I retook the test I mentioned a couple posts again as I think my color perception is improving.  Unfortunately the results were erased before I could cut and paste the picture to post here, but my score was in the 70s which is improved.  The blue/green discrimination is the area I have the most trouble with.

I had gone for my final routine follow up a couple weeks ago and the opthalmologist seemed a bit skeptical.  I told her that the green LED in the tonometer was green in my non-LAL eye but white in the LAL eye.  She had me do the Ishihara test which was normal, but it isn't designed to test for the type of problem I noticed.  I continue to believe that the very bright UV light causes this change which I hope will improve over time.

I was able to drive without difficulty a long distance and can read normal print without reading glasses.  So functionally I am now glasses free.  I am going to get refracted to see if I might benefit from glasses for driving as I'd like 20/20 in both eyes for night driving and for prescription sunglasses.

As time goes by I'm liking the LAL more and more.  It is pretty cool not to need reading glasses and as I can see green/blue better now and am optimistic that will continue to improve I'm happier.  Had I just gotten an IOL that couldn't be adjusted it seems likely I'd be back to progressives again.

Light Adjustable Lens and Neuroadaptation

I've noticed since having the Light Adjustable Lens final adjustment, I'm experiencing an interesting phenomena well described here neuroadaptation article.  Many of the new IOL's, particularly those that attempt to overcome monofocal limitations, such as multifocals, can present patients a challenge adapting to the visual changes compared to their preexisting, albeit diseased, lens.  I think I'm having this with the LAL.  The vision from the lens, even when the image is in focus, is different than my previous visual experience.  I suspect it is related to the aspheric profile and increased depth of focus.  When I'm really paying attention to it I find it somewhat annoying.  However, if I'm distracted or after a glass or two of wine, I don't notice it at all.  Based on the neuroadaptation model my guess is that my brain is rewiring to adjust to the new type of images being presented to the retina.  The other possibility is that the disparity in color vision as I recover from the UV exposure is part of the problem.

Light Adjustable Lens - part three

An update on my status as I continue cataract surgery recovery after having a Light Adjustable Lens implanted. So color vision seems to be slowly returning and I tested myself at www.xrite.com/online-color-test-challenge to see how I'd do. Even without a Light Adjustable Lens, this is a fun test. How did I do? This is my current status with the eye the LAL IOL was put in (a higher number is worse, and a score of 98 is poor color discrimination for my age and gender);

 







This definitely confirms what I'd been noticing since the UV lock in treatments, a loss of color discrimination in the treated eye.  So hopefully I will see improved color vision as time goes by. Taking the same test with both eyes I scored a near perfect 4, so clearly it is the Light Adjustable Lens eye that was negatively impacted with the UV exposure.  I can't rule out the blue light filter in the lens also impairs color.









The other interesting thing I'm finding is that I appear to be seeing somewhat into the ultraviolet wavelength on the LAL side now.  This has been reported by others with different IOLs  post cataract surgery and I think it's really not meaningful in any way, but it is something I notice particularly in bright sunlight where there is a bit of a glow to objects illuminated by the sun.  I also see a white light coming from black light bulbs.  Interesting.

Light Adjustable Lens, aka LAL, experience

OK, so an update to my "Light Adjustable Lens" experience.  I had 2 adjustments and then two lock-ins of the LAL and am scheduled for my last, hopefully, follow up in a couple weeks. So how did it go and was it worth it? Because my healthy eye has pretty good vision at both far and near, the eye with the Light Adjustable Lens works in combination for a sort of mini-monovision with a great deal of overlap in accommodation ranges. I'm glasses free for computer work, intermediate vision such as for television or going to restaurants, and can drive without problems with good light conditions. I'm still adjusting to the vision with this lens as it is different than what I had before and hope for continued improvement over the months ahead with less awareness of the differences in eyes and vision pre and post op. Color vision was a huge issue with the lock in and adjustment UV treatments the Light Adjustable Lens requires. I'm several weeks out now and while my blue vision is getting better my ability to see green has a ways to go. Some of the color difference are because my eye without the IOL does have a discolored lens and I wonder if the blue light filter on the LAL also impacts color perception, but the biggest difference is because of the UV treatments washing out the color receptors in my retina. This is not discussed as a side effect or problem on the industry websites for the Light Adjustable Lens which is unfortunate because it is quite dramatic. I will have to give this a bit more time before I can make a final decision on if the discomfort, cost, and time was worth it. However, I am pretty comfortable in my daily activities without glasses and in large part I attribute this to the enhanced depth of focus, treatment of astigmatism, and focal point set by my ophthalmologist. And I'm definitely sexier without progressives. :-)

Light Adjustable Lens - my experience thus far

I'm going to post some information about my experience with cataract surgery overseas. At 52 years young I ended up needing to get this done with a steadily worsening cataract in the left eye. Being a physician I researched on the procedure and options I might have to get the best possible outcomes. I read about multifocal lens, toric lens, so called accommodating lens, and of course the standard monofocal they give to most patients. I went to my ophthalmologist at a George Washington University affiliated clinic anxious to talk about what would be the best course and was dissapointed that he didn't seem very knowledgeable about the options. I set up an appointment for a second opinion at a major and internationally known institute affiliated with a medical school. I thought surely they'd have information on the latest and greatest. Unfortunately, there too I was dissapointed with the ophthalmology resident who saw me being uninformed and even a bit clumsy with the instruments. The staff doctor who came in for two minutes to oversee the resident did suggest that one of my considerations, the Light Adjustable Lens, might be a reasonable option in light of my previous Lasik surgery. Their whole focus  was to train residents in how to do basic cataract surgery with standard monofocal lens, and crank through as many patients as possible during their time in the clinic. This too was not what I was looking for. Doing my own research I found a clinic in Berlin run by a doctor whose published results using the LAL was quite promising.
 
The LAL or Light Adjustable Lens is a US developed technology that is not yet available in the US, although it is undergoing clinical phase III trials. It is available overseas. This technology allows implantation of the lens by standard cataract surgery and after  two weeks of healing, 'fine tuning' of the lens in the eye using ultraviolet light. The research shows that when subjected to 'aspheric' adjustments you can get a broader range of improvement in vision and not at just one focal length as per standard monofocals. As I researched accommodating lens I found that many ophthalmologists have been disappointed in the end results and they end up acting just like monofocal lens because the eye really doesn't end up being able to flex them as it would with our natural lens. Multifocals looked promising but my ophthalmologists were concerned with some very early signs that suggest I might develop retinal problems down the line and with multifocals the price you pay for having both near and far zones of focus in the lens is that each zone has less overall light on the retina which could be a problem if your retina needs as much light as it can get to function because of disease. I set up my appointment by email and went in for my first appointment in Germany in October 2013. The office for private patients is very very nice and I felt comfortable and well taken care of. The doctor had good English although some of her staff were not as fluent.  They answered my questions and concerns and did a very thorough examination. We set up a date for the surgery a few months down the road and I had it performed two weeks ago, in February 2014. The surgery was performed in Cottbus which is a town about an hour by train south of Berlin. I was lucky to have a friend of the family who lives in Berlin help me with transportation and language issues. The staff in Cottbus were actually a bit more fluent with English than in Berlin which surprised me. The surgery was pretty standard as far as cataract replacement goes - I had general anesthesia which meant I slept through the procedure and awoke with an eye patch which I had to keep on until the next days follow up. If you are reading this and considering getting an LAL I'd tell you that the requirement to wear the ultraviolet protecting glasses is harder than I thought it would be. Perhaps this is because I am maintaining a full work schedule but because the doctor wanted me to use the sun glass UV blockers at all times including indoors it makes reading much more difficult. Also, because there is no way to insert a corrective lens in the UV blockers I struggle to read small print and use the computer especially with the low light from the tinted lens. The other frustrating part is that my eyelids constantly smudge the lens as the glasses need to be close to my face to block peripheral UV from coming in on the sides. On the plus side is that when I have walked outside on a sunny day with UV glasses and hat, I get enough light to appreciate how much better my vision is on the cataract replaced eye. I'm also amazed to see that my perception of the color white is much different in that eye compared to the non surgery eye. My far vision seems to be fairly good in the surgery eye in the sunlight and I think I can legally drive although for sure it isn't 20/20. Reading - forget it. I bought some cheap readers at the train station on the way back home (I wasn't allowed to fly and stayed in Berlin a couple extra days because of concern about my eye pressures). However, on the surgical eye my reading is pretty similar to my other eye because I have presbyopia, the normal loss of reading vision that comes with aging. I'm off for the follow up and first adjustment to the lens this weekend. I'm hoping to have the lens adjusted for reading and we'll see what kind of far vision I have with the focus set for close. The published results suggest that with a reading setting on the lens I may still have good enough vision to drive legally without glasses, but if not then I can always get far glasses for driving or when I need far vision. We shall see - it will make all the inconvenience and cost of this worthwhile if I get the bonus of some far vision with the reading vision as well.