Light Adjustable Lens Experience

[psbpsbpsb]

I had started to discuss my experience with the Light Adjustable Lens in http://www.medhelp.org/posts/Eye-Care/adaptive-IOLs-outside-the-US/show/2076228 but found it was closed today.  I've just had my second adjustment and wanted to give the many interested folks in the community an update on my experience.

I had the second adjustment yesterday afternoon.  As with the first adjustment the appointment began with the optician working with me to look at where I was with my visual acuity and also getting an update on my intraocular pressures.  After being dilated and waiting an hour or so, I went in with the ophthalmologist and had the UV irradiation.  As before, they used topical anesthetic, a contact lens and eyepiece were applied, and the UV light turned on.  This time I didn't find the experience as uncomfortable.  It may be she used less irradiation this time or perhaps I still had part of the lingering washed out vision from the first adjustment still present.  After, I was essentially unable to see out of the treated eye because of a large, intense red/pink distorted area covering most of my visual field.  As the afternoon and evening went on it faded only slightly but I did seem to be able to have more sharpness with some distant objects than before, again, very hard to tell.

This morning still a lot of redness and pink hues especially noticeable when looking at white objects.Green LED lights look white.  But my acuity is returning and I feel that there was definitely an improvement with the second treatment.  The plan is for me to return in a few days for the first lock in and then the second lock in a couple days after that.  It is hard to really know just how well the lens is working at this point as I haven't recovered from the UV irradiation and I'm wearing the dark UV blocking glasses.  But I'm feeling optimistic that my intermediate vision is much better and reading vision also significantly better than my untreated presbyopic eye.  

Unless they close this forum or the moderators delete this post I'll put a couple follow ups on and some observations as I get the lock ins done.


This discussion is related to adaptive IOLs outside the US.

[psbpsbpsb]

I did have astigmatism addressed with the lens adjustment.  The ophthalmologist told me she left a 'little bit' intact as it would be of some optic benefit.  I've found using cheap over the counter reading glasses from the drug store helpful for very fine print close up without any distortion of the image, in the past I found that due to the astigmatism in the eye those weren't as beneficial as now.  I drove yesterday in bright light conditions without glasses and without problem.  I'm typing this on my computer without eyeglasses.  Every day I feel as though I'm doing better with this lens, there is definitely an adjustment period. Still with major green/blue discrimination problems but some of the other color issues seem better with improvement in the pink/red tinge issue.

[KayakerNC]

Great stuff!
Did you have any astigmatism pre-op?  If so, how did they deal with it?
Thanks again for all the updates.

[psbpsbpsb]

I'm only a week out from the last lock in and I expect the UV exposure side effects to reduce and resolve over time.  How long that will take I don't know but I wanted folks to know this happens so they aren't as surprised as I was.  I'm looking forward to being able to see green leaves again especially with spring right around the corner.

My healthy right eye has good vision and minimal presbyopia so my results are going to be very influenced by that.  It has never been operated on.

[flossy93]

Thank you so much once again for the thoughtful and detailed update.  It does sound as though you are getting multi-focal vision at various distances already.  Some folks who pay for premium lenses are never free of reading glasses and the fact that you do not need your progressives is a great sign.

It's very interesting to read that the color impairment and contrast decrease aspects of the UV exposure are not fully documented and explained as a side effect.  Depending on one's profession these defects in vision could be quite problematic, even if temporary.  I can't believe you are the first patient to notice these issues, although you are probably more articulate than most patients at explaining the defects you see.  

Have you had any opportunity to evaluate your night vision with regard to halos and other typical symptoms of multifocal implants?  I was wondering since the LAL doesn't have the typical abrupt transitions from one lens 'zone' to another whether it would still generate nighttime halos and glare like some multifocals.  I'll be interested in your experience in that area when you have had a chance to observe your results.

Thank you once again for your valuable feedback.  I really hope you find that the cost, effort and inconvenience of the LAL process ultimately gives you a very satisfactory final outcome.

[psbpsbpsb]

Hey folks, this is the one week anniversary of my last lock in treatment.  So at one week out my eye continues to recover from the UV light used for the procedure.  My experience may be different than the average person, I don't know because few, if any, have posted on this, but in my case the after effects of the UV were pretty dramatic and still have not resolved a week later.  In dim light conditions I have definite decreased light sensitivity in the central part of the eye corresponding to the scotoma present the initial few days after the lock in and some of my color vision is changed.  For example, there is a green button for 'post a comment' on this web page and when I look at it with the left eye where my lens is, it is the color blue.  Some blue street signs are the color green!  Reds are much more pronounced and in general greens/yellows are washed out looking almost white.  I think it is gradually improving and as I read about 'blue light hazard' online I note the recovery of the retina to the phototoxic effects of light can take weeks or even months.  I hope that surgeons and the manufacturer of this IOL will discuss this more openly as a side effect and warn people in advance.  I don't see anything published about this and it needs to be researched.

On the positive side I am finding my refraction is pretty good.  Using an eye chart in less than ideal circumstances, I'm seeing at least 20/40 distance and possibly 20/30 with good light conditions, and J4 or thereabouts for reading vision.  There is definitely a 'pseudoaccomodation' phenomena at work and I am feeling as though my brain is still learning how to interpret the signals and integrate it with the other eye.  The difference in color vision and differences in the ability between each eye to see in dim light make this harder.  When I walk outside in very bright light conditions my far vision is best.  I'm able to work on the computer quite well.  I think there might be a mini-monovision effect at work here too.  With both eyes my UCVA is 20/20 distance.

So at one week out - the UV light had side effects I'm still recovering from, I'm definitely getting a benefit at different visual ranges that might be better than a standard monofocal, and there is going to be more time needed to allow my poor old brain to adjust to these changes.  If they don't close this forum topic I will try and give you an update in a few more weeks.

While I was jealous of folks who are able to go in, get a quick surgery done, get refracted and have glasses with resultant good vision all in short order with minimum cost, I am also thinking that the long term benefits of this lens and the various requirements and costs involved may be quite wortwhile.  My old progressives are sitting on my desk collecting dust and I'm able to get around quite well.  I'm optimistic but just don't feel I've gotten the full benefit of this yet and don't know for sure if I can recommend it.

[psbpsbpsb]

A quick update.  Lock in two was finished Wednesday morning, 3 days ago.  Follow up will be in three weeks.  It is great to be out of the UV blocking sunglasses.  The day of the second lock in my vision was pretty bad due to the usual effect of the bright UV light.  It was better the next day and better still now.  I was told to expect several weeks of recovery.  

I cannot fairly report the final outcome yet because there has not been enough time for full recovery from the UV exposure.  My color vision is way off and there are contrast issues.  This morning I can read fairly small print with inverted colors enabled and bold text on my ipad (to decrease the contrast problem with a white background) and can also read a small scrolling banner on BBC news from a distance.  Intermediate/computer distance seems best of all.  The reading distance is not a 'crisp' vision but this may be a contrast problem.  Will give an update and summary after a bit more time goes by.