Understanding available LAL IOL diopters

[hogwell]

I am myopic with around -9D glasses prescription.
I was interested in the Light Adjustable Lens from RxSight, but my doctor says they don't currently offer it for
someone with my near-sightedness.
This surprises me, and I'm trying to understand a little bit about the diopter strength he measured for me with iTrace.
I understand that this is different, of course, than an eyeglass prescription,
which includes an existing natural IOL.
Specifically, he said I needed around a 7.5, so either a 7 and 8, but they only go to (start at?) 10.
Does this make sense? Seems like if they only go to 10, they would have a 7 or 8,
but I didn't really follow what he was saying, and just accepted what he said.
Meanwhile, I see that the LAL spec sheet at the RxSight website shows diopters from +4D to +30D available,
adding to my confusion.
Anyway, he said he'd suggest that RxSight offer my strength in the future.
He did think it could be a good choice for my bad eye with macular issues.
So, I guess I'll wait another year and see what options appear.
Can anyone shed some light on what he was saying?

[John C Hagan III, MD, FACS, FAAO]

I will forward this to our lead LAL surgeon, and ask him to reply which I shall post.

[John C Hagan III, MD, FACS, FAAO]

Our Discover Vision Centers in Kansas City was among the highest quality surgical practices in the world to be chosen to do the original research on Light Adjusted Lens (LAL) the most advanced intraocular lens in early 2023.  This is from a top world surgeon who was among the first 10  eye surgeons in the world to implant LAL:

ANSWER:   The LAL  lens goes down to +4 and has for quite a while.  I weekly put in powers from 4-10.  The posting patient is very smart patient.  Patient is correct, as posted the surgeon the patient consulted is incorrect.  

SUGGESTION FROM DR HAGAN: Seek a different opinion from the most experienced and skilled surgeon you can travel easily to and from for the necessary post operative adjustments.

[hogwell]

This is good to know, thanks for checking on this for me, Dr. Hagen.
This clinic has just started using the LAL a month or so ago, so maybe he's not clear on the sizes offered yet. I could also be wrong about my measurements... I'll double check the next time.
Meanwhile, I think I'll postpone an IOL in my bad right eye (20/60) for now, since I would have to do it in my good left eye (20/20) as well... I'd rather not risk my good eye until it develops a bigger cataract.
Also, there will hopefully be more experience later with the LAL and the adjustments. (I wonder, do these take a lot of practice, or are they pretty easy to learn?)

[John C Hagan III, MD, FACS, FAAO]

It's like any surgery, there is a learning curve, however the best surgeons 'flatten the curve' and usually have the largest volume.  Surgeons that do not do LAL will often bad mouth it to their surgical candidates.  I don't keep track of all the postings here but with your high myopia, your "team" should include a comprehensive Ophthalmologisst or Cornea/Refractive/Cataract specialist AND a retina surgeon.  You need at least an annual exam with dilation, OCT and other testing by an Eye MD with special training in retina and vitreous disease and surgery. Cataract surgery will carry a significant inreased risk of retinal detachment so if you do proceed, when you proceed, have your retina exam prior to surgery and OK the surgery and soon after the surgery to check the retina post op.

[hogwell]

Good advice.
I do follow up with my retina MD surgeon with regular OCTs, etc. My new cataract MD is also a glaucoma and cataract specialist.
The only problem is that these doctors are now at separate, competing Eye clinics in the same town and I am concerned about their ability to work together and communicate test results efficiently. (I've found that getting medical records between different medical offices a challenge.)

[John C Hagan III, MD, FACS, FAAO]

Normally (and these clinics may not be normal)  retina surgeons don't do cataract surgery and cataract surgeons don't do retina surgery so there is no competition. I Kansas City where I practice there are several large 'competing practices' but we work together, exchange records and respect the quality provided by the other groups.  I don't think I can offer any further advice, especially if those two groups are the only ones you can easily get to