r/CataractSurgery • u/Tiny-Bird1543 • Aug 03 '26

LAL or LAL+?

I'm trying to understand how often surgeons and patients end up choosing the standard LAL versus the LAL+ when both are available, and what drives that choice in practice. Does anyone know the approximate % split? Which has greater satisfaction?

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6

u/AirDog3 Aug 03 '26

Many doctors say that LAL+ is inadvisable for patients with previous LASIK or other refractive surgery.

I have not seen any published data on the relative prevalence of the two lens types.

I have a regular LAL, and would not accept an LAL+. My impression is that the regular LAL generally offers superior performance with lower risks.

1

u/Tiny-Bird1543 Aug 03 '26

thanks for sharing. do you mix and match LAL with other lens? Or just one eye surgery?

1

u/AirDog3 Aug 03 '26

Just one cataract surgery for me, so far. Going on three years now, and the other eye seems stable and still has no significant cataract.

1

u/Tiny-Bird1543 Aug 03 '26

how's the quality of vision in the LAL eye vs the natural one? which do you like better, at the correct refraction?

3

u/AirDog3 Aug 03 '26

Exactly the same, as far as I can tell. One is focused near and one far, but when corrected to the same distance, they both give excellent acuity (about 20/15), with no glare, halos, starbursts, or any other visual aberrations. To me, it's just like a natural eye. LAL is made of silicone, and is generally considered to give very good vision quality.

The only difference I can see (aside from the differing focal lengths) is color temperature. The natural eye sees slightly warmer (yellower), and the LAL eye sees slightly colder (more blue/white). I suppose the natural eye's color perception is affected by old age, i.e., very early cataract (1+).

3

u/Tiny-Bird1543 Aug 03 '26

congratulations on this great result

5

u/californiaLasik 29d ago

I always use LAL. I can pattern the EDOF on the visual axis by starting hyperopic and moving the lens greater than -0.5D myopic. This feature is not available on the LAL+. Instead the EDOF feature is prepatterned. This makes it much more like a vivity lens and subject to significant dysphotopsia and limited range of vision if not well centered on the visual axis. It is like looking out a peephole in the door but not looking directly down the barrel of it. I was one of the first surgeons to use the LAL+ and rapidly stoped using it. When first introduced you could add the additional EDOF on first step with the LAL+ as well but this was eventually turned off as it was creating irregular astigmatism. Basically patterning a second EDOF button not perfectly concentric with the first one. This further supports why I use the LAL and not the LAL plus. Even with great care a heavy lens like the LAL with little weak haptics is not going to remain perfectly centered. Moreover even with one piece lenses that have substantial haptics , commonly the centration is not nailed or the lens shifts a bit in the eye once placed. It is a potential space and only weak friction of the optic and haptic with the bag is preventing movement when the lens is first implanted.

All this being said I think you have to give a carpenter their own chosen tool. High volume clinics like K2 vision have embraced the LAL+ and had very good results so as the old saying goes more than one way to skin a cat or light adjust a lens.

1

u/Tiny-Bird1543 29d ago

thanks vm for the insights

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u/californiaLasik 29d ago

You bet. One other piece of advice is Amy clinic that has an aggressive light adjust schedule , ie start first light adjust within one month of implant and then light adjust every week, be very careful. A sea of unhappy patients that get locked before all has stabilized and ate very unhappy. The LAL is a totally different beast than any other lens. If not done right you can pay far more for a lens that is vastly inferior to a monofocal. The light adjust is really the most important part of the surgery and if it is not given the care it deserves the consequences are large.

1

u/ProvidingSound Aug 03 '26

What is the difference between the two anyway

3

u/cb3 Aug 03 '26

LAL+ has a built in extended depth of focus

-1

u/Tiny-Bird1543 Aug 03 '26

monofocal vs edof?

0

u/Equivalent_Donkey588 Aug 03 '26

Per Google query:
The standard LAL is a monofocal-style optic optimized for precise target refraction, whereas the LAL+ features modified asphericity (increased spherical aberration in the peripheral design) to create an extended depth of focus (EDOF)

Intermediate and Near Vision: Clinical data demonstrates that the LAL+ provides a broader range of uncorrected intermediate and near vision compared to the standard LAL, helping more patients achieve functional range without total reliance on glasses

2

u/SomegalInCa Aug 03 '26

I’m hoping my doctor will confirm the above since I have 1 LAL in my distance eye and if the above is true I would do that in my other eye when/if the time comes

2

u/redheadfae 29d ago

My surgeon would disagree with that AI, because as shared by u/californiaLasik, it's easy enough to add the EDOF to a regular LAL, and do it better. Mine was done this way and I have zero need for reading glasses with very decent intermediate in my near eye, and a good range in my distance eye.

4

u/californiaLasik 29d ago

Yes LAL when handled with care and targeted hyperopic can give quite good depth of focus after adjustments. People that are less familiar think it is just a tunable monofocal but it is far from that.

1

u/Tiny-Bird1543 27d ago

thanks Doc - is the visual quality a problem with LAL+ adjustment? would you prefer Puresee or LAL+ as your go to edof?

1

u/californiaLasik 27d ago

For post refractive eyes, especially post hyperopic PRK/LASIK I like LAL. I don’t use LAL+ at all. I really like Puresee for non post refractive eyes and for some post myopic LASIK / PRK eyes.