Light Adjustable Lens (LAL). Truth v Hype. Patient & surgeon perspective. PanOptix/LAL combination.
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- čas přidán 2. 02. 2024
- We have been using the light adjustable lens since August 2023. As we have been using the light adjustable lens or LAL for premium cataract surgery and Lens replacement surgery, I have shared several videos about this lens and how it works. Below this video you are welcome to click the links to view those videos.
(I have no financial interest in the products discussed in this video)
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In this video we discuss the following:
0:01 Introduction
0:19 4 "Features" of the Light adjustable lens...the selling points of the light adjustable lens
2:05 Light adjustable lens features that are accurate and features that are less accurate
2:25 The two groups of patients that seem to be the happiest and do the best with the light adjustable lenses: 1) patients who want far and mid-range vision with great clarity and minimal halo who are willing to wear readers, 2) patients who have successfully experienced and adapted to mono vision in the past.
4:00 the image quality of the light adjustable lens vs the Vivity lens
4:30 Who would I recommend NOT have the light adjustable lens for?
5:00 Our patient's personal vision journey with the light adjustable lens
8:41 Patient interview after receiving the light adjustable lens. Why is our patient not happy with her vision?
13:04 Intraocular lens exchange - remove the light adjustable lens and replace it with the panoptix lens
16:06 Patient experience with the light adjustable lens in her dominant right eye and the panoptix lens in her non-dominant left eye
20:00 Patient experience with the light adjustable lens before locking-in the lens
22:14 Conclusions and surgeon's lessons learned using the light adjustable lens and mixing the panoptix with the light adjustable lens
Financial disclosure: I have no financial interest in the products discussed in this video - Věda a technologie
This honesty and willingness to help is what we as patients really appreciate
I had LAL surgery on 1-9-24 and 1-16-24. Yesterday, 2-16-24 I had my first adjustment, (we were delayed a week due to a minor complication). My goal is to see well across all ranges while possibly needing reading glasses for super up close reading. As described in this video, we planned on my dominant eye to be mid-far and my other eye to be near-mid. My doctor said that she recommended to try to get as close as possible on the first adjustment while taking care to not go "too far." So it is now about 21 hours since the adjustment and I can say that I am very pleased. However, I totally understand how someone that is not suited to mono-vision would not be thrilled. It is apparent to me that my brain is "choosing" to process whatever is most clear and that is what I am actually seeing. I will go in on the 23rd for another adjustment but it is too early to tell if/what I will be requesting. It's still early days for me but if I could make one suggestion to all involved it would be to create a set of contact lenses with the desired Rx for each eye and have the patient try them out to see if mono vision would work. If not, I'd probably avoid LAL.
Thank you for sharing your experience!
SO GLAD I found your channel Dr. Wong!
I'm 50, have worn contact lenses most of my life and have had multifocals for the past few years as readers have become my "new norm". Last visit to the eye doctor resulted in not being able to get a new script as I now have cataracts in both eyes. Doing some research on available lens options before my first visit with a cataract surgeon. THANK YOU for the excellent detailed information and education you provide!
I wish I was closer to your practice as you are exactly the type of doctor I want looking out for my best interest. (from Michigan). Your professionalism is recognized. Great work!
Thank you Dr Wong for sharing this valuable lessen! This patient was also extremely helpful in sharing and articulating her experience with us. I too do not offer monovision unless they have successfully adapted to monovision before. She looks happy to be able to read her Rolex watch now with out the need for glasses. I think it’s great to have good options now to perform cataract refractive surgery. Your generosity in sharing your experience is helping me help patients live better lives with better vision! Thank you again!
I'm having a similar experience as this patient. It really helps to have this detailed explanation. I wish my surgeon was as good at explaining treatment and options as Dr. Wong is.
That was a great video and extremely helpful in trying to decide best method to go for……originally I was for the Panoptix Lense in both eyes or Vivity in one eye but, night time halos seem to be a real issue so this method is another option worth considering.
I noticed her vision before the operations was +2.5 approx however, for someone with extremely poor vision ie -12 and -7 perhaps they would benefit more so from LAL in each eye.
Some more real life experiences of post - LAL surgery would be much appreciated 😎Thanks again!! 👍
Thanks Dr. Wong amd Linda. I appreciate the lessons about RLE and ILS. I just started wearing glasses at 46. I have a feeling I will end up with an RLE in the future. Thanks for your experience. It teaches me too temper expectations
Excellent information. And thank you to your patient for her honest opinions and helping you learn .
Thank you for these videos. For being honest and helpful !
Dr. Wong, your videos help educate patients and other eye doctors about many aspects of eye surgery. We are lucky to have you in our field! I think you push our speciality forward with your dedication to teaching and your patients are lucky to have you as their ophthalmologist. I would've considered a CTL trial on this patient preoperatively to see if she would tolerate monovision, especially given her intolerance of monovision when wearing CTLs previously. Your persistence ultimately paid off and now the patient is 20/happy! Great work!
Thank you Charles!
Thanks for these really informative videos! Shortly I’ll need cataract surgery up here in Seattle. It’s great to know what the choices and limitations are. The little cadenza showing the cutting and extraction of the unwanted intraocular lens was a surprise I had to ff through but I wasn’t as nauseated as I thought I’d be! I think I’m almost ready.
Thank you so much for sharing this information. Your explanations of who would best benefit from these lenses, and the possible issues with lal is extremely valuable. As someone who is considering cataract surgery in the near future, I needed this information!
Excellent informational video. Thank you!!
Very nice case Dr. Wong.
This was a very useful video.
This is so very helpful. Thank you, Doctor.
I would like to see info on the new “LAL plus “
First time hearing of that.
Thank you, Dr. Considering LALs, so helpful!! Question can you do an experiment with mono vision contacts in advance of any iol surgery to test monovision ? If so, for how long?
Since the patient was not yet locked in, could the nearer vision eye be dialed in to mid-far to match the other, rather than run the risk (I’m told) of replacement? Was it because her priority was to eliminate glasses completely? I’m in the process of making the same choice. Your videos are so helpful. Thank you.
It took me about three months to not notice the difference In mono vision. I had mono vision for seventeen years before cataract surgery. In doing LAL with mono vision. I’m a previous RK and LASIK patient
This video is so helpful - especially as someone who is beginning to offer the LAL! I’ve definitely heard of surgeons putting this in the sulcus when the bag breaks… what do you think of that? Thank you!
Thank you Dr. Wong. Your videos contribute so much to so many who have questions. I am strongly considering the LAL in both eyes. I don't think I can tolerate mini-monovision of -0.25 and -1.25. If that is the case case, what would the quality of my vision be to target near/intermediate and wear glasses for distance? Is the quality better for distance/intermediate with the LAL? My cataracts are too advanced for contacts. How soon can I wear contacts after the LALs are implanted?
Have you tried offering the Vivity in the dominant eye and the Panoptix on the non dominant one, targeting for plano OU? Wouldn't it be an interesting option for patients who might be more prone to suffer for night vision haloes?
Thank you for another amazing video!
I have really appreciated the many videos you have created. They have been very helpful. In this one what concerns me the most is point 4; that the light adjustments are not consistently accurate. I am scheduled to get LALs in April so it is still early enough to change my choice of lens. I have been extremely successful with monovision contact lenses and planned to get the blended vision. My thinking is that I would get a range of vision without the disphotopsias and also get crisper vision and better contrast than the Panoptix. My questions are: Is it true the blended vision wouldn’t be a full range of vision like I have with my contacts (point 3)? Does it give more close vision than the Vivity? Also how do you get good results if the light adjustments are unpredictable (point 4)? Is lens replacement the only recourse if the patient doesn’t have good results? I’ve never had any eye surgery at all, not even LASIK, and have healthy eyes. I have high myopia in one eye and moderate in the other. The high myopic eye has 1.75 astigmatism and has the worse cataract. Is LASIK an option if the result isn’t good with the LAL?
Dr. Wong have you seen any postoperative shift as a result of 2nd lock in? All was great until right after that. Occurred in both eyes losing far sight in dominant eye and mid in non dominant. Reading your non-dominant eye is still 2020. Currently working through resolution….
I’ve just had LAL put in both my eyes 3 1/2 weeks ago. I’m having the same problem. This woman is having with the reading part. Can your vision be corrected through Lasix after these lenses have been put in? I have another appointment at the end of the week. I hope you can answer. Thank you.
Nice looking practice
Hi Dr. Wong, can you please tell me if there is cosmetic reflection with this lens?
Sir can you described differences between panfocal and trifocal lens obliged to you🙏
Hi Dr Wong I had this exact situation over the last year. But 6 months after the LAL was removed and replaced with the PanOptix lens my lens capsule broke. After 2 surgeries and a lens stitched to my eye I still cannot see well out of this eye. It’s been now over 5 months. Any suggestions
awesome videos dr. wong. so if you do both eyes with the lal, adjusted the same for far and mid vision in both eyes, it would be superior to the vivity lenses but you would still need readers. is that correct in most cases ?? thank you.
Great question. Following
I have the LAL‘s in both eyes and I’m having the same problem that she is. The only differences I have a lazy left eye. Bothers me the most is reading. It keeps flashing back-and-forth from blurry to clear
@SgtD1981 I have a kazy eye too and just had my first LDD. Can we talk?
Thanks, I will Dr. Wong normally before the ablatioo retina,and who cause a cataract I wear always one contact of lens, maar one for far and the other eye I used for nearby. I ever was a problem. Can I wear after 3 moths a lens for myophia it will do no harm at the surcery eye?
What do you recommend for someone who has never tried monovision? Or is there a way to try it before doing the surgery? I have been wearing progressive glasses but did try contacts (multi-focal) for a while but hated the result - felt like mediocre vision. I like the idea of monovision, but couldn't you do LAL with both. Dial it for monovision and if you don't like it (before lockin) go for far/mid in the one eye and mid in the other eye. Eg: Go from strong monovision to something intermediate?
Panoptix.
In both? What about the halos?
Dr. Wong, do you have any offices in northern california?
Hi Dr. Wong for the LAL lenses do you see "terminator eyes" in patients? I may have missed the answer to this question previously. I am only in my early 50s (52) and nervous I will have that flickering candle look. Which lens types are best to avoid the "terminator" eye/s? Thank you for sharing your experience and opinion.
The LAL does not have a cosmetic reflection that is visible to others. The Alcon family of lenses is the main lens type that can create a reflection that is noticeable by others - there "terminator eye."
Thank you for your swift and clear response@@ShannonWongMD. Is there any real downside aside from cost and time spent tweaking the LAL to other lenses? What new lenses are on the horizon?
Shannon, try a MiLoop to cut out the LAL. It works beautifully.
Good tip. Thank you!
Now I’m very nervous……I got the LAL lens in my left eye last Thursday and I am scheduled for my right eye this Thursday. I didn’t really like the monovision I got from contacts. I’m concerned with having the same results as your patient…. Not sure what to do now!!! Do you have any advice doctor?
If I had to trade my distant vision for better near and intermediate vision I could deal with glasses for distance….can they do this with LAL? I don’t think I can exchange the left lens due to the additional cost. Should I get the Panoptix in my right eye? My contacts were left eye for near and right for distance. I have my preop for my right eye tomorrow and don’t know what to do!!
Based on my experience thus far and your description, if I were you and received the LAL to both eyes, then I would expect one of two scenarios: 1) LAL both eyes with great far/mid vision and would use readers to see near or 2) LAL monovision/blended vision with a 50% chance that I would like it and a 50% chance that I would find the disparity between the eyes annoying.
@@ShannonWongMD Thank you so much for your timely reply!
Have you tried the newer updated LAL+ (plus) lenses yet? They are supposed to give more range of focus. I’m seeing some Reddit posts that say they got 20/15 Far and 20/20 Near both eyes. I’m not sure how a monofocal lens can achieve near, mid, far without blended mono vision though. I’m thinking about going with ClearrView 3 but still researching more. Thanks for the great videos! Very informative.
For patients that want full-range of focus - far/mid/near - with normal night vision, we are finding that the Clearview 3 lens is the best lens for this patient population. We are using less light adjustable lenses since starting to use the Clearview 3 lens. The light adjustable lenses do not have far/mid/near performance from each lens.
Thanks, I might have to come to Austin for ClearView3. I’m not finding many IOL options in south Florida and you probably are the best from what I’m researching. I watched several hours worth of your CZcams videos. I feel very confident and informed now. My local eye surgeon only does LAL for some reason. My number one priority is near iPhone vision.
When is the second generation LAL coming out? I've read good result that are even better!
We have used the light adjustable lens "plus" and have spoken with fellow ophthalmologists who have used the "plus" version. There seems to be little difference between the "plus" and regular light adjustable lens in terms of patient outcomes thus far.
For a person who tolerates monovision well would you still recommend Panoptix over LAL for glasses independence?
We would explain the pros/cons of PanOptix binocular vision vs LAL blended vision, then let the patient choose.
I got alcon vivity ,my vision is clear but i feel headache n pain wth little bit pressure in my eyes ,what sh'ld i do sir plz reply thnks
I have stopped using mono vision and multifocal IOL,s and instead use mini mono vision using some of the newer EDOF IOL,s , but not the vivity lens . Panoptix is still an option with good results but I can achieve similar result using EDOF lenses
Why not the Vivity? What are the newer EDOF IOLs?
3:04 in my opinion, this is an example of the video having terrible contrast with th lime green titles at the screen top. There's also an earlier example.
7:56 there are white fonts used with light backgrounds.
I suggest better labels are needed.
Very helpful. I had my first adjustment today and my far vision is very sharp, but I still have not fully adapted my near vision. I'm only 7 hours post adjustment so I am hoping to show more improvement in the next 24 hours.
Are you happy with your near reading vision 3 months later? My priority is seeing my iPhone and don’t want mono vision. I’m considering ClearView 3 instead of LAL.
@@JazJonFL After my second adjustment my near vision became sharp, but I lost my far vision. Also I have to wear single vision glasses for the computer. I also got driving glasses. I am overall happy with my decision because I can do 95% of what I do without glasses, but I can't really advise about the Clearview 3.
But why patients must have had some experience with mono-vision? Can't LAL IOLs be setup for both eyes equally, so that person should see clear at far and mid distances and using glasses at close distances?
Exactly what I want to know too
Dr. Wong, has this happened to any of your patients? I’ve read comments from a couple of people that their eyes, after many adjustments, were near perfect until the lock-in. After the lock-in they no longer had good distance vision.
Not yet.
Just had this happen to me upon second lock in, and I am working through a resolution. I’m told it’s been a one or 2% issue. They are calling it post operative shift and working with the manufacturer. My technology background tells me it’s either the lens, the machine or the process.
I'm struggling with mine.
Are patients at risk for IFIS, e.g., briefly exposed to tamsulosin, bad candidates for LALs?
IFIS is a non-factor in my opinion. We see it regularly and it is "no-factor."
Your first point says: “Provides EDOF better than monofocal”. Are you referring to the new LAL+ lens and not the standard LAL lens?
We just started using the LAL+. It is too soon to tell if the LAL+ is "better" than the LAL. Early results in our experience show that they are about the same. This video is based on LAL (OG).
@@ShannonWongMD Hi Dr. Wong, do you have any updated or additional perspective on this issue? I'm currently trying to decide between LAL (which will cost me $4,500 out of pocket) and LAL+ ($,7,500). BIG price difference, but if the EDOF results are truly not much different then I will rest easy choosing the standard LAL. Thank yo.
@@bando255 The difference between LAL and LAL+ is imperceptible to me and to the patient thus far after using both.
@@ShannonWongMD Thank you so much for taking the time to reply. That's a huge weight off my shoulders in making this decision. I will confidently proceed with standard LAL.
Can you get near and medium without glasses and far with glasses?
I have the same question. Would the quality be the same as far/intermediate?
I notice the patient is not wearing the sunglasses which I have been told are mandatory until the lock-in. Why is this?
UV blocking RX sight glasses are only required outdoors (not indoors).
Please can you clarify the difference between LAL and LAL+
LAL + is supposed to give better intermediate range vision than the LAL (non-plus). Personally, I have found the two versions to be almost identical in terms of range of vision.
@@ShannonWongMD Thank you 👍
It took me about three months to get used to monovision
Did you have the LAL done? I just had mine done a month ago. I’m in the adjustment phase. The biggest issue I’m having is when I’m reading. It’s like I can see through both eyes one blurry and one clear and I’m unsure of what I’m seeing. Did that happen to you? I’m on my second adjustment. Did your surgeon offer you minor adjustment with Lasix?
None of you doctors EVER talk about people with dry eye conditions.
czcams.com/video/Q6VxWizduMw/video.html
I'm thinking to take up banana suturing as a hobby
@weop907tgb
0 seconds ago
I had LAL implants a little over a year ago and have already had the left eye replaced with a vivity and I'm having the right eye replaces as soon as possible. My doctor believes that my body rejected the silcone LAL lenses causing cells to form on the lenses. I'm not sure i agree with that my vision became extremely blurry (partly due to some pco but mostly cells forming on the lenses) to the point that I had to have it replaced. The LAL in my right eye has become blurry as well. I have had the vivity for a few months now and I love the clarity. and near vision. I do not reccomend tht LAL lenses if you are trying to see near and far, the mimi mono vision is a harsh adjustment. I'm still trying to decide which lens to do in. my right eye because I have a strong perscription and will need some lasik if I use the vivity.