As someone who spends hours in front of Visual Studio Code and editing videos in Da Vinci Resolve, this video and the patient's explanation was extremely helpful.
Recently had my light adjustable lenses inserted. This was about two weeks ago. Initially the vision was what I would call “bionic vision“ extremely clear, but then over the last two weeks it degraded. Yesterday went for my first LAL “adjustment.“ Back to seeing very clearly now. I have a few more adjustments to go. So far so good. Incredible how expensive it was over the basic, but the piper must be paid.
Assuming you didn't have it covered by insurance from cataracts, what was the per eye cost for LAL? I just had a consult and they quoted $15k for both eyes
Thanks for this video. I had the 1st lens implanted 4 weeks ago; the second, 2 weeks ago. I am scheduled for the first adjustment in 3 days. Like the featured patient, I need sharper vision for computer and near vision in my non-dominate eye. Will perhaps get a very small adjustment for better distance in my dominant eye. Even at this point, I am glad I made the decision to get light adjustable lenses.
9:11 that card clearly states in large letters that it is to be held at 14" from the eye being tested. How does the fact that he's holding it at 30" alter the results? it seems to me that the distance being tested, in reality, is intermediate distance.
Outstanding video and documentation of a patient's experience! Dominant eye targeted for plano and non-dominant targeted for -1.25 is typically what I aim for as well. Can't wait to see more LAL videos.
Im surprised that you didn't make the patient wait at lest 6 months,, As you know it could take up to 8 months to completely heal,, It took me a good 6 months to have all of the bothersome side affects go away.. I have a panoptix multi lens in both eyes, My rt eye took a long time to completely heal, the left was much faster.. today im 20/20 rt eye ,, 20/15 left and J 1 +.. The bright light and halos are quite big ,, If I every do replace the lenses it would be because of the halos at night I need to learn more on the light adjustable lens.. Thank you for this video.. Lou
I also had panoptix in both eyes two months ago but I am still seeing glow and ghosts around every letter and everything. Did you suffer the same thing?
Yes!!! I had that and much more,, My vision was so blurry in the mornings that i couldn't see my face in the mirror and would stay that way until about 4PM and even then my vision was only 50% clear, I was going nuts!!! it was like that for 4 months, I was in the Doctors office consistently, my cornea was the problem with swelling and dry eye, I didn't have my left eye done until 6 months later and that eye healed in 2 months , and now i am fantastic ,, just hallows at night, that now im starting to get use to...No 2 eyes are the same and people heal differently.. keep putting eye drops in to keep your eyes moist and give it at least 6 months, If your doctor did everything rt, your end result will be great.. Go get a second oppion to help you set your mind at ease I got 2 other options..@@bassamabdulwahab6606
@@louisgaccione7794 Halos at night and ghosting/doubling near distance and distance not cystal clear on Panoptix lens. LAL looks like it could resolve all those issues. Just need to hear from more patient experiences.
I had my left eye operated on with PanOptix (2 years ago). I had exactly the same issues as this patient (similar ago too) with PanOptix with reading (ghosting, doubling etc) [I do desk work]. Distance was wasn't cystal clear either, with Halo at night a massive issue. So very very disappointed. Hence, I didn't operate on my right eye. So, I am glad to see LAL working well. Would love to see more LAL patient experiences. As, I will be looking for LAL in the near future (both eyes) once more companies adopt it in the UK. Just wish this was unable 2 years ago. Thanks.
Great video Dr Wong. Can patients have laser procedures say for a retinal tear or other issue when a light adjustable lens has been implanted and “locked in” ?
This lens seems to be the one for me unfortunately, where I live the top eye specialist isn’t as yet providing LAL as part of his portfolio however, I think it’s only a matter of time when he does….Thank you for this information and your patient’s feedback 👍
I think the reasons that the LAL adoption is slow are mostly these two -- 1) it requies a lot of after surgery care time (light delivery treatments) on the part of a small or medium sized practice... big multi doctor practices have specialists that only do the adjustments so it is more efficient, and 2). whether purchased, leased or rented, the light delivery machine for adjustments isn't cheap. LIke most newer technologies in every area of medicine, the two coasts tend to adopt new procedures before the big middle part of America.
Quick question: What distance is someone supposed to hold the Jaeger chart for near? I thought it was 14 inches, but it looks like he's holding it at around 20 inches or so? Wouldn't that affect his rating?
Did the patient try adjusting the monitor(s) for optimum brightness and contrast before giving up on the first lenses? Not to nitpick, but I’m facing cataract surgery and that bit of context would be very helpful.
Thank you doctor. Need cataract surgery went for my examination. Will most likely get Rxsight light adjustable lens. Thank you again. BTY hard to read the screen .
Dr. Wong, I would love to know what this patient's manifest ref. was with the panoptix. It seems very possible that he had some uncorrected astigmatism causing the ghosting with pantoptix. I am also curious if he switched his cpu background from dark mode to white for code, if it may have reduced the problem without second surgery. Thank you.
I have the same exact issue with Panoptix as this patient but if I turn the brightness all the way up on screens I can live with it. I also have significant halos around points of light day and night. All that said I'm happy enough to live with them. The LAL was just coming out without a lot of info when I had surgery over a year ago. It's great to see more and more options though. When is the holy Grail accommodative lens coming? 😊
Even though this is an N of ! and in a patient who had another lens first this was super helpful. Given all of the extra visits what is the different in price?
Very informative video, Dr. Wong, thank you. I'm curious why you did a second LDD treatment on his right eye when the patient had excellent vision at 20/20-1 distance and J1+ after the first LDD treatment. Adding -0.5D more near in the next LDD treatment reduced his distance vision with the same near vision. Also, his left eye improved markedly, especially near vision, from J7 to J3 without any light treatment. Could you comment? Thank you.
@@ShannonWongMD How did the left eye improve without treatment and why not get it to the same as the 20/20-1 J1+ as the other before the last treatment? TIA
I do a fair number of premium IOL surgeries & Panoptix is an excellent IOL, gives great distance, intermediate & near vision. One needs to explain the dysphotopsias to the patient & give some time to adapt. By a month almost all are comfortable.
Yes, I have Panoptix in both eyes and I think they are excellent, the halos were not a problem for me because I expected them and since I had cataracts, I already had some habit of them, I think it is more difficult for those who have surgery to remove their glasses because they have expectations of total perfection and some short-sighted people do not see as closely as they did before the operation. I did not have glasses before the operation and from the first moment I saw well at all distances and the neuroadaptation works very well, I am now 4 years old in one eye and 3 years old in the other and I only see halos in lights but not consciously, They go unnoticed now, but they never bothered me.
I’m trying to decide what lenses to get. I don’t want any of the shiny reflections coming off my eyes. My understanding is silicone lenses don’t have this problem? Are there any silicone multifocal lenses that provide for good vision at all distances without the “sparkle”?
over 1 year and have panoptix both eyes. vision not 20/20 more like 20/30 to 20/40 and fluctuates during the day so I cant get eyeglasses. was better off before the surgery. Doctor blames it on dry eye so no fix.
@@3100fps I have dry eye too but I’m hoping that being on Xiidra for a few years has helped that. I’m having a Panoptix placed tomorrow. Fingers are crossed!
No. Each case is different. For example, I had cataracts, first in one eye and I didn't wear glasses and I searched on the internet and from the first moment I knew that I wanted a trifocal lens and I knew about the halos and I didn't care because I knew very well that I didn't want glasses and I got Panoptix And from the first moment I saw very well at all 3 distances and the halos did not bother me because I knew I would have them and I knew about neuroadaptation and a year later I put another Panotpix lens in the other eye when the cataract appeared in the other eye. It never bothered me to have the Panoptix lens in only one eye and when I put on the other Panoptix lens a year later it worked very well too, at first I also saw halos in the letters, but it didn't bother me and everything became normal and I've been in it for 4 years now one eye and 3 in the other and happy, the halos of lights will always be there but it is as if they do not exist because they make no difference. I see excellent.
Seems to me that comparing a multi-focal lens to a monofocal lens is not a valid comparison. I have a Panoptix and a Vivity - and prefer the Vivity. I must add that I am sure that any IOL is better than contact lenses or LASIK. I would like to see Dr. Wong's opinion on using Pilocarpine to permanently constrict the pupil to provide better vision. Seems to me that constricting the pupil defeats the effect of the multifocal lenses since only the center of the IOL is getting light. I predict the guy in the video is going to want another IOL exchange.
I will never change my panoptix multifocal toric iol, my far vision is 20/20 partially and my near vision accuty is J1+, only I am disappointed of negative disphotosia
No, they are not lies, they are excellent, what happens is that you should read for yourself and inform yourself, not be painted with golden birds and not see the bad. I have Panoptix and they are excellent, I knew I would see halos but I knew I wouldn't need glasses. For example, I feel that these LAL lenses would not be for me, however with the Panoptix I knew what to expect and if you think that there are perfect lenses, you will be disappointed in any one they give you, because there aren't any, you just have to read the advantages and disadvantages of each and think about which one you think you would adapt to. Although if I were you, I think I would not have surgery on my eyes to remove my glasses, of course my opinion is not objective because I have never used glasses, I had to have surgery because I had cataracts so I had no choice, but I think that even with I would prefer glasses to an operation that will bring other disadvantages, so I must inform you very well so that you do not fall into false expectations because you will not be able to go back.
@@harjitsamra1313 No, they are not lies, they are excellent, what happens is that you should read for yourself and inform yourself, not be painted with golden birds and not see the bad. I have Panoptix and they are excellent.
So happy for your patients. They are blessed with such an experienced and attentive refraction surgeon!
As someone who spends hours in front of Visual Studio Code and editing videos in Da Vinci Resolve, this video and the patient's explanation was extremely helpful.
LAL Lens is incredible. How amazing you can change the RX while it's in the eye. Great patient, great doctor, great results.
Recently had my light adjustable lenses inserted. This was about two weeks ago. Initially the vision was what I would call “bionic vision“ extremely clear, but then over the last two weeks it degraded.
Yesterday went for my first LAL “adjustment.“ Back to seeing very clearly now. I have a few more adjustments to go. So far so good.
Incredible how expensive it was over the basic, but the piper must be paid.
Hello. And how it is your vision now? Could you provide more information?
Assuming you didn't have it covered by insurance from cataracts, what was the per eye cost for LAL? I just had a consult and they quoted $15k for both eyes
@@jamesreader5955 Price wise it depends on location. Recently in New Jersey my friend had LAL replacement at $5000 each eye.
Thanks for this video. I had the 1st lens implanted 4 weeks ago; the second, 2 weeks ago. I am scheduled for the first adjustment in 3 days. Like the featured patient, I need sharper vision for computer and near vision in my non-dominate eye. Will perhaps get a very small adjustment for better distance in my dominant eye. Even at this point, I am glad I made the decision to get light adjustable lenses.
9:11 that card clearly states in large letters that it is to be held at 14" from the eye being tested. How does the fact that he's holding it at 30" alter the results? it seems to me that the distance being tested, in reality, is intermediate distance.
I'm glad you pointed this out. So the J score is wrongly reported. Still good results though
Outstanding video and documentation of a patient's experience! Dominant eye targeted for plano and non-dominant targeted for -1.25 is typically what I aim for as well. Can't wait to see more LAL videos.
Im surprised that you didn't make the patient wait at lest 6 months,, As you know it could take up to 8 months to completely heal,, It took me a good 6 months to have all of the bothersome side affects go away.. I have a panoptix multi lens in both eyes, My rt eye took a long time to completely heal, the left was much faster.. today im 20/20 rt eye ,, 20/15 left and J 1 +.. The bright light and halos are quite big ,, If I every do replace the lenses it would be because of the halos at night I need to learn more on the light adjustable lens.. Thank you for this video..
Lou
I also had panoptix in both eyes two months ago but I am still seeing glow and ghosts around every letter and everything. Did you suffer the same thing?
Yes!!! I had that and much more,, My vision was so blurry in the mornings that i couldn't see my face in the mirror and would stay that way until about 4PM and even then my vision was only 50% clear, I was going nuts!!! it was like that for 4 months, I was in the Doctors office consistently, my cornea was the problem with swelling and dry eye, I didn't have my left eye done until 6 months later and that eye healed in 2 months , and now i am fantastic ,, just hallows at night, that now im starting to get use to...No 2 eyes are the same and people heal differently.. keep putting eye drops in to keep your eyes moist and give it at least 6 months, If your doctor did everything rt, your end result will be great.. Go get a second oppion to help you set your mind at ease I got 2 other options..@@bassamabdulwahab6606
@@louisgaccione7794 Halos at night and ghosting/doubling near distance and distance not cystal clear on Panoptix lens. LAL looks like it could resolve all those issues. Just need to hear from more patient experiences.
I had my left eye operated on with PanOptix (2 years ago). I had exactly the same issues as this patient (similar ago too) with PanOptix with reading (ghosting, doubling etc) [I do desk work]. Distance was wasn't cystal clear either, with Halo at night a massive issue. So very very disappointed. Hence, I didn't operate on my right eye. So, I am glad to see LAL working well. Would love to see more LAL patient experiences. As, I will be looking for LAL in the near future (both eyes) once more companies adopt it in the UK. Just wish this was unable 2 years ago. Thanks.
Great video Dr Wong. Can patients have laser procedures say for a retinal tear or other issue when a light adjustable lens has been implanted and “locked in” ?
This lens seems to be the one for me unfortunately, where I live the top eye specialist isn’t as yet providing LAL as part of his portfolio however, I think it’s only a matter of time when he does….Thank you for this information and your patient’s feedback 👍
I think the reasons that the LAL adoption is slow are mostly these two -- 1) it requies a lot of after surgery care time (light delivery treatments) on the part of a small or medium sized practice... big multi doctor practices have specialists that only do the adjustments so it is more efficient, and 2). whether purchased, leased or rented, the light delivery machine for adjustments isn't cheap. LIke most newer technologies in every area of medicine, the two coasts tend to adopt new procedures before the big middle part of America.
Agree, costs of new equipment and people to do it is a big factor…Thanks for your response 👍
Quick question: What distance is someone supposed to hold the Jaeger chart for near? I thought it was 14 inches, but it looks like he's holding it at around 20 inches or so? Wouldn't that affect his rating?
Did the patient try adjusting the monitor(s) for optimum brightness and contrast before giving up on the first lenses? Not to nitpick, but I’m facing cataract surgery and that bit of context would be very helpful.
Thank you doctor. Need cataract surgery went for my examination. Will most likely get Rxsight light adjustable lens. Thank you again. BTY hard to read the screen .
Very informative!
Dr. Wong, I would love to know what this patient's manifest ref. was with the panoptix. It seems very possible that he had some uncorrected astigmatism causing the ghosting with pantoptix. I am also curious if he switched his cpu background from dark mode to white for code, if it may have reduced the problem without second surgery. Thank you.
I have the same exact issue with Panoptix as this patient but if I turn the brightness all the way up on screens I can live with it. I also have significant halos around points of light day and night. All that said I'm happy enough to live with them. The LAL was just coming out without a lot of info when I had surgery over a year ago. It's great to see more and more options though. When is the holy Grail accommodative lens coming? 😊
Even though this is an N of ! and in a patient who had another lens first this was super helpful. Given all of the extra visits what is the different in price?
Very informative video, Dr. Wong, thank you. I'm curious why you did a second LDD treatment on his right eye when the patient had excellent vision at 20/20-1 distance and J1+ after the first LDD treatment. Adding -0.5D more near in the next LDD treatment reduced his distance vision with the same near vision. Also, his left eye improved markedly, especially near vision, from J7 to J3 without any light treatment. Could you comment? Thank you.
Good question. The patient wanted better near vision from the right eye and was willing to lose some far vision to gain near vision.
@@ShannonWongMD How did the left eye improve without treatment and why not get it to the same as the 20/20-1 J1+ as the other before the last treatment? TIA
I do a fair number of premium IOL surgeries & Panoptix is an excellent IOL, gives great distance, intermediate & near vision. One needs to explain the dysphotopsias to the patient & give some time to adapt. By a month almost all are comfortable.
Have you noticed a difference in the number of people affected by this issue after moving to the Clarion?
@@brianchild6092 I'm interested in this question too. Thanks in advance.
Yes, I have Panoptix in both eyes and I think they are excellent, the halos were not a problem for me because I expected them and since I had cataracts, I already had some habit of them, I think it is more difficult for those who have surgery to remove their glasses because they have expectations of total perfection and some short-sighted people do not see as closely as they did before the operation. I did not have glasses before the operation and from the first moment I saw well at all distances and the neuroadaptation works very well, I am now 4 years old in one eye and 3 years old in the other and I only see halos in lights but not consciously, They go unnoticed now, but they never bothered me.
I’m trying to decide what lenses to get. I don’t want any of the shiny reflections coming off my eyes. My understanding is silicone lenses don’t have this problem? Are there any silicone multifocal lenses that provide for good vision at all distances without the “sparkle”?
Why not implant a power aiming for -0.75 in the nondominant eye, aim for plano in the dominant eye, and skip the LAL altogether?
Because then people can't charge premium prices XD
That ghost glow
Contrast loss
Posterior cats
Presbyopia
No lens replacement
Whats the solution?
Good to see
People are playing with the premium lenses
This mean monovision is better than Trifocal (be it be best of Trifocal like panoptix), right Sir?
over 1 year and have panoptix both eyes. vision not 20/20 more like 20/30 to 20/40 and fluctuates during the day so I cant get eyeglasses. was better off before the surgery. Doctor blames it on dry eye so no fix.
This is not related to topic of this video, consult your doctor.
@@3100fps I have dry eye too but I’m hoping that being on Xiidra for a few years has helped that. I’m having a Panoptix placed tomorrow. Fingers are crossed!
Good luck I was never treated before my surgery but I understand pretreatment makes your odds of good results increase dramatically. @@SThompson953
No. Each case is different. For example, I had cataracts, first in one eye and I didn't wear glasses and I searched on the internet and from the first moment I knew that I wanted a trifocal lens and I knew about the halos and I didn't care because I knew very well that I didn't want glasses and I got Panoptix And from the first moment I saw very well at all 3 distances and the halos did not bother me because I knew I would have them and I knew about neuroadaptation and a year later I put another Panotpix lens in the other eye when the cataract appeared in the other eye. It never bothered me to have the Panoptix lens in only one eye and when I put on the other Panoptix lens a year later it worked very well too, at first I also saw halos in the letters, but it didn't bother me and everything became normal and I've been in it for 4 years now one eye and 3 in the other and happy, the halos of lights will always be there but it is as if they do not exist because they make no difference. I see excellent.
I think it is, I have ghosting with everything I read and glasses seem to amplify the ghosting so nothing crisp and clear
Seems to me that comparing a multi-focal lens to a monofocal lens is not a valid comparison. I have a Panoptix and a Vivity - and prefer the Vivity. I must add that I am sure that any IOL is better than contact lenses or LASIK. I would like to see Dr. Wong's opinion on using Pilocarpine to permanently constrict the pupil to provide better vision. Seems to me that constricting the pupil defeats the effect of the multifocal lenses since only the center of the IOL is getting light. I predict the guy in the video is going to want another IOL exchange.
Interesting.
I will never change my panoptix multifocal toric iol, my far vision is 20/20 partially and my near vision accuty is J1+, only I am disappointed of negative disphotosia
I am getting a Panoptix toric tomorrow. So what negative dysphotopsia symptoms do you have? Your far, intermediate, and near vision are okay though?
@@SThompson953I am experiencing a dark crescent
So the Panoptix turned to be a big lie
You can’t have it all. There is no free lunch.
Definitely a BIG BIG LIE. They get your hopes high and you then have to deal with the PanOptix issues. LAL is looking positive ;-)
No, they are not lies, they are excellent, what happens is that you should read for yourself and inform yourself, not be painted with golden birds and not see the bad. I have Panoptix and they are excellent, I knew I would see halos but I knew I wouldn't need glasses. For example, I feel that these LAL lenses would not be for me, however with the Panoptix I knew what to expect and if you think that there are perfect lenses, you will be disappointed in any one they give you, because there aren't any, you just have to read the advantages and disadvantages of each and think about which one you think you would adapt to. Although if I were you, I think I would not have surgery on my eyes to remove my glasses, of course my opinion is not objective because I have never used glasses, I had to have surgery because I had cataracts so I had no choice, but I think that even with I would prefer glasses to an operation that will bring other disadvantages, so I must inform you very well so that you do not fall into false expectations because you will not be able to go back.
@@harjitsamra1313 No, they are not lies, they are excellent, what happens is that you should read for yourself and inform yourself, not be painted with golden birds and not see the bad. I have Panoptix and they are excellent.