must be at least 20/20. Black is black instead of gray; I have nice contrast again in my right eye. Now I feel I could drive safely... and am amazed how bad my left eye is (which was the better of the 2 eyes just that morning). There is no fog anymore. Bright lights at an angle don't obliterate my vision as it did before. No multiple images.

However, my close vision is not so good. It is worse than before, and worse than my left eye.

POST-OP Tuesday 5/6/2014 at 9:00 AM

Again I am examined, and the doctor says it all looks good, the lens is centered, etc. I get some more eye drops and am free to go, to return 2 weeks later..

I am back for Monday - Saturday adjustments. (The plan was for an adjustment Monday, Wednesday, Thursday, and final lock-in Saturday)

I feel my distance vision is not quite as sharp at distance as it was earlier. However, I may be able to focus fairly well from distance to arms length, where immediately after surgery it seemed I could tell I was losing sharpness at about 6-7 feet. But this is all pretty subtle stuff and hard to measure given differing variables of brightness, text size and so on.

Monday AM 5/19

After the usual eye tests,( visual acuity, pressure, and so on) Dr Chayet examined me and discussed the results. The lens seemed centered; everything looked good. He said normally the adjustments were a roller coaster with overcorrection first in one direction, and then in the other until final lock-in. That last lock-in also will shift the lens .25 diopters (in the 'nearsighted' direction), which is what he wanted, so he normally planned to be at 'perfect' before the last Saturday final lock-in. For some reason, I was already close to that and he said I had left him a 'narrow window'. He told me I had a small astigmatism which surprised me. He said that was not uncommon following cataract surgery (as though it might be a result of surgery), but with the LAL, it wasn't a problem since it would be 'adjusted out'. My eyes were dilated, and I believe some desensitizing drops were used. Then I sat down at the LAL machine.

Due to the ultraviolet light intensity, they covered my non-operating eye with a patch, and I was to keep the other eye shut as much as possible to keep a good dilation - so I didn't observe much. Dr. Chayet manually placed and held an object (perhaps a glass lens?) directly and firmly against my eye which was very "uncomfortable" to say the least. I tried to avoid a blink reflex for what was maybe 45-60 seconds of treatment. Initially as I sat down there had been 8 golden light sources places around the perimeter of my view (I'm guessing for the machine to use for alignment of some sort?).  They remained on for the duration.

When the procedure actually began, a very bright light appeared between those golden light sources, and with that and the object being firmly pressed onto my eye it was a challenge to hold still. An assistant actually applied some pressure to the back of my head so I would stay forward and pressed into the head fixture of the machine during this time. Then it was over, and the object was removed from contact with my eye. My eye felt more than a little abused. I was free to go immediately (wearing my protective goggles again, of course).

I don't recall noticing much difference in the 'color' perception of my right eye in the bright monday light; only a small pink shift.

Wednesday AM 5/21

After the usual tests and examinations by others, Dr Chayet tested my acuity as better than 20/20 (perhaps 20/16?), which is where he planned to be, but he planned to be there 'later'. He consulted 'with the machine' and decided we would go ahead and do a first lock-in today, and then have a final one on Saturday. (i.e. no need for a Thursday treatment). We repeat the earlier procedure, but this time the light seemed more intense. The 8 golden lights appeared cherry red afterwards when viewed with the right eye.

My right eye vision was noticeably darker and redder than the left. Nighttime was especially dramatic. Light sources like headlights on cars were deep red, the sky is deep red, and so on, as though a red filter was placed over my eye.
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Avatar universal
Short version: I have had cataract surgery at the Codet Vision Institute in Tijuana, Mexico, where I had a  Calhoun Light Adjustable Lens implanted into my right eye.

I will need to  break this post into 3 pieces to fit within the character limits. Hope they stay together.

Long version Part I:
I'm a 56 year old male with cataracts. I've not worn glasses except for reading glasses (about +1.5 diopters), however I have had a prescription for corrective lenses since approximately age 48, (I didn't wear these glasses, as I couldn't tell a net benefit except for the lower reading portion.) In the prescription my right and left eye have from - 0.25 to - 0.50 Spherical and Cylindrical correction.

I work as an engineer, with lots of time on the computer, dealing with reading material and occasional close-up inspections and probing of live circuits.

It was about 10 years ago that I started having presbyopia and began dealing with multiple pairs of (different powers of) reading glasses for differing purposes. Then about 4-5 years ago, I started getting cataracts.

My symptoms of that were a feeling of looking through fog, or through a dirty windshield. The brighter the day, the thicker the fog. In addition to that, I had multiple, slightly misaligned images in each eye. The two main images in each were not very far apart angularly, but enough that it was hard to discern, say, "1' from "11". Reading glasses corrected this for close distances. Both eyes seemed to have very similar symptoms, but were slightly different; and the right eye had notably more fog.

Driving became difficult, especially in areas I was unfamiliar with, and especially at night. By the time I could read the signs, it was too late to make use of the information. I believe I instinctively found some workarounds - like finding a way to get some accommodation, with effort,  for short periods, or learning to use my hands or arms to shade my eyes from the direct sun when needed.  But on occasion I couldn't do that. On a motorcycle I turned into the low sun in the evening and both hands were busy; I felt basically blind in the right eye, and nearly blind in the left.

Oddly, when tested by an optometrist, they always test me in a dark room that minimize the symptoms. And as mentioned above, I seemed to  learn to do something that tended to focus the images somewhat, with significant effort (possibly I still had some accommodation? - however, I could not tell that the pupils got smaller when doing this). The results are they would tell me,with both eyes together, I had 20/20 vision.

I have been looking the last few years at options. I was hoping for an accommodating lens to be proven to work, and to be approved in the U.S. where I live. The Synchrony lens seemed to be the most promising option, but it doesn't appear that it has actually lived up to expectations.  (see previous posts from Anomalychick including Mar 17, 2013 for some details about that - apparently there was non-accommodation in perhaps 30% of the cases - (she went with the Synchrony lens regardless, and as I recall, there was some other issue with her results.)

The MultiFocal lenses had too many drawbacks for me (mainly issues with night driving 'artifacts'). However, there was a trifocal called FineVision that had some appeal available outside the US.

However, I decided to go with the Light-Adjustable Lens even though there is no accommodation at all with this fixed-focus lens. (see a previous (and later) post from brzez on Apr 02, 2013 for some details on this lens; as he went with the light adjustable lens (LAL) from Calhoun Vision). The benefit here is that the lens is adjusted AFTER the lens has been implanted and some healing of the eye has occurred. This makes it highly likely that you will not need glasses (or Lasik as a corrective second procedure), for at least at the distance you select (in my case, far distance). There are other interesting things that can also be done with the LAL, but I didn't entertain these, though I might do so with the 2nd eye in the future. My intent was to do one eye only at the current time.

The closest/least expensive option for me was to travel from my home in Virginia (U.S.) to Tijuana, Mexico to the Codet Vision Institute for surgery by Dr. Arturo Chayet. The process to get the lens is expensive ($3900/eye) and a bit troublesome (for those not living near the surgeon, they have things organized so that you can do it in two trips; 3 days minimum are required to get a consultation, surgery, and post-op check, and a full Monday-Saturday is required after a 2-week healing period for adjustments), but the potential advantages in accuracy following eye-healing made the trouble worth it to me.
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This may be my last post on this topic.  I'm now several months out from the procedure.  My color vision in the blue/green spectrum is close to normal although it continues to recover and is not 100%.  I went in for refraction while I was on a trip to the US to get some driving glasses last week.  The LAL eye is about 20/50 distance and pretty good for reading without glasses.  My prescription is -100 = -50 x 180 with +175 add.  Since my non operated on eye is plano, I'm able to get around without glasses.  

When the time does come for the other eye I'll probably elect to get an LAL again.  The question for me will be, would that eye be a candidate for a multifocal IOL and will there be good templates for the LAL to be set multifocal for that eye?  It is a very cool technology and you can see how they could use this to tremendous advantage for multifocals.
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20/50 is a bit on a low side? Do I understand correctly your target correction was for intermediate (computer work)?
Is this the reason your distance is not so great (uncorrected)?
If you wear distance glasses - what your corrected acuity is? Surely much closer to 20/20?
Avatar universal
Thanks kindly.  My hope is I continue on this trend and my postings will come to an end. :-)

I definitely would consider the LAL for the right eye when that time comes, but I'll also probably want to hold out as long as I can because of how complicated it was to get this done and the long process.  The country in Europe I'm residing does not have this available and while it is only an hour flight to Berlin, that still is a pretty big hassle.  I'll be flying out next week for a checkup.

I took a color test to see just how bad my vision had been impacted by the UV.  I set up a blog with the results and here it is  www.lightadjustablelens.blogspot.com/

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Great update.  Keep 'em coming!
I don't know when you'll need the other (right) eye done, but is the LAL still in consideration?
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Great to hear the update and that you are continuing to do well with the LAL.  

It's really a surprise how long the altered color and contrast perception persists.  Although I've only read a little about the LAL procedure, your posts are the first I've heard about it.  It's very good that your color perception is continuing to improve; hopefully the trend will continue!

Thank you again so much for the informative posts and the work you have put in so we can all understand the LAL process from the patient's perspective.  It is greatly appreciated!
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An update.  So color vision has slowly improved.  Traffic lights now look green instead of white.  Looking at trees and vegetation still looks white and washed out and I do have some differentiation issues between certain shades of blue and green.  I'm still not using glasses and think I can get around pretty well without them.  I used a distant eye chart and think I'm about 20/30 with optimal conditions on the LAL side.  Reading is probably around a J4-5 again with optimal conditions.  Contrast and lighting play a big part in how well I'm able to see.  Improvement has been a gradual process and I believe there is a neuroadaptation that must take place.  The way I focus on objects on the LAL side is different than how I focus on the unoperated on eye.  There is a bit of 'latency' when I focus on the left, as though my brain somehow has to figure out what I'm trying to focus on.  My guess is that this is a part of the increased depth of focus and aspheric quality to my visual system.  On a good day with sunlight and in the morning, sitting outside with my wife having a coffee, I'm absolutely delighted with how well I can see.  I'm also really happy to be able to do my work on the computer without much problem.  Driving - all depends on lighting conditions.  I don't think I'd be comfortable driving at night, at least not yet.  I may end up getting some driving glasses for optimal vision particularly at night.  Another issue - I was a Lasik patient many years ago and I think I have issues with dry eye, apparently this gets better as the cornea heals for some weeks after cataract surgery.  It isn't a huge problem but dry eyes and eyelid inflammation really make a dramatic difference in the quality of my vision.  So I'm still not at my final endpoint yet, the healing process and adjustment process with this lens takes some time.  Overall the trend has been consistent improvement.
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I did have astigmatism addressed with the lens adjustment.  The ophthalmologist told me she left a 'little bit' intact as it would be of some optic benefit.  I've found using cheap over the counter reading glasses from the drug store helpful for very fine print close up without any distortion of the image, in the past I found that due to the astigmatism in the eye those weren't as beneficial as now.  I drove yesterday in bright light conditions without glasses and without problem.  I'm typing this on my computer without eyeglasses.  Every day I feel as though I'm doing better with this lens, there is definitely an adjustment period. Still with major green/blue discrimination problems but some of the other color issues seem better with improvement in the pink/red tinge issue.
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Great stuff!
Did you have any astigmatism pre-op?  If so, how did they deal with it?
Thanks again for all the updates.
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I'm only a week out from the last lock in and I expect the UV exposure side effects to reduce and resolve over time.  How long that will take I don't know but I wanted folks to know this happens so they aren't as surprised as I was.  I'm looking forward to being able to see green leaves again especially with spring right around the corner.

My healthy right eye has good vision and minimal presbyopia so my results are going to be very influenced by that.  It has never been operated on.

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Thank you so much once again for the thoughtful and detailed update.  It does sound as though you are getting multi-focal vision at various distances already.  Some folks who pay for premium lenses are never free of reading glasses and the fact that you do not need your progressives is a great sign.

It's very interesting to read that the color impairment and contrast decrease aspects of the UV exposure are not fully documented and explained as a side effect.  Depending on one's profession these defects in vision could be quite problematic, even if temporary.  I can't believe you are the first patient to notice these issues, although you are probably more articulate than most patients at explaining the defects you see.  

Have you had any opportunity to evaluate your night vision with regard to halos and other typical symptoms of multifocal implants?  I was wondering since the LAL doesn't have the typical abrupt transitions from one lens 'zone' to another whether it would still generate nighttime halos and glare like some multifocals.  I'll be interested in your experience in that area when you have had a chance to observe your results.

Thank you once again for your valuable feedback.  I really hope you find that the cost, effort and inconvenience of the LAL process ultimately gives you a very satisfactory final outcome.
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Hey folks, this is the one week anniversary of my last lock in treatment.  So at one week out my eye continues to recover from the UV light used for the procedure.  My experience may be different than the average person, I don't know because few, if any, have posted on this, but in my case the after effects of the UV were pretty dramatic and still have not resolved a week later.  In dim light conditions I have definite decreased light sensitivity in the central part of the eye corresponding to the scotoma present the initial few days after the lock in and some of my color vision is changed.  For example, there is a green button for 'post a comment' on this web page and when I look at it with the left eye where my lens is, it is the color blue.  Some blue street signs are the color green!  Reds are much more pronounced and in general greens/yellows are washed out looking almost white.  I think it is gradually improving and as I read about 'blue light hazard' online I note the recovery of the retina to the phototoxic effects of light can take weeks or even months.  I hope that surgeons and the manufacturer of this IOL will discuss this more openly as a side effect and warn people in advance.  I don't see anything published about this and it needs to be researched.

On the positive side I am finding my refraction is pretty good.  Using an eye chart in less than ideal circumstances, I'm seeing at least 20/40 distance and possibly 20/30 with good light conditions, and J4 or thereabouts for reading vision.  There is definitely a 'pseudoaccomodation' phenomena at work and I am feeling as though my brain is still learning how to interpret the signals and integrate it with the other eye.  The difference in color vision and differences in the ability between each eye to see in dim light make this harder.  When I walk outside in very bright light conditions my far vision is best.  I'm able to work on the computer quite well.  I think there might be a mini-monovision effect at work here too.  With both eyes my UCVA is 20/20 distance.

So at one week out - the UV light had side effects I'm still recovering from, I'm definitely getting a benefit at different visual ranges that might be better than a standard monofocal, and there is going to be more time needed to allow my poor old brain to adjust to these changes.  If they don't close this forum topic I will try and give you an update in a few more weeks.

While I was jealous of folks who are able to go in, get a quick surgery done, get refracted and have glasses with resultant good vision all in short order with minimum cost, I am also thinking that the long term benefits of this lens and the various requirements and costs involved may be quite wortwhile.  My old progressives are sitting on my desk collecting dust and I'm able to get around quite well.  I'm optimistic but just don't feel I've gotten the full benefit of this yet and don't know for sure if I can recommend it.
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A quick update.  Lock in two was finished Wednesday morning, 3 days ago.  Follow up will be in three weeks.  It is great to be out of the UV blocking sunglasses.  The day of the second lock in my vision was pretty bad due to the usual effect of the bright UV light.  It was better the next day and better still now.  I was told to expect several weeks of recovery.  

I cannot fairly report the final outcome yet because there has not been enough time for full recovery from the UV exposure.  My color vision is way off and there are contrast issues.  This morning I can read fairly small print with inverted colors enabled and bold text on my ipad (to decrease the contrast problem with a white background) and can also read a small scrolling banner on BBC news from a distance.  Intermediate/computer distance seems best of all.  The reading distance is not a 'crisp' vision but this may be a contrast problem.  Will give an update and summary after a bit more time goes by.
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