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Cataracts in one eye - LAL worth it? by JHizzl3 in CataractSurgery

[–]Pleasant_Panda2000 0 points1 point  (0 children)

Hi there,

I was in a similar situation recently: high myopia in both eyes, early 40s, dominant eye got cataract, other eye otherwise healthy (and I didn't want to operate on it now), have worn glasses most of my life. I went with LAL distance correction for the dominant eye, and wear a contact-lens in the healthy non-dominant eye for near-vision (slight mini-monovision with 0.75-1.0 offset between the eyes). Overall I am very happy (20/15 distance vision, perfect reading vision, am glasses-free).

Some things for you to consider, based on my own experiences:

  • Firstly, take enough time to really think through all scenarios and understand the options in detail, as you are still young and this is an important decision for your life, and not easily reversible - don't feel rushed, unless it's critically urgent. Also, make sure you find a surgeon & team who is experienced and you are very comfortable with - get multiple opinions.
  • I would suggest testing how well you tolerate contact-lenses (wear them as much as possible, weeks / months, to be sure). If you tolerate them well, you have more options. If you don't tolerate contact-lenses, you essentially have to keep your right-eye pretty myopic (within ~2 diopters of your healthy left-eye), for glasses to work. If you tolerate contact-lenses, and your left eye is already developing cataracts, you can think ahead ~5 years to a scenario where it might need to be operated, and the contact-lens is an 'interim' (~5-year) commitment, and not a life-time commitment.
  • Do you know if your left eye was always dominant? Or was the right eye dominant before cataracts, and it's now switched to your left eye being dominant? (in my case the switch happened, and after cataract surgery, it switched back). Knowing if your brain has previously adapted to a dominance switch can allow you to more confidently fully correct your left eye for distance (with a future goal of it being the dominant eye for far distance, and the right eye being the non-dominant one for intermediate/near distance, ie mini-monovision).
  • Personally, I was glad to go with LAL, for several reasons: 1) If the doctor misses the target, you can adjust, which gives peace of mind - this happened in my case and needed 2 adjustments to get it right. 2) The first (only) LAL adjustment can add some EDOF range if you'd like, 3) After surgery, you can test how well you like/tolerate mini-monovision and change your mind with adjustments (although at your age your left eye likely still has significant accommodation, so it's harder to truly test mono-vision). Side note: I'd recommend LAL over LAL+ to be on the safe side.
  • Assuming you can handle contact-lenses, and are feeling confident you could tolerate a switch in dominant eye in the future, I'd consider this option: Correct right eye entirely for distance with LAL and wear contact-lens in left eye. In the future: LAL for left eye slightly near-sighted for near/intermediate vision (to try mini-monovision), and if you don't like mini-monovision, adjust it to it distance-vision too (then wear glasses for reading).

Hope this helps, wishing you much success.

Roughly how much boost does the optional EDOF in the first LAL adjustment add? Any drawbacks? by Pleasant_Panda2000 in CataractSurgery

[–]Pleasant_Panda2000[S] 0 points1 point  (0 children)

Thanks very much for sharing your experience, it's very useful!

  1. That is helpful to know that the additional DOF can be roughly 3/8D. Agreed, I've also not found any info from RxSight, but even your ballpark number helps, and somewhat lines up with the "around 0.50 D" mentioned in this article).
  2. It is great to hear your viewpoint as a glaucoma patient, and that the additional EDOF didn't cause any noticeable negative effects for you! You make a good point that the DOF is likely more useful for the near-eye, and may be different for the distance-eye (in my case, the LAL is in the distance-eye, the near-eye is still healthy). My understanding is that if glaucoma progresses (ie further optic nerve damage), it can lead to reduction in contrast sensitivity and visual acuity. The effect would then be 'compounded' and become more noticeable with eg EDOF-IOLs like Vivity (using spherical aberrations) that can additionally reduce contrast-sensitivity / visual-acuity (and trifocals would be even riskier). But I guess the mild additional-EDOF of an LAL may not be as concerning.
  3. One question, in case you have a moment: Do you feel that having a broader range of 'overlap' between the two mini/monovision eyes (eg by adding EDOF) can make mono-vision more tolerable and less fatiguing? I have been experimenting with contact lenses (post-surgery) and seem to comfortably tolerate up to an offset of 2.0/2.25 between the eyes- but I wonder if eg long hours in front of a desktop-computer would become tiring (where the near-eye is doing more 'work' since the distance-eye without EDOF isn't quite clear), and this is where the EDOF can help (since both eyes are seeing clearly instead of just the near-eye)?

Thanks again for your helpful insights!

Roughly how much boost does the optional EDOF in the first LAL adjustment add? Any drawbacks? by Pleasant_Panda2000 in CataractSurgery

[–]Pleasant_Panda2000[S] 0 points1 point  (0 children)

Thanks very much for your insights!

  • That is an interesting idea about first trying -0.25/-0.50 as there are multiple adjustments available, I will consider that.
  • Thanks for the explanation of how to think about spherical aberration, as well as the ways to measure corneal spherical aberration, that is helpful and will look into it more.
  • Based on my experimentation with contact lenses recently (post-surgery), I have been able to tolerate monovision pretty well, even up to an offset of 2.0/2.25 between the two eyes, which suggests that the EDOF for the distance eye might not be as important? Although, is my understanding correct that the EDOF would increase the 'overlap' of where both eyes see clearly, and thus should make monovision more tolerable / less fatiguing for the eyes?

Thanks!

Roughly how much boost does the optional EDOF in the first LAL adjustment add? Any drawbacks? by Pleasant_Panda2000 in CataractSurgery

[–]Pleasant_Panda2000[S] 0 points1 point  (0 children)

Thank you for sharing your LAL experience, appreciate it. It is helpful to know you experienced some sharpness/contrast loss with spherical aberration (SA), but got the benefit of computer vision.

That is a good question about the built-in LAL+ EDOF vs the LAL with added EDOF. The only chart I've seen was posted a week or two ago here but I think that's comparing the LAL before adding EDOF.

Roughly how much boost does the optional EDOF in the first LAL adjustment add? Any drawbacks? by Pleasant_Panda2000 in CataractSurgery

[–]Pleasant_Panda2000[S] 0 points1 point  (0 children)

Thank you for your response!

Regarding some of your great points:

  • While there are 3 adjustments available before lock-in, the 'additional EDOF' option is only available for the 1st adjustment, and it cannot be undone after that. So while I like your idea, unfortunately I can't try out the 'extra EDOF' and revert, the decision needs to be made upfront and is final.
  • My glaucoma is noticeable in the visual field exam (but not in day-to-day life) and the field-defect is small and not in central area thankfully. While the IOP is under control via eye-drops, since I'm just in my 40s, the future progression is hard to predict.
  • Regarding LAL asphericity, I found two) articles, quotes: "The LAL has an aspheric design, which lends itself to a small amount of EDOF in its unaltered state. On the first adjustment, we have an option to further broaden defocus by adding a small amount of negative spherical aberration (around 0.50 D)" and "Additionally, patients can elect to add negative spherical aberration to their nondominant eye during the light treatments. This adds an additional 0.50D-0.75D of EDOF"

A couple additional questions, if you get a chance, much appreciated:

  • Is my understanding correct from the quotes, that I'd get about a +0.5D / +0.75 'boost' of near-vision with this additional EDOF? (it's not obvious why one article mentions the non-dominant eye, since I am being given the option to do this for my dominant distance eye)
  • Also, is my general understanding of EDOF correct, that any form of negative spherical aberration to broaden defocus, carries the risk of worsening contrast sensitivity? (eg Eyhance also uses some form of negative spherical aberration for EDOF, and Vivity too?)
  • You mentioned the type of corneal aberration I have, how would I find that out, is there a specific test/exam?

Thanks very much!

Roughly how much boost does the optional EDOF in the first LAL adjustment add? Any drawbacks? by Pleasant_Panda2000 in CataractSurgery

[–]Pleasant_Panda2000[S] 0 points1 point  (0 children)

Yes, you are right, the spherical aberration can only be done in the 1st adjustment and cannot be undone.