Clear or Blurry Future? Exploring Light Adjustable Lenses for Cataract Surgery

The Berne Podcast with Dr. Sam Berne

Keywords

light adjustable lenses, cataract surgery, vision correction, depth perception, blue light protection

Summary

In this podcast episode, Dr. Sam Berne discusses light adjustable lenses (LAL) used in cataract surgery, explaining their benefits, drawbacks, and potential impact on depth perception. He emphasizes the importance of understanding how these lenses work, the necessity of UV protection during the adjustment period, and the need for blue light protection to prevent potential eye issues. Dr. Berne also shares his personal recommendations regarding vision correction options. See his BONUS podcast on his membership site: https://drsambernesmembership.com

Takeaways

Light adjustable lenses (LAL) are a new option for cataract surgery.
LAL allows for customization of vision correction post-surgery.
Patients must wear UV protective glasses during the adjustment period.
Depth perception can be affected by blended vision from LAL.
Monovision and blended vision can create confusion for some patients.
Surgeons can adjust the non-dominant eye after surgery for better results.
Blue light protection is important to prevent eye damage.
Not all interocular lenses have blue light blocking capabilities.
It’s advisable to try monovision contacts before surgery.
LAL may be worth considering if blended vision is acceptable.

Chapters

00:00 Introduction to Light Adjustable Lenses
02:20 Benefits and Drawbacks of Light Adjustable Lenses
05:42 Depth Perception and Vision Challenges
07:36 Blue Light Protection and Final Thoughts

“Hey everybody, welcome to the podcast today. So I’m to take a question that I’ve been getting a lot of something called light adjustable lenses. These are new lenses that cataract surgeons are putting in your eyes. And so what are the pros and cons? Do I recommend it? What do you have to watch out for? That’s what we’re going to talk about today. So light adjustable lenses are new intraocular lens that cataract surgeons are putting in your eyes.

So just like regular cataract surgery, they take out the clouded lens and they’re putting in this new interocular lens. I call it the LAL light adjustable lens. So after the surgery, there’s a two to three week healing period and once your eyes have healed, then the adjustable process can occur with this new interocular lens. So during this time you get a pair of ultraviolet glasses that protect you from UV light.

because it’s the UV light that actually creates the changes in the light adjustable lenses. So after the eye heals, you’ll go back to the doctor and he will start making some adjustments in the lens using a special UV laser and this UV light causes a retargeting of the shape of the lens.

So the refractive errors myopia, hyperopia, and astigmatism can be fine-tuned by reshaping the lens in the eye. Typically, you’ll need two to three light treatments to complete the reshaping and come up with a prescription that you can see clearly out of. So once you get to the end result of having clear eyesight, then there’s a final lock in where the lens will be permanent.

in terms of the prescription that you’re getting. In some of the studies I’ve seen, there’s been a 92 % success rate in having clear eyesight from the light adjustable lens. So you get this great customization of your prescription and it works really well. If you’ve had things like PRK or Lasik surgery because it can really find to the final result of having clear eyesight.

Sam Berne (02:20.652)
So three initial drawbacks. I see is number one. You have to use UV protecting glasses during the period of measuring. What is the final LAL prescription number two? You have to do somewhere between two and four extra office visits to fine-tune the reshaping and get the prescription that you want and number three is the cost. So usually these lenses are not covered by insurance. So you’re going to have to pay out of pocket.

If you want these, okay, so now my personal opinion when you look at the light adjustable lenses as it relates to depth perception, I see some potential problems. So like the mono vision correction where one eye is corrected for distance usually the dominant eye and the non-dominant eye is corrected for near the light adjustable lens has a similar concept.

But instead of calling it mono vision, they call it blended vision. But still you’re dealing with one eye is corrected for distance and the other eye is corrected for intermediate and near. Well, this sets up a problem with the brain being able to decipher and process vision is when you are in this blended vision very similar to mono vision. It can either create double vision.

other kinds of blur or the brain just suppresses or shuts off the eye that’s not using so like for example, if you’re driving the right eye is really the only eye that’s your dominant eye. That’s the eye that’s only going to be used for driving and then if you’re at the computer or reading the left eye, which is the non-dominant eye in most people is going to be used exclusively for that. So it’s going to put more stress and pressure

on each eye to work at those particular distances and this reduces and in some cases even eliminates depth perception. So you remember how I talked about the difference between eyesight, which is seeing the eye chart clearly in vision is the eye brain body connection. And so in terms of this LAL technology, it can be very helpful in terms of eyesight correction. However, you need to be careful

Sam Berne (04:48.213)
that because the eyes are going to be corrected at different distances. This could create confusion and difficulty in terms of using both eyes together. So one of the things that you could do is you could try a mono vision or a type of blended different contacts and that would be before the surgery to see how your brain in your eyes respond.

You know, for some people I’ve worked with with monovision with Lasik surgery and cataract surgery. They do just fine with it. Others. However, have difficulties adjusting because the eyes are focusing at different distances and this creates confusion. I strain I fatigue double vision irregular blurred vision. So to know before you do the surgery to have that monovision in contacts. See if it works now.

Another thing the surgeon can do after the surgery is he can make adjustments in the non-dominant eye with the new interocular lens and he can back off the difference between the distance intermediate near so we can make the blended vision they closer together and in doing that that might be a way where you can actually be able to read use the computer and see in the distance but make no mistake about it.

that either blended vision or mono vision from this light adjustable lens technology does create an obstacle in your depth perception. It’s one of the reasons why I still recommend the monofocal for distance. In other words, both eyes are corrected for distance with the cataract surgery. So you’ve got really good depth perception at distance and then you get a pair of glasses for your intermediate or near vision and one last point.

I haven’t been able to determine whether these lenses have the blue blocker in them. I can say that most interocular lenses don’t have blue blocking protection or original hardware. know, our original lenses do have the pigment to block some of the blue light. Now with blue light, what we’re dealing with here is it dries the eyes out faster and in extreme cases.

Sam Berne (07:07.549)
It can lead to things like macular degeneration. It’s why a lot of my post-operative patients who’ve had cataract surgery if they haven’t had the blue protection put in the interocular lens and they weren’t told that they have a higher risk of developing things like macular degeneration and other retinal problems. So you want to ask your surgeon if there’s blue protection in the lenses. If there is not then you’re probably going to need to get some blue protection.

in some type of glasses if you’re on screens after 6 p.m. So those are the pros and cons. I would give it a mild. Yes, I think it’s worth checking out. But if you can try the blended vision mono vision before the surgery and you can accept it, then the light adjustable lens could work really well for you. So that’s our show for today. I want to thank you so much for tuning in.

Remember my membership. You can always get on that and I have some exclusive content on that. So check it out and until next time everyone take good care.”