RxSight vs multifocal IOLs

[Jim_in_Italy]

I am returning to this community after years. I had cataract surgery with a Tecnis Symfony toric IOL in 2015 and was extremely satisfied with the results. 20-20 vision. Dr Hagan: you were an enormous help, both to me and to all this community, for which we are indebted. Unfortunately, i am one of those 75 year olds who has developed astigmatism which impairs my vision somewhat but I still manage without eyeglass correction 95% of the time.

I am now answering questions about my experience from my brother and a friend who need cataract surgery. I have encouraged them to join medhelp, and submit questions which I know that you, Dr Hagan, will be so kind to answer. But I wanted to send them the link to your primer on choosing an IOL, and in so doing, I found your remarks about , and recommendation for, the LAL RxSight.

My question is this: does the RxSight act as a multifocal lens like the Symfony and newer versions from J&J? Or is each eye corrected for a specific distance, like a monofocal solution?  I imagine that there could be a monovision correction where the non dominant eye is under-corrected for near vision/reading.

Many thanks, Dr Hagan

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

Hello Jim, welcome back. Pleased you are pleased. The Light Adjusted Lens (LAL) can correct most spherical and astigmatism up to about 0.50 to 2.5 diopters.  It is a monofocal IOL. Happiest patients are those who have used contact lens, or previous LASIK for monovision.  We never assure a patient that they will not need glasses for some things and/or to equalize eyes for a given distance.  The LAL has proven useful for corneas that are usually hard to predict post op uncorrected refractive error. e.g. previous radial keratotomy (RK), trauma. To treat the pupil needs to dilate well and poor dilators are not treated with LAL.  The beauty of LAL is that post op the patient can say they want one eye a little better at distance, or near, or intermediate, or can try mono-vision for a while. Experience of the surgeon and post op adjustment staff is important.