Nice video. I have some limited experience with LAL having done the FDA study. Impressive distance vision and excellent astigmatism correction. A lot of treatment and visits which translates into an expensive choice for commercial patients. I’ve been using Eyhance with the same targeting of -0.75 to -1.25 non dominant has given incredible intermediate and near results and distance eye plano to -0.25 is excellent distance and intermediate. Considerably less cost. No dysphotopsias either (just like LAL). Astigmatism corrects very well with toric version. Different tools that work’s similar.
That’s a really good strategy! I like the Eyhance a lot. Another way patients can get excellent results (if they’re ok with monovision) is to put the LAL in the far eye, and an Eyhance in the near eye. Near vision is more forgiving than far distance in general, since a book or phone can be shifted a couple inches further or closer if refractive error is slightly off-target. Similar results to LAL in both eyes but at half the cost (if they don’t have significant astigmatism). Btw I love your videos!! You are a great surgeon 👏
Thank you Dr. Krad - informative video. I had a lens replacement 2 weeks ago in my dominant eye and will have the lens replacement in the non-dominant eye replaced in a few days. However, I am hesitant to move forward because I have a wavy shadow (like a serpent's tail) moving back and forth across my pupil. The surgeon said it was "trimoxi" and it will dissipate. It has not changed in two weeks and is quite frustrating. Thoughts?
Hello Dr I had cataract surgery 3 years ago Dr implant wrong number lens for long distance vision in the right eye left eye treated by another Dr it's okay I'm having problem in seeing working etc can you suggest any solution for my problem kindly answer thanks
Great question about the dominant Plano eye. I found a journal article that describes this process. They use a VR headset to test various conditions. The addition of the proper amount of spherical aberration increases visual acuity for near and intermediate and reduces it for far. (See link and paste below). lo.um.es/lo.um/wp-content/uploads/2020/04/2020_JRefractSurg_Spherical_Hervella.pdf The enhancement of depth of focus by inducing spherical aberration has been previously reported. We found that adding negative spherical aberration led to a substantial benefit at near and intermediate visual acuity, whereas far visual acuity decreased for both conditions of spherical aberration in comparison with the control condition.
Just got the LAL placed in the second eye 2 days ago. Can’t wait for the eyes to heal and have them do the light adjustments. Right now close vision is vey blurry. Far vision is superb. I do have high astigmatism in both eyes plus had congenital cataracts. Any recommendations?
So when is the juvene, or power vision, or the jellisee lens being approved? Every visit I’m told “in a year or two” but I’ve been told that for twelve years now.
My surgeon offered me -0.75 non dom and -0.5 in dom for RayOne EMV Toric. The idea that I would be able to see piano books at 30-40 Inch and see my hands while Food preparing at 15 inch. Another doctor said I won’t be able to achieve it with RayOne with these diopters and wants to sell me PureSee. I’m very confused what lens to choose. I wrote about RayOne EMV as I noticed it on click pic but I didn’t hear about it in the video. Just wondering if anyone can answer my question.
It would be uncommon to have clear/crisp near vision at 15 inches with the RayOne EMV with a target of -0.75 in one eye and -0.5 in the other. I don’t have personal experience with the Puresee, but from what I’ve read about it, it should provide stronger near vision than the RayOne EMV.
Something else that I've been thinking about: Is the gain in EDOF lost if you go back the other direction? So for example if someone starts at plano and you adjust to -0.5 or higher for their near eye, and they're unable to tolerate it, so you adjust that eye back to plano--will their near vision with that eye still benefit from the EDOF of the first treatment?
@@DoctorKrad Amazing, thanks! And according to what I've been hearing/reading about this, this EDOF is only possible so long as 1) you're going towards myopia with minimum -0.5 and 2) this is done in the first treatment. LAL should still be treated as a monofocal lens, but i'm super curious if RxSight communicates this consistently and clearly about the LAL because any added benefit in depth of field--regardless if monovision ends up working--would mean happier patients. This also has implications for target refraction: aiming for plano or slightly hyperopic might be the best strategy to try to induce EDOF, contrary to the practice of aiming slightly myopic for target.
Have most of your LAL patients had previous experience with monovision (contacts or glasses) and if so for how long? If not, was it harder/take longer for the patient's brain to adjust?
The material cost depends on the Surgery Center's contracted rate with the manufacturer. I operate at 4 surgery centers (due to insurance mix), and they all have a different price tag for the same lens. The range I've seen is from $350-$550
Gotcha. I was thinking about your question at the end on how to add depth of focus to a plano eye. Wondering if targeting +0.50D for the implant and then targeting plano with the first LDD treatment would work since it's doing a -0.50D adjustment.
Just got the Clarion Vivity UV. Not satisfied. Got the blinder feeling at outside of the eyes. Rt eye blurry far and near, and this was my best eye tobegin with. I was not impressed with the measurement tools for cornea. Took two techs to get measuresment about 15 mins and each came upwith different numbers, should of walked out then. Guess I have unusal anatomy with eyelids and a nose?
I also suspect they mis-measured my eye. Vivity lens was installed in left eye. Was suppose to give distance vision with some intermediate. Now anything beyond 2 ft distance is out-of-focus. I cannot drive without glasses.
Depth of Focus after CATARACT, - and what is the DEPTH OF DAMAGE by a piece of plastic of the eye itself and what will happen to the eye after some time... ADVERTISERS avoid this side....!!!
Nice video. I have some limited experience with LAL having done the FDA study. Impressive distance vision and excellent astigmatism correction. A lot of treatment and visits which translates into an expensive choice for commercial patients.
I’ve been using Eyhance with the same targeting of -0.75 to -1.25 non dominant has given incredible intermediate and near results and distance eye plano to -0.25 is excellent distance and intermediate. Considerably less cost. No dysphotopsias either (just like LAL). Astigmatism corrects very well with toric version.
Different tools that work’s similar.
That’s a really good strategy! I like the Eyhance a lot. Another way patients can get excellent results (if they’re ok with monovision) is to put the LAL in the far eye, and an Eyhance in the near eye. Near vision is more forgiving than far distance in general, since a book or phone can be shifted a couple inches further or closer if refractive error is slightly off-target. Similar results to LAL in both eyes but at half the cost (if they don’t have significant astigmatism). Btw I love your videos!! You are a great surgeon 👏
Thank you Dr. Krad - informative video. I had a lens replacement 2 weeks ago in my dominant eye and will have the lens replacement in the non-dominant eye replaced in a few days. However, I am hesitant to move forward because I have a wavy shadow (like a serpent's tail) moving back and forth across my pupil. The surgeon said it was "trimoxi" and it will dissipate. It has not changed in two weeks and is quite frustrating. Thoughts?
I have that as well but it doesn’t bother me too much
Hello Dr I had cataract surgery 3 years ago Dr implant wrong number lens for long distance vision in the right eye left eye treated by another Dr it's okay I'm having problem in seeing working etc can you suggest any solution for my problem kindly answer thanks
Great question about the dominant Plano eye. I found a journal article that describes this process. They use a VR headset to test various conditions. The addition of the proper amount of spherical aberration increases visual acuity for near and intermediate and reduces it for far. (See link and paste below).
lo.um.es/lo.um/wp-content/uploads/2020/04/2020_JRefractSurg_Spherical_Hervella.pdf
The enhancement of depth of focus by inducing spherical aberration has been previously reported. We found that adding negative spherical aberration led to a substantial benefit at near and intermediate visual acuity, whereas far visual acuity decreased for both conditions of spherical aberration in comparison with the control condition.
Just got the LAL placed in the second eye 2 days ago. Can’t wait for the eyes to heal and have them do the light adjustments. Right now close vision is vey blurry. Far vision is superb. I do have high astigmatism in both eyes plus had congenital cataracts. Any recommendations?
Omar! Love the reading cards. Where can I buy some?
I’ll see if I could send you one :)
So when is the juvene, or power vision, or the jellisee lens being approved? Every visit I’m told “in a year or two” but I’ve been told that for twelve years now.
My surgeon offered me -0.75 non dom and -0.5 in dom for RayOne EMV Toric. The idea that I would be able to see piano books at 30-40 Inch and see my hands while Food preparing at 15 inch. Another doctor said I won’t be able to achieve it with RayOne with these diopters and wants to sell me PureSee. I’m very confused what lens to choose.
I wrote about RayOne EMV as I noticed it on click pic but I didn’t hear about it in the video. Just wondering if anyone can answer my question.
It would be uncommon to have clear/crisp near vision at 15 inches with the RayOne EMV with a target of -0.75 in one eye and -0.5 in the other. I don’t have personal experience with the Puresee, but from what I’ve read about it, it should provide stronger near vision than the RayOne EMV.
@@DoctorKrad Thank you so much, Dr. Krad, for your opinion. I clarifies more things I was told at the consultations. Love to watch your channel.
Something else that I've been thinking about: Is the gain in EDOF lost if you go back the other direction? So for example if someone starts at plano and you adjust to -0.5 or higher for their near eye, and they're unable to tolerate it, so you adjust that eye back to plano--will their near vision with that eye still benefit from the EDOF of the first treatment?
Yes, you can go back towards Plano. The lens power will change, but the lens will retain the EDOF benefit. That part is not reversed
@@DoctorKrad Amazing, thanks! And according to what I've been hearing/reading about this, this EDOF is only possible so long as 1) you're going towards myopia with minimum -0.5 and 2) this is done in the first treatment. LAL should still be treated as a monofocal lens, but i'm super curious if RxSight communicates this consistently and clearly about the LAL because any added benefit in depth of field--regardless if monovision ends up working--would mean happier patients. This also has implications for target refraction: aiming for plano or slightly hyperopic might be the best strategy to try to induce EDOF, contrary to the practice of aiming slightly myopic for target.
great job 👏❤
Have most of your LAL patients had previous experience with monovision (contacts or glasses) and if so for how long? If not, was it harder/take longer for the patient's brain to adjust?
What is the cost of Alcon toric lens compared to J&J Eyhance toric lens?
The material cost depends on the Surgery Center's contracted rate with the manufacturer. I operate at 4 surgery centers (due to insurance mix), and they all have a different price tag for the same lens. The range I've seen is from $350-$550
What post-op target MRSE did you use for selecting the pre-LDD treatment lens power?
I'm targeting Plano
Gotcha. I was thinking about your question at the end on how to add depth of focus to a plano eye. Wondering if targeting +0.50D for the implant and then targeting plano with the first LDD treatment would work since it's doing a -0.50D adjustment.
Just got the Clarion Vivity UV. Not satisfied. Got the blinder feeling at outside of the eyes. Rt eye blurry far and near, and this was my best eye tobegin with. I was not impressed with the measurement tools for cornea. Took two techs to get measuresment about 15 mins and each came upwith different numbers, should of walked out then. Guess I have unusal anatomy with eyelids and a nose?
I also suspect they mis-measured my eye. Vivity lens was installed in left eye. Was suppose to give distance vision with some intermediate. Now anything beyond 2 ft distance is out-of-focus. I cannot drive without glasses.
@@carlmax46 got Lasek on my right eye that bought things in focus. Might be worth checking out. My cataract doctor paid for it.
Depth of Focus after CATARACT, - and what is the DEPTH OF DAMAGE by a piece of plastic of the eye itself and what will happen to the eye after some time...
ADVERTISERS avoid this side....!!!
Idiotic millions of people have had their vision saved with iol