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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.
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.
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.
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.
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.
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.
2 Comments
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?
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?
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/
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/
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?
I don't know when you'll need the other (right) eye done, but is the LAL still in consideration?
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!
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!
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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