Any Recommendations for (accomodative) IOL?

[rsbrux]

A few years ago I had a Lenstec Tetraflex IOL implanted in my left eye due to a cataract.  I am pretty well satisfied with the result, but I can see the edge in the dark with peripheral lighting, and I am also having first signs of PCO in that eye.  It is now time to have my right eye operated and I am wondering if there are better choices available. Does anyone have any more recent recommendations?

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

You are obviously an intelligent person and have put a lot of time and effort into studying IOLs. Like buying a car, the decision is up to you. The primary advantes of the LAL are that post operative adjustments can be made up to about 6 weeks post operative, it corrects astigmatism without having to worry about operative orientation of the toric IOL.  It is not true that the majority of patient get PCO and need Yag capsulotomy. Studies have show an incidence of 10-20%.  

[rsbrux]

Thanks that gives me hope of avoiding PCO in the right eye. I am still interested in having another accommodative lens, however.  Do you have any experience with them?

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

Short answer 'no'   most of my patients go for  monofocal due to costs,  then toric for astigmatism,  the surgeons in our group (14) use a variety of accommodating IOLs and now LAL.

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

Our practice has switched to the Light Adjusted Lens (LAL) with excellent results. If I needed cataract surgery now for myself, that is what I would pick. (5/2/2023)

[rsbrux]

Thanks for the advice.  Would you care to elaborate on why you think an LAL would be a better choice?  I chose the Tetraflex mainly because of its accommodating quality.  I can read comfortably with the implanted eye down to a distance of around 50cm. I was hoping that its relatively large lens diameter would also reduce the likelihood of seeing the edge in low, indirect light, but have been disappointed in this.  Does the LAL have a larger lens or lower incidence of post-operative PCO?  The surgeon who operated on my left eye said that the vast majority of his patients get PCO sooner or later, regardless of which lens they choose.