LAL+ Full Release Just Happened

AR is Auto Refraction - from the Auto Refraction machine - machine usually has a hot air balloon in the distance as it shines light through one's eye and computes the refraction data. This is both a check sum and a starting point for the MR - Manifest Refraction which manually done.

Update.

Had second complete refraction for surgeries, yesterday, 11 July. While I thought there was change going on over the last couple of weeks in both eyes relative to near versus distance, the refraction yesterday was pretty close to the one on 21 Jun.

21 Jun
OD Plano +1.25
OS -1.50 +0.75

11 Jul
OD +0.25. +1.25
OS -1.50 +1.00

OD - the dominant eye (OD/R) now being +0.25 means it is longer than normal (plano), but some not insignificant amount of astigmatism is affecting it. The cylinder (astigmatism) did not change.
OS - the non-dominant eye (OS/L) is showing an additional +0.25 D of cylinder (astigmatism) - this may be what I am feeling most. I also noted I would like to have a bit more closer vision in the non-dominant eye (mono-vision)

I think my Doc was saying all the right things, noting he is part of a couple of ophtho forums where they exchange notes and discuss how LAL develops EDOF. Since the refraction was so close to the previous, he offered to do the first adjustment yesterday, but I asked for another week. He was very agreeable and noted we would have another refraction which was a good thing - he’s not in a hurry, either - so, good answer, I think.
His plan was to get OD back to plano and to eliminate the cylinder (astigmatism) - if this works out well, may be done with the OD. On OS (intended for monovision) he noted it was being affected by the cylinder, so he plans to eliminate the cylinder which should change the Spherical Equivalent to -1.50, whereas it is now -1.00 so near vision should improve and provide more EDOF and this moving myopically.

He noted few other things I found interesting:
1. He has done quite a few LAL+ since their release, but has not, so far seen significantly greater EDOF than with the non plus LAL following the usual process of moving myopically.
2. Instead of implanting two LAL+, he is leaning towards LAL in the dominate eye (for distance vision) and LAL+ in the mono-vision eye.
3. Being in a rush to adjust and lock in is counter to the best interests of the patient.
4. He is beginning to discuss LAL with anyone over 50 who wants mono-vision (no glasses for the most part) instead of PRK or LASIK (he does all these). This is simply reflective of the overwhelming likelihood of developing cataracts and the seemingly lifetime utility of the LAL (yeah, I know time will tell).
5. I asked - he agrees many ophthamologists don't like LAL because it may cost them money, disturb their in-out process with normal cataract replacements.

As always, would appreciate any feedback or your experiences!

Does your doctor implant the Clearview 3? Thank you for posting about the S
LAL. Since I have not had Lasik I am not sure that the LAL l is the right lens for me. Thank you for posting. I just can't figure out what is the right thing to do for my eyes.

Update -
I've put a lot of data into previous posts, so wanted to get this seen JIC anyone is looking for a complete flow to at least post First Adjustment.
Surgeries - 5 Jun (non-dominant OS), 12 Jun (dominant OD)
See photo for MR data starting with initial consult on 28 Nov 23 and another four sets of refractions (we decided to wait at that point for the release of the LAL+, but after release, following an extended review and consult with another session of refraction and keratotomy, the surgeon said he did not think it suitable for my eye's topography, so we reverted back to LAL.
I had already forgotten how BAD my eyes had become in just 2-3 years (11/28/23 consult), due mainly, I suspect, to the cataracts.
While there was a change of 0.25D in a couple of the refractions, over a period of 5-6 weeks post surgery, the largest Manifest Refraction (MR) change came on the day scheduled for the first adjustment, yesterday. The sphere of my non-dominant (OS) was -0.75 vs the previous -1.50 - same tech did three of the refractions, the surgeon did one and an optometrist did one . In the world of sphere, this may not be a huge difference.
After discussion yesterday, the surgeon input plano and zero cylinder for the OD, and -1.25 and zero cylinder for the OS. The LDD took 1-2 minutes.
The doc slipped the contact lens used only for the adjustment on with a bit of eye lubricant (said some patients used as a night time eye lubricant) onto each eye in turn - the non adjusting eye was covered with a patch, what looked like LEDs in a circle came on in the eye piece, followed by a green pin point that I was to focus on. Occasional noise as the LDD administered the light. Doc pulled the lens off prior to pushback from the LDD, then repeated on the other eye. A nurse was present and the two used a verbal and visual confirmation for each LDD setting, and confirmed with me. It was not necessary for the nurse to hold the back of my head as is shown in some videos.
It has been about 22 hours since the first adjustment. My sense is that my dominant eye is about the same distance as before - but is a bit clearer (recall it had +1.25 cylinder) so likely less astigmatism, now. The non-dominant eye seems to allow focus in closer - previous to the first adjustment it would begin to blur at about 15" or so - now it begins to blur around 6-7" (all plus or minus a bit) - and a bit crisper. At least initially, the basics of the planned adjustment may have been met - ie OD seems less astigmatic, and OS seems a bit better closer and less astigmatic.
Surgeon noted it could take 48 hours for adjustment effects to be seen - and, then, until the next refraction, can't really compare data. Next refraction (and maybe adjustment) in three weeks - they have never been in a hurry - a major thing they appear to understand. Summary - if it never got any better I would feel like this has been worth the trip! My surgeon and his team seem like they are "in the loop" with others discussing how LALs work, and are very patient centric.

jhs,

Not sure if he does - my choice of the LAL was based on the ability to modify the lens after implantation - I would have done this whether I had previous PRK, or not. No other lens offer this rather binary advantage.

So, now about 43 hours post First Adjustment.

Had to go back and check to see what I had posted around the time of the first refractions following implantation of both LALs.

OD/Dominant - previously noted distance as being good (MR of plano), with sphere blur starting at about 3' as I brought objects closer - had astigmatism I could feel, as well - could still everything on car dash, computer, etc. Today it is near plano - maybe NOT quite as good (can't tell for sure without refraction), but I don't get blur until around 18" as I bring objects in - this is great if it holds. The clarity is better - hopefully this mean the cylinder (astigmatism) was adjusted lower - hopefully to zero.

OS/Non dominant - previously noted seeing well from 12" out to about 10' - but, then as time went on distance improved quite a lot to be as good as the OD. Today, I lose objects coming closer when they get to about 6-7" which makes sense since the first adjustment was supposed to bring OS from -0.75 to -1.25 (one half diopter closer). I believe I have lost some distance, though - which makes sense given the new monovision differential of -1.25 - and, may have lost some mid range, as well. I think the astigmatism is better (less cylinder).

My next refraction is in three weeks - will post if something significant changes between now and then

Hello,
Thank you for the wonderful post. Is your next adjustment in 3 weeks?
It is so helpful to ask you questions.
Julie

jhs,

Remains to be seen whether will adjust on same days refraction - depends on what the refraction indicates.

Six days after my first adjustment my sense is that my distance dominant eye is not quite as good as I would like - it may no longer be plano, but astigmatism seems better. Non dominant left seems about the same. Need some metrics to determine what has happened.

Hi mayoconectuser1,
You have been in my thoughts and I am wondering how it is going. I hope to hear from you soon and I hope you are doing well. You are very gracious to share your LAL experience.

Hi All,

Have been statusing on the LAL fb page - pretty good summaries from a lot of folks. Page is administered by an ophthalmologist in Sacramento.

Following the first light adjustment on 18 Jul, I returned for refraction and review on 7 Aug. During that period of time my subjective sense was that the dominant eye was a bit "shorter" and not as clear. The refraction (MR) supported this, -0.50 +0.50 and unaided at 20/25+2 and J7 - so, we got rid of some astigmatism, but not all and ended up with more spherical error. Non dominant eye seemed pretty darn OK, with better short and midrange - even distance was pretty good (I guessed at maybe 20/30-40). Refraction showed it at -2.00 +0.50 indicating some of the cylinder (astigmatism) was gone, but not all. The -2.00 sphere indicated the near should be better, but interestingly I seemed to have some EDOF with good mid and OK distance. Decided to wait a bit longer for stable refractions.

I returned for refraction on 14 Aug - on and off a few airplanes. OD was 20/25 and J5 with -0.75 +1.00. OS was 20/30 and J1 with -2.00 +0.50. Given the stability in refractions, we decided to adjust ONLY the dominant eye. My subjective sense following this was that the OD was definitely better distance, and about the same mid/near (more like the J5 than the J7). OS continued as before since we didn't adjust it.

Next refraction was 28 Aug (yesterday) (I had been on and off four airplanes in between - saying this only so folks know this isn't an issue). OD was 20/20, and on phoropter I could get perhaps as good as 20/15 with three of the 20/10 letters with J7 - mainly cylinder still. OS was -2.25 and +1.00 (sphere was -0.25 more myopic and the cylinder was worse by +0.50 diopter), BUT I could just get to 20/20-2 with J1 (this is pretty incredible and maybe lucky, but certainly 20/25 or 20/30 which is still incredible with -2.25 diopters different (monovision) from the distance eye). I had some shadowing with the OS on distance, so we're thinking adjusting the cylinder will be helpful. We decided to do nothing, until next week. May just address the cylinder on OS and leave OD alone for a bit longer.