Is it true that this lens type (the 'light adjustable lens; LAL') is more suited for distance vision and not for up close? I ask this because I opted out of this option for my recent surgery and went with the Multifocal lens…cost was the same.
Hey Rick,
The LAL is considered a "monofocal" lens, meaning it will only focus light for one focal length, whether that be distant, intermediate, or near. It is NOT a multifocal lens. But it does have an
extended depth of focus (EDOF) which gives more 'range' of focus compared to the older monofocal lenses, meaning you could have an LAL for distance that also works pretty well for intermediate, too. This is one of the things that makes the LAL unique.
Many doctors are going with the LAL for patients who might have gone with the multifocal lens in the past because most people get both eyes operated on one right after the other and the doctor will set one eye for distance (usually your 'dominant' eye) and that eye will also have pretty decent intermediate vision due to the EDOF of the light adjustable lens (LAL).
Then the doctor will set the other eye to be more focused at intermediate and near, achieving a sort of 'monovision' setup (one eye for far/one eye for near.) Doctors could (and have) done this in the past using the conventional monofocal IOLs but (big but!) if the patient didn't like it and couldn't tolerate the monovision setup, the only way to 'fix' it was to go back into the eye and remove/replace one of the lenses.
Thankfully, with the LAL, the lens can be adjusted
after the surgery to find a 'sweet spot' of lens power that provides the vision the patient likes and can function with, usually achieving good vision distant
and near. As more and more doctors start using the LAL and get comfortable with it and what it can (and can't) do, they will more likely migrate away from the multifocal IOLs, little by little. And for some patients, the multifocal may still be the best option depending on the person and how they use their eyes and their visual history (maybe they tried monovision with contact lenses previously and couldn't tolerate it?)
We are so fortunate that we have a large array of IOLs to chose from these days and your doctor, who has looked at your eyes and knows your visual history can make the best recommendation for YOU. In your case, based on your conversations with the doctor, he (or she) must have felt the multifocal IOL would be the best fit for your lifestyle and vision needs. Be happy! The multifocal lenses are great quality and many people love them. If you aren't liking it, don't be afraid to talk to your doctor to see what options there are to try and get you to 'happy'. They can swap it out for an LAL or a monofocal ('standard') lens if push comes to shove, or maybe a tweak with some LASIK will do the trick? But most people are happy post surgery once they get used to their new lens. Hopefully that includes you, too.
LAL is a breakthrough in IOL technology that is really showing promise due to its extremely clear optics, ability to be adjusted, and its extended depth of focus (EDOF). More and more ophthalmologists will be offering this option as word spreads in the eye surgery community. It is just another tool in the toolbox for your eye doctor and you, the patient.
It isn't always the right answer for everyone. For a lot of people, the standard monofocal IOL that Medicare covers at no additional cost is just fine and provides excellent vision. It's good that people try to get educated about all this because some offices PUSH 'premium' lenses (toric, multifocal, LAL, etc.) really HARD on people when the patient may not actually need anything more fancy than the standard lens. I hate to see that. Finding a surgeon that just wants to help YOU by recommending the best lens for you - even if they don't make 'extra' on it - is so vital. Ethics still matter. If you feel you are being pressured and "pushed" to get a "premium" intraocular lens (IOL), ask your doctor WHY they feel you "NEED" a premium lens and decide if that sounds right to you or you are still suspicious and uncomfortable. If uncomfortable, ask your insurance company if you can go to another ophthalmologist and get a second opinion. That's fair.
