Great video. Incredibly open and honest. For those of us still to make the final decision about which IOL option to go for, this case certainly is a little sobering. It definitely makes you cautious and even more careful about what you wish for! Without actually experiencing these dysphotopsia phenomena yourself makes it so tricky to assess whether you'll end up happy or sad, post surgery. Likewise assessing what degraded 'quality' of vison might feel like notwithstanding you can achieve 20/20 or better visual acuity. No easy, sure fire answers it would seem. When it is all said and done, I'm betting a monovison setup using monofocal lens' as the path of least resistance and with the greatest chance of great vision (near and far) without the "complications". Thank you Dr Krad and your patient for what was one of the best pre-cataract surgery tutorial I've watched to date.
Seems like monovision with monofocal would be best too-if they can dial it in during surgery. I’m trying to get a contact lense trial going to see if I’d like monovision.
Fascinating video, I learned a lot! Would love to see a future video where you discuss the pros and cons of the Alcon Clareon and Alcon Acrysof, vs their competition, for a glaucoma patient (with 3.8 diopters of astigmatism).
to the patient. first thank you for sharing and helping others. I am a nervous wreck doing this procedure as Im a pilot. curious because you mentioned a yellow tint on the LAL plus. Do you have that with the standard LAL also? That would drive me crazy. thanks for helping us all
That was me in the video and I now have great quality vision at both near and far. No glasses necessary. Just as good as when I wore progressive glasses but I do have a mono vision set up to make this work for me. I knew very well that mono vision does not work for everybody before I started this. Since my initial goal was good reading without glasses but was afraid of some of the horror stories of various multifocal experiences since I want to still drive at night, etc. I was thinking LAL originally but didn’t know how I would react to mono vision to achieve this. The CV3 was brought up as the best way to get the best reading vision possible with very minimal dysphotipsia at far and most people seem to react very well to this lens. Unfortunately, I was not one of them and my brain was perceiving way too much information that most people with the CV3 are just naturally filtering out. Note, just saying someone has 20/20 J1+ does not tell the whole story. No one talks about how long it takes to decipher words even at much larger text sizes. If was taking me 1-2 sec per word to read even large text on a computer or phone screen. I’m so glad I swapped out the CV3 for LAL/LAL+ and that Dr. Krad was so understanding and desirous to do what it takes for me to have the best possible vision. Stay away from doctors that just want your money and tell you you should be happy with your “20/20 J1+” vision when it is clearly not the rest of the story!
I definitely appreciate the transparency that you provide here. It’s just nice to hear the positives and negatives with all of these lens options. More specifically, listening to real patients tell their story it is important to get an understanding of what the expectation may or may not be. I live in Canada and this type of transparency/video is not abundant in my humble opinion I think for the most part because cataracts are covered on a basic level. However, if you’re needing premium lenses, which is usually the case, this is always an extra fee, which is often not talked about and not discussed until you go in for your appointment. Where the upsell begins lol I have been considering getting my lenses replaced in the US but I’m not sure if that’s a good idea or not? Maybe you could shed some light on this and maybe what kind of pricing one could expect for procedure using top-of-the-line premium lenses. Cheers :)
I've been thinking about making a video that would provide patients with transparency into the finances associated with cataract surgery and lens upgrades. Perhaps I will do so in the near future
@@DoctorKrad that would be awesome! In the meantime, would it be possible for me to provide my email to you so that you can provide additional pricing information as I would like to be able to go to you if possible. My daughter lives in Michigan so it’s not out of the question visiting the US. I forgot to mention a very important note trying to find doctors that will exchange lenses is somewhat problematic here to say the least. Only a few doctors will do it. It’s not so much the complications that are involved, as it is with our hip/coverage of the basic lensmy assumption, is that it’s avoided for that reason perhaps with us being said, however, there are some surgeons that will do it as far as I know.
@@DoctorKradplease do I am in the same predicament of this fellow Canadian. I have multifocal lenses that have had the yag laser procedure done in both eyes. I have not been able to adjust to the new lenses and am now in the process of looking into surgeons like yourself in the US to maybe help my situation out. I am currently looking to visit a fellow down in Texas but it seems you might be easier to get to travel wise if you are willing to look at me? Thanks for the great videos
Hey I am a fellow Canadian who has had refractive lens exchange. Just a heads up to you from my opinion and my personal experience is don’t let the word premium lenses fool you to believe they are better. Just because you are paying extra for those lenses doesn’t mean they will be better than the government provided lenses. You really have to understand exactly what the surgeons are saying in the English terms they use. It can get a bit confusing with what they are saying and what they are meaning with the terms they use. It’s hard to question the surgeons in my area as they only seem to give you a very small window of time to actually talk to them. You are just another one of their cattle being processed through their processing plant is what it seems. There are lots of people who seem to like the multifocal lenses but there are also lots of others like myself that are living a bit of a nightmare with them. One example for me was I was told I would have halos with these multifocal lenses I received but only for 6 weeks. That led me to believe it was a healing process from the surgery. Short time suffering for long term gains was my thought. After my original eye surgery my surgeon was telling me everybody heals at a different rate when I asked how long does he think the halos will last as well as the blurry vision I have. Little did I know the way the lenses are built the halos will never go away. It’s all in the mechanics of the lenses. Anyways I hope you have a better experience than I have had.
love it! Hey for ur main wound - did u simply reopen the original main wound? Do you have a timeline for when you create a new main wound? And when you do create a new main wound, do you make it over/below/thru/beside the original? Thanks so much for sharing!
Nope. Had I not had these “unreasonable” expectations I would still be suffering with bad quality vision instead of the great vision I am using to type on my iPad to you right now :)
Nice video, with real life experience…there is no perfect IOL that can replace our natural lens and if the patient does not have cataract, than this type of problem is worse, than a really nice conversation prior to RLE is essential
You have stated that the LAL lens does not correct for astigmatism, Is there a surgical option after the implantation to correct the astigmatism or only glasses???? If not, is there a lens you would recommend instead?
It’s hard to tell the difference now that I’ve had them a while. Of course one is set to far (LAL) and one to near (LAL+) so that makes it difficult to compare as well… so I’ll stick with my initial impression that the LAL has slightly less starburst but that comparison was so soon after surgery that it is hard to really know if that was caused by swelling of the cornea, etc.
@@tltolman73 Is it mono or mini monovision? What is the vision difference in each eye? I don't think mono vision is good for me, but considering the mini mono vision. Less disparity between the two.
@@lindacutrara9172 I guess it is technically mini-mono? I’m not sure what the cut off is. My near was set for -0.75 during the Light adjustment treatment but it ended up being closer to -1.125… which I liked how well my reading became up close so I kept it. However, the best part of LAL is you get to try it out. If it is too much you can reverse it. If it is too little you can add some more.
Nice comparative video! Is it best to do a Yag treatment in an LAL before a light adjustment if posterior bag opacification is noticed vs after the first light adjustment? What if only one light adjustment is anticipated in a LAL?
We did the YAG before the first light treatment for both eyes in this case and I’m glad I did. My first eye had significant PCO which was causing over 0.5 diopters of perceived astigmatism (it reduced to anlmost nothing after the YAG). Had we done a light treatment before the YAG we would be trying to correct vision issues which would then change again after the YAG guaranteeing another light treatment would be necessary. In my case, we only needed 1 light treatment for each eye to hit what I feel are optimal results and this is coming from a guy with “unrealistic” expectations😉 Even though my 2nd eye had relatively low PCO, I decided to do the YAG before as well because what if I locked in without a YAG but then later needed one? It could potentially change my vision quality without any ability to correct it with light treatments and then I would need a 5th surgery to fix it😳
It's typically easiest to do an IOL exchange with the posterior capsule intact. But I've found patients have the best refractive outcomes with their light treatments when a YAG is performed if any signicant opacity is present before performing their first light treatment.
Just recently helped my patient switch one of his ClearView 3 IOLs in one eye to a LAL+. Our patient has noticed a signiciant yellow tint (as you explained this patient noticed too with the UV blocking) but did your patient comment about neuroadapting to that disparity before his right eye had the exchange?
The color difference never really neuroadapted in the month or so I had CV3 and LAL+. With the CV3 eye open and LAL closed, everything had a cooler (blue) tint and the vice versa eye open/closed everything was more warm (yellow). With both eyes open, it was somewhere inbetween. Interestingly, my natural lenses had the similar warm tint of the LAL since I recall noting how blue the sky became after getting the first CV3 compared to my other natural lens.
@@tltolman73 Hey Mr patient :-) Do you see the edge of the lens whenever your pupils are completelly dilated? (dim light) Any negative (shadows) or positive disphotopsias (glare, starbursts, etc..)? Thank you and congrats for your new vision 🙂
@@agusticuria3331 I’m experiencing no negative disphotopsia with the LAL, day or night. When I had the CV3, I had very slight dark crescents I would notice on my peripheral vision in certain situations like trying to focus on something up close. For positive disphotopsia, I will sometimes see starbursts on bright lights but it is usually temporary where my brain filters it out after a second or two. I find my overall night vision to be better than when I wore glasses before which was already quite good.
Great video. Incredibly open and honest. For those of us still to make the final decision about which IOL option to go for, this case certainly is a little sobering. It definitely makes you cautious and even more careful about what you wish for! Without actually experiencing these dysphotopsia phenomena yourself makes it so tricky to assess whether you'll end up happy or sad, post surgery. Likewise assessing what degraded 'quality' of vison might feel like notwithstanding you can achieve 20/20 or better visual acuity. No easy, sure fire answers it would seem. When it is all said and done, I'm betting a monovison setup using monofocal lens' as the path of least resistance and with the greatest chance of great vision (near and far) without the "complications". Thank you Dr Krad and your patient for what was one of the best pre-cataract surgery tutorial I've watched to date.
Seems like monovision with monofocal would be best too-if they can dial it in during surgery. I’m trying to get a contact lense trial going to see if I’d like monovision.
Great information from Dr Krad and your patient 👍
Fascinating video, I learned a lot! Would love to see a future video where you discuss the pros and cons of the Alcon Clareon and Alcon Acrysof, vs their competition, for a glaucoma patient (with 3.8 diopters of astigmatism).
to the patient. first thank you for sharing and helping others. I am a nervous wreck doing this procedure as Im a pilot. curious because you mentioned a yellow tint on the LAL plus. Do you have that with the standard LAL also? That would drive me crazy. thanks for helping us all
Another great video. Thank you!!!!
Dr he end up needing glasses at all? This is a fantastic video that I will rewatch. I’m considering all of these lenses. Thank you!
That was me in the video and I now have great quality vision at both near and far. No glasses necessary. Just as good as when I wore progressive glasses but I do have a mono vision set up to make this work for me. I knew very well that mono vision does not work for everybody before I started this. Since my initial goal was good reading without glasses but was afraid of some of the horror stories of various multifocal experiences since I want to still drive at night, etc. I was thinking LAL originally but didn’t know how I would react to mono vision to achieve this. The CV3 was brought up as the best way to get the best reading vision possible with very minimal dysphotipsia at far and most people seem to react very well to this lens. Unfortunately, I was not one of them and my brain was perceiving way too much information that most people with the CV3 are just naturally filtering out. Note, just saying someone has 20/20 J1+ does not tell the whole story. No one talks about how long it takes to decipher words even at much larger text sizes. If was taking me 1-2 sec per word to read even large text on a computer or phone screen. I’m so glad I swapped out the CV3 for LAL/LAL+ and that Dr. Krad was so understanding and desirous to do what it takes for me to have the best possible vision. Stay away from doctors that just want your money and tell you you should be happy with your “20/20 J1+” vision when it is clearly not the rest of the story!
@@tltolman73so glad you’re doing well! I’m very interested in your journey because I’m trying to make the lens choice too.
I definitely appreciate the transparency that you provide here. It’s just nice to hear the positives and negatives with all of these lens options. More specifically, listening to real patients tell their story it is important to get an understanding of what the expectation may or may not be. I live in Canada and this type of transparency/video is not abundant in my humble opinion I think for the most part because cataracts are covered on a basic level. However, if you’re needing premium lenses, which is usually the case, this is always an extra fee, which is often not talked about and not discussed until you go in for your appointment. Where the upsell begins lol I have been considering getting my lenses replaced in the US but I’m not sure if that’s a good idea or not? Maybe you could shed some light on this and maybe what kind of pricing one could expect for procedure using top-of-the-line premium lenses. Cheers :)
I've been thinking about making a video that would provide patients with transparency into the finances associated with cataract surgery and lens upgrades. Perhaps I will do so in the near future
@@DoctorKrad that would be awesome! In the meantime, would it be possible for me to provide my email to you so that you can provide additional pricing information as I would like to be able to go to you if possible. My daughter lives in Michigan so it’s not out of the question visiting the US. I forgot to mention a very important note trying to find doctors that will exchange lenses is somewhat problematic here to say the least. Only a few doctors will do it. It’s not so much the complications that are involved, as it is with our hip/coverage of the basic lensmy assumption, is that it’s avoided for that reason perhaps with us being said, however, there are some surgeons that will do it as far as I know.
@@DoctorKradplease do!
@@DoctorKradplease do I am in the same predicament of this fellow Canadian. I have multifocal lenses that have had the yag laser procedure done in both eyes. I have not been able to adjust to the new lenses and am now in the process of looking into surgeons like yourself in the US to maybe help my situation out. I am currently looking to visit a fellow down in Texas but it seems you might be easier to get to travel wise if you are willing to look at me? Thanks for the great videos
Hey I am a fellow Canadian who has had refractive lens exchange. Just a heads up to you from my opinion and my personal experience is don’t let the word premium lenses fool you to believe they are better. Just because you are paying extra for those lenses doesn’t mean they will be better than the government provided lenses. You really have to understand exactly what the surgeons are saying in the English terms they use. It can get a bit confusing with what they are saying and what they are meaning with the terms they use. It’s hard to question the surgeons in my area as they only seem to give you a very small window of time to actually talk to them. You are just another one of their cattle being processed through their processing plant is what it seems. There are lots of people who seem to like the multifocal lenses but there are also lots of others like myself that are living a bit of a nightmare with them. One example for me was I was told I would have halos with these multifocal lenses I received but only for 6 weeks. That led me to believe it was a healing process from the surgery. Short time suffering for long term gains was my thought. After my original eye surgery my surgeon was telling me everybody heals at a different rate when I asked how long does he think the halos will last as well as the blurry vision I have. Little did I know the way the lenses are built the halos will never go away. It’s all in the mechanics of the lenses. Anyways I hope you have a better experience than I have had.
love it! Hey for ur main wound - did u simply reopen the original main wound? Do you have a timeline for when you create a new main wound? And when you do create a new main wound, do you make it over/below/thru/beside the original? Thanks so much for sharing!
nice guy. you are much more brave than me. he clearly has unreasonable expectations.
Nope. Had I not had these “unreasonable” expectations I would still be suffering with bad quality vision instead of the great vision I am using to type on my iPad to you right now :)
Nice video, with real life experience…there is no perfect IOL that can replace our natural lens and if the patient does not have cataract, than this type of problem is worse, than a really nice conversation prior to RLE is essential
You have stated that the LAL lens does not correct for astigmatism, Is there a surgical option after the implantation to correct the astigmatism or only glasses???? If not, is there a lens you would recommend instead?
Very informative video. So is LAL working better compared to LAL+?
It’s hard to tell the difference now that I’ve had them a while. Of course one is set to far (LAL) and one to near (LAL+) so that makes it difficult to compare as well… so I’ll stick with my initial impression that the LAL has slightly less starburst but that comparison was so soon after surgery that it is hard to really know if that was caused by swelling of the cornea, etc.
@@tltolman73 Is it mono or mini monovision? What is the vision difference in each eye? I don't think mono vision is good for me, but considering the mini mono vision. Less disparity between the two.
@@lindacutrara9172 I guess it is technically mini-mono? I’m not sure what the cut off is. My near was set for -0.75 during the Light adjustment treatment but it ended up being closer to -1.125… which I liked how well my reading became up close so I kept it. However, the best part of LAL is you get to try it out. If it is too much you can reverse it. If it is too little you can add some more.
@@tltolman73 Thank you for responding. I like the concept of this lens. I hope it is the right option for me. Thank you again.
What were those mobile dark particles that appeared upon insertion of the LAL, @20:03?
Air bubbles
Nice comparative video! Is it best to do a Yag treatment in an LAL before a light adjustment if posterior bag opacification is noticed vs after the first light adjustment? What if only one light adjustment is anticipated in a LAL?
We did the YAG before the first light treatment for both eyes in this case and I’m glad I did. My first eye had significant PCO which was causing over 0.5 diopters of perceived astigmatism (it reduced to anlmost nothing after the YAG). Had we done a light treatment before the YAG we would be trying to correct vision issues which would then change again after the YAG guaranteeing another light treatment would be necessary. In my case, we only needed 1 light treatment for each eye to hit what I feel are optimal results and this is coming from a guy with “unrealistic” expectations😉 Even though my 2nd eye had relatively low PCO, I decided to do the YAG before as well because what if I locked in without a YAG but then later needed one? It could potentially change my vision quality without any ability to correct it with light treatments and then I would need a 5th surgery to fix it😳
It's typically easiest to do an IOL exchange with the posterior capsule intact. But I've found patients have the best refractive outcomes with their light treatments when a YAG is performed if any signicant opacity is present before performing their first light treatment.
Just recently helped my patient switch one of his ClearView 3 IOLs in one eye to a LAL+. Our patient has noticed a signiciant yellow tint (as you explained this patient noticed too with the UV blocking) but did your patient comment about neuroadapting to that disparity before his right eye had the exchange?
The color difference never really neuroadapted in the month or so I had CV3 and LAL+. With the CV3 eye open and LAL closed, everything had a cooler (blue) tint and the vice versa eye open/closed everything was more warm (yellow). With both eyes open, it was somewhere inbetween. Interestingly, my natural lenses had the similar warm tint of the LAL since I recall noting how blue the sky became after getting the first CV3 compared to my other natural lens.
@ thank you for the feedback!
Great information-interesting to see how to navigate these “detailed oriented” patients…..
How is his vision far mid near now.
Awesome!
@@tltolman73 Hey Mr patient :-) Do you see the edge of the lens whenever your pupils are completelly dilated? (dim light) Any negative (shadows) or positive disphotopsias (glare, starbursts, etc..)? Thank you and congrats for your new vision 🙂
@@agusticuria3331 I’m experiencing no negative disphotopsia with the LAL, day or night. When I had the CV3, I had very slight dark crescents I would notice on my peripheral vision in certain situations like trying to focus on something up close. For positive disphotopsia, I will sometimes see starbursts on bright lights but it is usually temporary where my brain filters it out after a second or two. I find my overall night vision to be better than when I wore glasses before which was already quite good.