LAL+ Full Release Just Happened

I'll update as I go through the process.

Non dominate left is on 5 Jun, followed by dominate right on 12 Jun.

My goal is to be completely free of glasses - as I was following PRK. The logic says (1) use LAL to prevent surprises with the previous PRK, then (2) monovision since this is the only way to avoid glasses. In virgin eyes, it might make sense to consider Clearview 3 or some other EDOF or multifocal.

Can't yet find much on difference in outcomes between LAL and LAL+ ... except mention by a youtube ophthamologists at an Austin clinic who noted in passing their patients didn't report much of a difference between the two. I'm OK with the caution I've seen from my surgeon - he checked with a few colleagues and RxSight before telling me why he could not use LAL+.

Couple of recent articles.
https://www.reviewofoptometry.com/article/keeping-up-with-the-newest-iols
https://www.reviewofophthalmology.com/article/which-lens-for-which-patient

Those are excellent articles. I have watched so many YouTube(s) - and read all the comments. I am excited for you, and appreciate your willingness to share your LAL journey, I wish I could talk to some patients in Kansas City who have had the LALs implanted.

Non dominate LAL implanted yesterday about 1100. IV had a bit of drowsy meds so I don't really recall much at all. Some bright lights, then recovery area. Did not feel any of the tools used to retain eyelids. Zero pain. Had clear eye shield over the eye, Gave me the three sets of glasses - tinted, clear and clear with 1.5 magnification. Very quick and easy. Only thing painful was the IV.

Spouse drove me home and I took a nap for a couple of hours. Mechanical issues 😀 using the clear lenses over the clear curved plastic eye shield, but could watch TV and read - still no pain. Not sure if the clear glasses do much over the shield since I don't know if the shield filters 365 nm light.

Initial thoughts are that the left eye light is whiter and right more yellow - probably due to the cataract being removed from the left eye. With shield can't tell much, yet, but perhaps the left (previously my near vision eye) is now much longer vision oriented. Very early.

Shield did a great job for sleeping - no worries and very comfortable. No pain this morning, either.

Post op visit is this afternoon and shield will be removed - so will know more tonight and tomorrow. Likely some swelling, so should be a few days before anything definitive,

This doc uses the dropless process so meds are injected into the white of the eye and dissolve over time - antibiotic and an NSAID - https://www.health.harvard.edu/diseases-and-conditions/what-is-dropless-cataract-surgery

Next week is the dominate eye. Perhaps they do somewhat close together - assuming the first eye surgery outcome is solid - in order to be able to test eyes together. Will find out more.

Back from post op visit ... plastic shield removed. Operative eye still a bit swollen, but can already see better with it long than the other eye - this should be the short eye - doc says no problem, we'll adjust starting in a couple weeks.

Zero pain so far.

Wore protective sunglasses this afternoon - will wear clear one inside house in daytime.

Update - dominant eye (right) cataract removed and LAL implanted. Different experience than first.

Same everything - same doc, facility, meds, same physical size LAL (slightly higher power of +25 vs +24 on first one). This time there was some subconjunctival bleeding (likely from the implantation of the meds (interocular NSAID and antibiotic - referred to as "dropless" meaning no follow up drops are required). Initially "crunchy" feeling with some discomfort - this discomfort had faded by about 12 hour point when the doc did his follow up call. Vision was pretty blurry - good color like the left (yellowed cataract now missing 😀).

At this point the first eye was very clear. Even the initial positive dyphotopsia of the angled light streak when looking at streetlight at night - at 10 and 4 o'clock - was gone. Still had tiny bit of "fuzz" around the light, but none of the colored concentric rings I had prior to the op.

Right eye has continued to improve in clarity - slowly - the difference is likely a difference in post op swelling I was told. I have an angled light streak at 2 and 8 on the clock. My understanding is these are associated with the capsule being a bit wrinkled so it goes away.

Post op check looked normal.

The blood has begun to be reabsorbed - this morning (3rd day) it looks better. Swelling fading, I think, as well - visual acuity improving. No pain.

I have a check with optometrist after a week - intent is to begin establishing baseline refraction data. Next is beginning cycle of adjustments at three weeks after the second eye. Depending on outcomes of each cycle there should be 2-3 of these about a week apart.

Decision to be made ... how much difference between long (right dominant) and short (left non dominate) eye? Most accept that full monovision starts at 1.5 D, with mini monovision from .75-1.5 D. The sweet spot varies by individual. My previous target for PRK (and I got close to it) was 1.5 D - I was happy with this - BUT ... I can understand why so many folks chose long vision and wear short glasses - the long clarity is pretty awesome.

More later.

Your journal for the LAL surgery is amazing. So easy to follow. This means so much to me. I am glad you are doing so well and will send thoughts your way each day. Sounds like you have an excellent surgeon. Thank you for posting and will be thinking of you.

I meet with my surgeon this Thursday. I want intermediate/near micro monovision and wear glasses for distance. You are probably correct and he will tell me it is not appropriate. I have been nearsighted for 50 years - about -2.5D and can't imagine not seeing the clock when I wake up or being able to read the print on vitamin labels. I am a bookkeeper and need to read paper and see the computer.

Latest update - had refraction ninth day after second surgery. At this point all the subconjunctival bleeding had reabsorbed, both eyes felt fine and there was no remaining angled light streaks.

My sense prior to the refraction:
- dominant (R) eye seeing well long with blur beginning at around 3' (although can easily see car instruments, etc - even with just this eye) - refraction says 20/30, so pretty much aligned with my experience
- non-dominant (L) seeing well from 12" out to about 10', and OK after that (not as good as R, though) - refraction says 20/30-2, again aligned with my experience
- combined I think 20/20
- I can sit outside and see individual leaves on trees way out and color is outstanding with the R eye and with both eyes (OU)

The refraction (see photo) indicates
- R eye - sphere is plano so the PRK surgeon must have done a good job and the cataract surgeon estimated well on the length of my eye, but there is certainly some astigmatism (+1.25)
- L eye - sphere is about where it should be in a basic monovision scenario and this is also where the previous PRK had it, so, again, good PRK with predictable sizing by the doc, also some astigmatism (+0.75)

First dilation (and probable adjustment) is 11 Jul (four weeks on first eye and five weeks on the second). I'm guessing now, but doc might simply adjust out the cylinder (astigmatism) and wait for that to settle, or might also do something more fancy with the non-dominant eye at the same time to obtain better monovision - I don't understand this part well, but he could take some of the sphere out, which might, given the design of the LAL provide more mid/distance on that eye while not affecting the near. Will discuss options, but always looking for input here.

Photo of refraction - see below.

Edit - not able to add the jpeg for some reason.

OD Plano +1.25
OS -1.50 +0.75

Here's the photo - still trying .... was only 4.3MB, but wouldn't work, so chipped out a piece.

Hi mayoconnectuser1
For your refraction, I do not understand what AR means?
Is your vision different indoors from outdoors? Does different light seem to make a difference in the clarity of your vision? You are doing so well! Thank you for your help. Thank you for posting!