Dear Dr., I am considering participating in the RXSight post-approval clinical trial vs. paying the very expensive fee to have these LALs put in place by the same Ophthalmologist. About 1/3 of the trial will have standard mono lenses.
I am a 56 y/o female doc who has very mild amblyopia and strabismus since early childhood with mild exotropia remaining in my L eye (I had eye muscle surgery in 1976).
My L amblyopic eye is farsighted with acceptable computer vision (uncorrected) and my R dominant eye is nearsighted, with mostly good reading vision.
I have a terrible time with progressive glasses due to the narrow midrange channels, and occasionally get distance diplopia when I am tired. Lately I have noticed some peripheral vision issues on the L and some disappearing images.
I have been doing some eye exercises, patching, and am treating my dry eye for the first time, and I do see some mild visual improvement, perhaps a line better with my glasses on than before.
I seem to get to at least 20/20 with both eyes, with correction.
I chose the RXSight lenses because I felt that they had a better focal range, less halos/starbursts, could adapt to my astigmatism, and are nicely adjustable during some key healing times post-surgery.
I do a lot of computer work, use my iPhone and iPad a great deal, do minor medical procedures (I typically use reading glasses or magnifying lenses for these), drive long distances in rural areas in all sorts of weather, deathly afraid of rainy roads at night and deer, and naturally I have developed cataracts which are causing refraction prescription changes, some night vision issues (worst as mentioned when raining) and some haziness, darkness in my L amblyopic eye.
I was advised that doing the insurance-covered standard monovison lenses and surgery would not correct the astigmatism, would be fixed at one point, and keep me progressive glasses-dependent.
The diopter difference in prescription between my amblyopic eye and my dominant eye has been giving me a lot more eye strain lately, so I was hoping to minimize the difference in prescription between my eyes since I have an opportunity to put in new lenses.
In the past I have tried a single distance contact in my R eye, and it drove me crazy because I totally lost my ability to read with that eye, which I have been doing for my whole life. I tend to prefer single vision distance glasses and readers when I get a new prescription, and have struggled so much with progressives, that now that I do need progressives for midrange vision, like computer work, driving dashboard, mirror, etc., I end up by just not wearing them at all except when I am driving, since the distance window is nice and open.
At close vision, my R dominant eye takes over for reading. I only rarely use reading glasses, although they do help me see much better now that I am presbyopic, and I have trouble reading with progressives at all.
I have had a lot of issues trying to get my pupilary distances right, I think because my L eye strabismus wars with the fairly good distance vision I have there despite the amblyopia, that my brain struggles with the R dominant eye not seeing well at a distance, instead of switching pathways, so I have more double vision at a distance and it does not fix in one spot but moves around a bit.
My last pupillary distance that the Optometrist measured himself was L 28.5 and R 29. Up till this reading (total of 57.5), over the past 10 years my PD has been calculated anywhere from 61-64 with the R eye ranging from 30.5 to 29 and L eye ranging from 33 to 28.5. This variation, naturally, has been devilling for progressives. I have often ended up with 10 or more pairs of old glasses, and I find myself switching back and forth.
I just looked at my prescription changes over the past 10 years.
Currently I am OD S -2.75/C -0.50, Axis 150; OS S -0.50/C -0.5, Axis 65.
The Optometrist I saw in July 2023 added Horizontal Prisms at 2.50 IN bilaterally, but it seems to give me more crossed double vision near, unless the PD is too narrow (the PD was taken 3 times by different staff within a couple of weeks with readings on any given day that varied by about 1.5mm).
What is interesting is that my prescription has been changing all over the board. From 2014-2023 OD S has ranged from -3.00 to -2.00/C +0.50 to -1.00, Axis 65-175; OS S -0.75 to +0.75, Axis 5-150.
So, realizing that I may get the monovision lenses and not the LAL's, I suspect that I may be disappointed and end up down the road wanting to explant those lenses and put in whatever the current technology is.
I considered PanOptix on both eyes, but with the glare and halos, I am afraid of night vision issues. I also thought of doing PanOptix on one eye (possibly the L eye which would correct reading and boost computer vision) and RX Sight on the R eye for midrange and distance OR midrange and close. Or I could swap the two and put the PanOptix on the R eye, and do the LAL on the L for midrange and distance, since I am presbyopic at near anyway.
I have read a LOT of opinions and testimonials on the different lenses. I know that having a surgeon who is outstanding is part of the success factor, and at least I do have that, whether in the clinical trial or with the premium lenses at my cost. I am not sure if halos and starbursts would bother me a lot or not, but I do like crisp vision if I can get it. With the LAL, I understand that there can be issues with erythropsia, but the technology has been reported to be about as precise as is available in a lens in the US. With the PanOptix, the range of vision is very good at all 3 ranges for most people, and none of my surgeon's patients have requested explantation.
I know that typically multifocal lenses are not recommended for people with strabismus/amblyopia, but mine is very mild.
Notably, the outstanding Ophthalmologist's team was divided with the Optometrist recommending the PanOptix (If I was his sister) and the Ophthalmologist recommending the LAL (if I was his sister).
Is it worth the $11K gamble to opt into the clinical trial? Would explantation be a terrible idea if I ended up with the monofocal lenses?
I thought I would pick your brain. I did read the great article you posted from a couple of years ago. Now that there are more viable treatments, I wondered whether you could provide an updated opinion.
Thank you so much for participating in this forum.