Aa
adaptive IOLs outside the US
I am in the US and considering going overseas to get a better IOL. The options here are so limited. I have myopia, astigmatism, presbyopia, and I've also had a retinal vein occlusion. With the retinal issues, I'm not going with a multi-focal because of the reduced contrast sensitivity and because they can interfere with any future retinal surgery. The only adaptive IOL in the US is still Crystalens. I've talked with doctors here that say they most patients don't really get much accommodation with it. I've seen many reports of patients having worse vision with Crystalens than they had before the surgery. I've worn glasses as long as I can remember, but with my prescription they're getting quite expensive. If the "premium" IOL will really get me out of glasses, or at least into cheap ones, it will be worth the cost in the long run. There are many other adaptive IOLs available in the rest of world. Does anyone have any experience with them? The only one I've seen on the forum is a report on the Synchrony lens where the patient ended up with effectively very expensive monovision lenses.
A related discussion, Light Adjustable Lens Experience was started.
The LAL is a very interesting concept, and your updates are greatly appreciated.
Thanks
Thanks
The UV glasses are provided by the manufacturer of the lens and have been tested to make sure they filter out the exact wavelength used to adjust and lock in the lens. They also have a lip on the top and sides to help block in ambient UV light from coming in between gaps from the glass frames and your face. They have a cord on the back so you can pull the glasses snugly. I'm using a floppy hat to help protect from sunlight when I go outside because of the difficulty I'm having keeping the glasses firmly against my face because of the smudging issue.
I'll post again sometime after adjustment #2.
I'll post again sometime after adjustment #2.
Wouldn't the Solar Shield type of sunglasses, available almost anywhere, inexpensive and 100% UV protection, work just as well?
http://www.solarshield.com/protection.html
http://www.solarshield.com/protection.html
Thank you again so much for posting about your experience with the Light Adjustable Lens and the reality of living with the UV-blocking glasses after the surgery.
It sure sounds like having to wear the UV blockers 100% of the time makes it harder to get through 'daily life.' The upside will hopefully be the best possible visual outcome from your cataract surgery, from which you will benefit for many years.
If you can stand to do so after everything you have been through, you might write up your comments for things Calhoun could do to make their system more feasible for patients (such as a holder for reading glass inserts in the UV glasses, adjustments for how close the UV lenses are to the face, and similar issues).
The only way Calhoun will learn what's hard for patients to tolerate is to hear from users in the field. If Dr. Paulig has been very diligent and careful about implementing their technology and is getting good results, they should be willing to listen to the suggestions she feeds back to the company.
Good luck keeping up your spirits while you are living in the 'twilight' for the next several days. I hope your final adjustment and lock-in go well, and that the pinkish hue continues to dwindle (it's great that it is already fading).
Thank you again SO MUCH for providing such detailed feedback on your experience with the LAL system. I think interest in this technology will continue to grow, especially if it ever gets approved in the US. Your comments are so helpful and very much appreciated. :-)
It sure sounds like having to wear the UV blockers 100% of the time makes it harder to get through 'daily life.' The upside will hopefully be the best possible visual outcome from your cataract surgery, from which you will benefit for many years.
If you can stand to do so after everything you have been through, you might write up your comments for things Calhoun could do to make their system more feasible for patients (such as a holder for reading glass inserts in the UV glasses, adjustments for how close the UV lenses are to the face, and similar issues).
The only way Calhoun will learn what's hard for patients to tolerate is to hear from users in the field. If Dr. Paulig has been very diligent and careful about implementing their technology and is getting good results, they should be willing to listen to the suggestions she feeds back to the company.
Good luck keeping up your spirits while you are living in the 'twilight' for the next several days. I hope your final adjustment and lock-in go well, and that the pinkish hue continues to dwindle (it's great that it is already fading).
Thank you again SO MUCH for providing such detailed feedback on your experience with the LAL system. I think interest in this technology will continue to grow, especially if it ever gets approved in the US. Your comments are so helpful and very much appreciated. :-)
So, am back home rested after my evening flight and am first day after the initial Light Adjustable Lens adjustment. This morning the pink/red hue is better although still present. I've read that it can fade over a few days or be persistent over weeks. I'm encouraged it has gotten better and time will tell. I spoke with the ophthalmologist, Dr. Paulig today as we needed to make a schedule change so I'll be getting adjustment number two on Friday then lock in next week. With an afternoon appointment I can fly into Berlin in the morning and back home that night. A comment - if you get this done there may be schedule changes due to unforeseen complications or problems. So be judicious in the amount of time you plan to take off and the need for flexibility. I think it can be stressful for both the doctor who has a busy practice and the patient to make this work because there is a time commitment for both in doing the follow ups and adjustments. Perhaps if this becomes more commonplace it will be easier but if these lenses are the minority in the doctor's practice they will be a break from the usual routine.
In talking to the doctor today she told me that typically the lens will take a few days to finish changing shape after the UV exposure. So I'll have to hold my opinion on how well this technology works. However, I do note today that I was able to reduce the font and icon size on my computer from large to medium and can still read it relatively well.
A last few observations. Get your hair cut the day before the cataract surgery because it is hard to do when you are wearing UV lens and trying to avoid getting soap in your eyes post op. Be prepared for more pain and discomfort post cataract surgery than web sites will have you believe, to me it felt like somebody punched me in the eye and I was quite tender for the first ten days after. I also had itchy eyes for a couple weeks. This has nothing to do with the LAL and is just normal post op cataract surgery experience but the online sites really downplay the discomfort. Last, my doctor is having me just use the sunglasses UV blocker at all times. She has had really excellent results with few complications and I believe this is because she takes a very conservative approach with her patients. The downside is that these UV sunglasses have you living in darkness except when you are outside in bright light and it is a bit depressing. It also makes it harder to see so knowing exactly where you are at with your vision post surgery and post adjustment is a little harder. Last comment, I sure wish they would either redesign the UV blockers or have more than one standard pair. When I have these against my face firmly my eyelids brush against the inside lens and cause smudges I must constantly clean. I also have to hold up store bought reading glasses on the outside of these to read because there is no provision for inserts.
I'll post more as time goes on and let you know how it all turns out.
In talking to the doctor today she told me that typically the lens will take a few days to finish changing shape after the UV exposure. So I'll have to hold my opinion on how well this technology works. However, I do note today that I was able to reduce the font and icon size on my computer from large to medium and can still read it relatively well.
A last few observations. Get your hair cut the day before the cataract surgery because it is hard to do when you are wearing UV lens and trying to avoid getting soap in your eyes post op. Be prepared for more pain and discomfort post cataract surgery than web sites will have you believe, to me it felt like somebody punched me in the eye and I was quite tender for the first ten days after. I also had itchy eyes for a couple weeks. This has nothing to do with the LAL and is just normal post op cataract surgery experience but the online sites really downplay the discomfort. Last, my doctor is having me just use the sunglasses UV blocker at all times. She has had really excellent results with few complications and I believe this is because she takes a very conservative approach with her patients. The downside is that these UV sunglasses have you living in darkness except when you are outside in bright light and it is a bit depressing. It also makes it harder to see so knowing exactly where you are at with your vision post surgery and post adjustment is a little harder. Last comment, I sure wish they would either redesign the UV blockers or have more than one standard pair. When I have these against my face firmly my eyelids brush against the inside lens and cause smudges I must constantly clean. I also have to hold up store bought reading glasses on the outside of these to read because there is no provision for inserts.
I'll post more as time goes on and let you know how it all turns out.
The latest update ... I went in for my first adjustment this morning. I waited for about four hours getting eye drops every 45 minutes or so. I do not know if this is normal or the doctor was just busy so they kept me dilated. I saw the optician early on and he made some measurements and asked me about how I wanted the adjustment. This is my left eye so I chose rear and intermediate.
When they did the adjustment they used anasthetic drops than had me look into the machine. The doctor used a contact lens and reticule and a bright, but not painful light was shined into my eye over the course of a minute or two. Everything turned pink and I was unable to see out of the eye much at all. She then went ahead and used the YAG laser to address some 'capsular necrosis'. I am now about four hours later and can see out of the eye but there is a strong pink hue to everything. I can't say at this point that my vision and focus are much better. Am flying home tonight and second adjustment is next week. Will see how my vision is tomorrow and try to write more. This was tough to do alone and with my fairly poor German, and there is yet another schedule change. Keep this in mind if you plan to travel to get this done.
When they did the adjustment they used anasthetic drops than had me look into the machine. The doctor used a contact lens and reticule and a bright, but not painful light was shined into my eye over the course of a minute or two. Everything turned pink and I was unable to see out of the eye much at all. She then went ahead and used the YAG laser to address some 'capsular necrosis'. I am now about four hours later and can see out of the eye but there is a strong pink hue to everything. I can't say at this point that my vision and focus are much better. Am flying home tonight and second adjustment is next week. Will see how my vision is tomorrow and try to write more. This was tough to do alone and with my fairly poor German, and there is yet another schedule change. Keep this in mind if you plan to travel to get this done.
Wow, thanks for posting! So happy to hear from an actual LAL patient. Please let us know how things go after your UV adjustment is done.
I read that Calhoun recognizes the time interval in the UV blocking glasses plus the overall number of appointments needed make the process difficult for patients. In the future they are going to try to streamline the procedure so it requires fewer trips back to the doctor to reach the 'final result' for the majority of patients.
Congratulations again on taking advantage of what seems like a very promising new technology. I hope your ultimate post-surgery outcome, combined if needed with some sort of eyeglasses, will return the sharp vision that you're missing now.
It's also good you will have any cataract clouding out of the way in case you do have a retina issues later on. There have been a few posters recently on both eye forums who have retina issues plus cataracts, and who now need the cataracts removed so their retina doctors can fully visualize and treat their rear-of-eye issues.
Please keep us posted on your LAL experiences - good luck!
I read that Calhoun recognizes the time interval in the UV blocking glasses plus the overall number of appointments needed make the process difficult for patients. In the future they are going to try to streamline the procedure so it requires fewer trips back to the doctor to reach the 'final result' for the majority of patients.
Congratulations again on taking advantage of what seems like a very promising new technology. I hope your ultimate post-surgery outcome, combined if needed with some sort of eyeglasses, will return the sharp vision that you're missing now.
It's also good you will have any cataract clouding out of the way in case you do have a retina issues later on. There have been a few posters recently on both eye forums who have retina issues plus cataracts, and who now need the cataracts removed so their retina doctors can fully visualize and treat their rear-of-eye issues.
Please keep us posted on your LAL experiences - good luck!
I'm an American assigned to an embassy in Western Europe and last week had an LAL implanted by Dr. Sylvia Paulig in Cottbus/Berlin. I've been in the UV blocking sunglasses ever since and will be heading back for my first adjustment next week. It has been harder than I thought to rely on the UV blocking glasses as I'm now without my progressive lenses and while I can get around fairly well am missing the sharp vision I had with them. Hopefully the adjustment will get me a better near vision. I had the left eye done and will be opting for a near vision adjustment with the idea that when the right eye needs to be done I will have the option of either monovision or going ahead and getting it also set to near and then only using glasses for driving, movies, etc. I bought some cheap reading glasses which I hold in front of the UV glasses when I need to read. Like others, I had a questionable finding on the retina and wanted to maximize the potential for vision if I go on to have retinal disease. I am a relatively young patient at 52 so getting the best vision possible for an active lifestyle is important to me. I also read research that suggested with an aspheric treatment and good depth of focus I would have advantages with intermediate and distant vision that would not be present with a standard monfocal lens. And being post lasik I would be much harder to adjust for the best outcome with a standard lens.
The IOL options in the US are definitely limited.
IOLs that have been successful in Europe for more than 5 years are still only dreamed of here. I understand the "thalidomide" problem in the FDA, but they seem to be in an extreme "CYA" mode.
I'd suggest writing your congress-critter, but they also seem to be in a do-nothing mode. Sad.
IOLs that have been successful in Europe for more than 5 years are still only dreamed of here. I understand the "thalidomide" problem in the FDA, but they seem to be in an extreme "CYA" mode.
I'd suggest writing your congress-critter, but they also seem to be in a do-nothing mode. Sad.
Yes, Calhoun's commentary is interesting esp since they mention the 'near add' is put in the center of the lens, where a traditional multifocal lens has the 'distance' portion of the lens. It'll be very, very interesting to see how this technology stands up against 'traditional' multifocal IOLs once there are results of both available.
Of course, in the US we have to wait for the FDA to approve Calhoun's procedure before there are patients on whom such an evaluation could be performed. Sigh.
Speaking of cool upcoming technologies, I recently saw a video interview with a doctor who's on the board of Avedro, the company developing corneal crosslinking for keratoconus and corneal ectasia. He was describing the change in correction they've observed in European patients who have received the crosslinking procedure for cornea issues (it's approved in some European countries although not yet in the US).
He said that based on the changes they've seen in cornea shape that one day there might be a use for the system in addressing mild spherical or astigmatic problems through reshaping the cornea via crosslinking, all without surgery. They found that they could pretty precisely control which areas of the cornea were being 'reshaped' with the UV-cured crosslinking solution. Of course it's only a byproduct of the approved treatment for now, but he said it's possible that one day mild diopter (2-3D) and astigmatic corrections could be made with that system.
Hopefully the Calhoun system will make it through the FDA process soon! It's a shame so many patients are driven outside of the US because they feel the approved IOL options within the US are too limited.
Of course, in the US we have to wait for the FDA to approve Calhoun's procedure before there are patients on whom such an evaluation could be performed. Sigh.
Speaking of cool upcoming technologies, I recently saw a video interview with a doctor who's on the board of Avedro, the company developing corneal crosslinking for keratoconus and corneal ectasia. He was describing the change in correction they've observed in European patients who have received the crosslinking procedure for cornea issues (it's approved in some European countries although not yet in the US).
He said that based on the changes they've seen in cornea shape that one day there might be a use for the system in addressing mild spherical or astigmatic problems through reshaping the cornea via crosslinking, all without surgery. They found that they could pretty precisely control which areas of the cornea were being 'reshaped' with the UV-cured crosslinking solution. Of course it's only a byproduct of the approved treatment for now, but he said it's possible that one day mild diopter (2-3D) and astigmatic corrections could be made with that system.
Hopefully the Calhoun system will make it through the FDA process soon! It's a shame so many patients are driven outside of the US because they feel the approved IOL options within the US are too limited.
An interesting article on customizing the LAL for near and intermediate. Since it is on Calhoun's website, they may be tooting their own horn, but there does seem to be a lot of options. We live in interesting times, for sure.
http://www.calhounvision.com/intl/Patient+Vision+Solutions
http://www.calhounvision.com/intl/Patient+Vision+Solutions
Thanks for the pointer to the article by Dr. Chayet; very interesting.
I also saw an article by a cornea fellow from Toronto reviewing the LAL in 2012 in European Ophthalmic Review. This article mentions experimentation was beginning at that time with creating different 'zones' on the LAL lens to help enhance near-vision while preserving distance vision (all in the same eye). Here's a link if you want to read this review:
http://www.touchophthalmology.com/articles/light-adjustable-lens-review?page=0,1
I don't know if their technology does a better job than a typical multifocal lenses in preventing halo and glare which seems to be a major side effect of most multifocal lenses. I haven't yet found any articles comparing vision using LAL implants customized to provide 'multifocal' capabilities with traditional MF lens implant acuities. This is probably because not many patients have had the LAL as yet, given how new it is, and fewer yet have had the multi-zone customization. It will be interesting to see how this product evolves in the coming years.
I also saw an article by a cornea fellow from Toronto reviewing the LAL in 2012 in European Ophthalmic Review. This article mentions experimentation was beginning at that time with creating different 'zones' on the LAL lens to help enhance near-vision while preserving distance vision (all in the same eye). Here's a link if you want to read this review:
http://www.touchophthalmology.com/articles/light-adjustable-lens-review?page=0,1
I don't know if their technology does a better job than a typical multifocal lenses in preventing halo and glare which seems to be a major side effect of most multifocal lenses. I haven't yet found any articles comparing vision using LAL implants customized to provide 'multifocal' capabilities with traditional MF lens implant acuities. This is probably because not many patients have had the LAL as yet, given how new it is, and fewer yet have had the multi-zone customization. It will be interesting to see how this product evolves in the coming years.
If you do a Google search for "Eyeworld Article 6878" you will come up with a very interesting article by Arturo Chayet, MD on customizing the LAL for near and far results meeting patient satisfaction.
Avoiding Halos, Glare, and additional surgeries just seems like a super advantage.
Avoiding Halos, Glare, and additional surgeries just seems like a super advantage.
Just wanted to comment that the Calhoun Light Adjustable lens, while an amazing technology, is a monofocal lens. It does not have adaptive or multifocal properties, which I think is what the original poster was seeking.
That said, the LAL sounds perfect for patient (like me) who are high myopes and are not candidates for LASIK after a cataract procedure. It sounds like it can be difficult to calculate the exact power needed for an IOL in high myopes; the LAL would allow the surgeon to tweak the power of the implanted lens - and the exact contour of the toric correction - AFTER surgery, through directed UV light exposure on the lens. It's very cool technology to be sure. I hope the FDA approves it soon for use in the US.
As with other monofocal lenses, the LAL can be used to deliver mini-monovision (if both eyes have a cataract replacement performed). But it's my understanding it doesn't differ from 'traditional' monofocal lens surgery in terms of mini-monovision, except that the exact degree of correction can be adjusted in the few weeks after surgery.
BTW my OD has also said that his patients have been disappointed in the Crystalens and thinks the accommodation provided by those lenses is below most patients' expectations.
That said, the LAL sounds perfect for patient (like me) who are high myopes and are not candidates for LASIK after a cataract procedure. It sounds like it can be difficult to calculate the exact power needed for an IOL in high myopes; the LAL would allow the surgeon to tweak the power of the implanted lens - and the exact contour of the toric correction - AFTER surgery, through directed UV light exposure on the lens. It's very cool technology to be sure. I hope the FDA approves it soon for use in the US.
As with other monofocal lenses, the LAL can be used to deliver mini-monovision (if both eyes have a cataract replacement performed). But it's my understanding it doesn't differ from 'traditional' monofocal lens surgery in terms of mini-monovision, except that the exact degree of correction can be adjusted in the few weeks after surgery.
BTW my OD has also said that his patients have been disappointed in the Crystalens and thinks the accommodation provided by those lenses is below most patients' expectations.
MEDICAL PROFESSIONAL
I agree with you that a multifocal lens is not a good option, in someone with retinal issues. I have been underwhelmed with the amount of accommodation provided by the crystalens. You might consider toric implants to correct your myopia and astigmatism for diatance, and then wear reading glasses. Before surgery, have the ophthalmologist demonstrate monovision in the office, with one of your eyes corrected for distance, and one corrected for near. If you do not like this option in trial lenses or contact lenses, then do not opt for it surgically.
The Calhoun Light Adjustable Lens (LAL) is an option north and south of the US, but not available in the US just yet, as the FDA seems to be in hibernation mode on IOLs.
You could google this lens and also check out the Codet Vision Institute for information on this technology. Right across the border from San Diego, so medical-tourism is a pretty good option.
You could google this lens and also check out the Codet Vision Institute for information on this technology. Right across the border from San Diego, so medical-tourism is a pretty good option.
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