Light-adjustable cataract lenses

[carbonbased]

I have a question about the relatively new light-adjustable cataracts. But first let me give you a little background.

I am 52 and due for cataract surgery soon. In fact I’m going in today for a second visit to have more accurate measurements done and what I think will be a long discussion about the options for lenses.

I have fairly extreme nearsightedness. My prescription was around -10 before the cataract issue. With cataracts it’s gotten worse, of course, but I can still shoot a rifle with a scope pretty well.

What this rather extreme nearsightedness does is greatly increase my chance of a retinal detachment. Many years ago when my dad had the surgery in his 50s, he had three retina detachment‘s and one eye never quite recovered 100%.

My surgeon had me go see a retina specialist as a precaution. It wasn’t great news; turns out that over 50% of both my retinas are thinning around the edges. This indicates a much increased risk of the retina tearing due to the shock of surgery.

The hope was they could basically use a laser and stitch my retina on the back of my eyeball before the cataract surgery. But due to the extensive thinning, the retina specialist said they would have to shoot so much laser in there I would get significant scarring. This itself tends to create more issues by potentially wrinkling the retina, which would then necessitate another surgery just to correct that.

So, there we are we are. I’m also a photographer and work on a computer all the time.

So back to the light-adjustable cataract lens; basically it takes a lot of the guesswork out of getting the right prescription because the surgeon can adjust the lens after surgery by using a special UV light.

The upsides are potentially an extremely accurate prescription and a fine-tuning of the near-far focus mix. Basically you can try out some options after the surgery vs. guessing which options you’ll like before surgery.

The downsides are:

1. expense (extra $11k on top of the base price, for two eyes)
2. after the surgery one must have at least five visits for them to fine-tune the lens and progressively lock in the prescription.
3. One must also wear special UV blocking sunglasses for two months even if you’re sitting inside with a windowshade open.
4. Fairly new tech (10 yrs)

In my case, the after-surgery requirements become even more onerous because the retina specialist said I should have the worst eye done now and to wait three months to see how it turns out (retina detachment).

Anyway, anyone had this light-adjustable lens? There are other options not ok’d in the USA, but available elsewear, like better multi-focal options…I’d be interested in this too. Maybe I’d wait for them to be FDA approved.

@Convex @Baron23

 

[Baron23]

I have a question about the relatively new light-adjustable cataracts. But first let me give you a little background.

I am 52 and due for cataract surgery soon. In fact I’m going in today for a second visit to have more accurate measurements done and what I think will be a long discussion about the options for lenses.

I have fairly extreme nearsightedness. My prescription was around -10 before the cataract issue. With cataracts it’s gotten worse, of course, but I can still shoot a rifle with a scope pretty well.

What this rather extreme nearsightedness does is greatly increase my chance of a retinal detachment. Many years ago when my dad had the surgery in his 50s, he had three retina detachment‘s and one eye never quite recovered 100%.

My surgeon had me go see a retina specialist as a precaution. It wasn’t great news; turns out that over 50% of both my retinas are thinning around the edges. This indicates a much increased risk of the retina tearing due to the shock of surgery.

The hope was they could basically use a laser and stitch my retina on the back of my eyeball before the cataract surgery. But due to the extensive thinning, the retina specialist said they would have to shoot so much laser in there I would get significant scarring. This itself tends to create more issues by potentially wrinkling the retina, which would then necessitate another surgery just to correct that.

So, there we are we are. I’m also a photographer and work on a computer all the time.

So back to the light-adjustable cataract lens; basically it takes a lot of the guesswork out of getting the right prescription because the surgeon can adjust the lens after surgery by using a special UV light.

The upsides are potentially an extremely accurate prescription and a fine-tuning of the near-far focus mix. Basically you can try out some options after the surgery vs. guessing which options you’ll like before surgery.

The downsides are:

1. expense (extra $11k on top of the base price, for two eyes)
2. after the surgery one must have at least five visits for them to fine-tune the lens and progressively lock in the prescription.
3. One must also wear special UV blocking sunglasses for two months even if you’re sitting inside with a windowshade open.
4. Fairly new tech (10 yrs)

In my case, the after-surgery requirements become even more onerous because the retina specialist said I should have the worst eye done now and to wait three months to see how it turns out (retina detachment).

Anyway, anyone had this light-adjustable lens? There are other options not ok’d in the USA, but available elsewear, like better multi-focal options…I’d be interested in this too. Maybe I’d wait for them to be FDA approved.

@Convex @Baron23

Hello my friend - no, I haven't heard of these adjustable lenses and I was just in to see my eye surgeon for follow up on my PVD and floaters subsequent to my right eye cataract surgery and to discuss my left eye scheduled for Nov.

TBH, that's a lot of downside. Wow.

And please keep in mind that I'm def no doctor, but even without your existing retina problems there certainly is a risk of retina tear or detachment coincident with PVD (posterior vitreous detachment...right?). If the vitreous jelly is too tightly bound to the three spots on the back of the eye (optic nerve and two spots off center to each side)...or if the retina is unusually delicate...there is a def risk for retina damage. My doc told me to memorize three things....1) repeated flashing white light near the center of my vision; 2) snow globe kind of effect; or 3) looks like a curtain coming down over part of my vision. These symptoms indicate a retina problem and you need to get into see a doc asap on an emergency basis. Time is not your friend in case of retina tear/detach.

Sorry, I can't be of more help and your situation sounds like it has unusual complications so your expert docs are, of course, the best source of advise and recommendations.

Me...I just kept it simple....fix my distance vision and that's what I got. I don't mind reading glasses and they are not a burden compared to the risk of issues with toric multi-focus lenses....or that's how I understand it.

Best of luck.

 

[Convex]

A person's eyesight is a precious thing, and it's stressful thinking about losing some of it, and on top of that, when your eyesight is in trouble, being a photographer is its own special torture.

11 grand for upgades LOL!!! I figure the only guy to refuse to pay for the upgrade was Ray Charles.

Your wallet went into deep depression, I know cuz mine did.

Listening to you brought me back to what my eye surgeon kept repeating to me, which has been touched on here, re several related issues including how the aging process changes your eyes, how you cope w/that, and what you have to do to take care of yourself after surgery.

At one point in his office, he looked me straight in the eye and said that at my age, my eyes were more fragile, that I needed to cope w/that, on top of the healing process w/my implant surgeries.

He kept telling me that at my age to take it easy/go very slowly because he considered my healing/getting everything back together process as taking roughly 6 months to a year if not longer.

I've actually changed my daily pace and actually live a more leisurely lifestyle which I thank God I can do since I'm retired. i don't do things at the pace I did before my surgeries because I'm not going to "rock the boat".

I wish you the best of luck as I'd wish anybody who has to face this challenge.

 

[Convex]

Carbonbased; here's an article representative of numerous articles I read on this, and some of the articles several times individually to insure I was getting the message right.

14 Pros and Cons of the Cataract Surgery Multifocal Lens - HRF

If your health needs require a cataract surgery and you want more freedom from eyeglasses after the recovery period, then you may wish to consider a multifocal intraocular lens so that your range of clear vision can expand. In the past, before this option became available, the goal of this...

healthresearchfunding.org

Below are the entries that Very important, and they reflected the cautionary tone of my surgeon where he constantly emphasized that the risks and prospects of success for an individual my age, w/my having glaucoma.

To address my glaucoma, my surgeon installed a stint (small relief valves to relieve the pressure in my eyeballs) in each eye and they've returned the pressure in both eyes back to normal. No more "floaters" since the surgery.

My surgeon got me to understand that you're not out of the "woods" w/the surgery: and so in this particular article the quotes below are EXACT same message my surgeon kept relaying to me.......


"4. It does not resolve the health issues that could trigger the cataracts.
A cataract surgery that involves multifocal lenses can correct or restore a person’s vision, but it does not work toward any health improvements that may be necessary. Aging is one of the most common causes of cataracts, and injuries can cause them in some individuals too. If you take steroid medications or have had a previous eye surgery, then there is a higher risk of experiencing this issue as well.

There are some preventable health conditions which can cause cataracts as well, such as high blood pressure, obesity, smoking, or drinking a significant amount of alcohol. You will need to address these issues after having the surgery to ensure that your quality of life standards can improve.

5. Some people are not good candidates for this procedure.
Patients may not receive approval for the multifocal lens surgery for a variety of reasons depending on where they live. Some people may be too old to successfully recover from this surgical intervention. Anyone with a pre-existing eye issue, such as glaucoma, might not be a viable candidate. Having poor overall health may also cause the surgery to be postponed or not even considered."

I'm 73, had the surgery about 9 mos. ago, and had to pass my physical w/flying colors or they weren't going to do the surgery.


My surgeon noticed from blood tests that I had a vitamin D deficiency; his response to that was "we've got to get rid of that" which evolved into my taking this combination forever (I'm not suggesting you take the same thing, just how he addressed my problem).

And taking my refresh tears to keep my eyeballs cleansed and moist forever. I walk 3-5 miles every morning, get plenty of rest.


I hope my story helps you.

 

[Baron23]

Carbonbased; here's an article representative of numerous articles I read on this, and some of the articles several times individually to insure I was getting the message right.

14 Pros and Cons of the Cataract Surgery Multifocal Lens - HRF

If your health needs require a cataract surgery and you want more freedom from eyeglasses after the recovery period, then you may wish to consider a multifocal intraocular lens so that your range of clear vision can expand. In the past, before this option became available, the goal of this...

healthresearchfunding.org

Below are the entries that Very important, and they reflected the cautionary tone of my surgeon where he constantly emphasized that the risks and prospects of success for an individual my age, w/my having glaucoma.

To address my glaucoma, my surgeon installed a stint (small relief valves to relieve the pressure in my eyeballs) in each eye and they've returned the pressure in both eyes back to normal. No more "floaters" since the surgery.

My surgeon got me to understand that you're not out of the "woods" w/the surgery: and so in this particular article the quotes below are EXACT same message my surgeon kept relaying to me.......


"4. It does not resolve the health issues that could trigger the cataracts.
A cataract surgery that involves multifocal lenses can correct or restore a person’s vision, but it does not work toward any health improvements that may be necessary. Aging is one of the most common causes of cataracts, and injuries can cause them in some individuals too. If you take steroid medications or have had a previous eye surgery, then there is a higher risk of experiencing this issue as well.

There are some preventable health conditions which can cause cataracts as well, such as high blood pressure, obesity, smoking, or drinking a significant amount of alcohol. You will need to address these issues after having the surgery to ensure that your quality of life standards can improve.

5. Some people are not good candidates for this procedure.
Patients may not receive approval for the multifocal lens surgery for a variety of reasons depending on where they live. Some people may be too old to successfully recover from this surgical intervention. Anyone with a pre-existing eye issue, such as glaucoma, might not be a viable candidate. Having poor overall health may also cause the surgery to be postponed or not even considered."

I'm 73, had the surgery about 9 mos. ago, and had to pass my physical w/flying colors or they weren't going to do the surgery.


My surgeon noticed from blood tests that I had a vitamin D deficiency; his response to that was "we've got to get rid of that" which evolved into my taking this combination forever (I'm not suggesting you take the same thing, just how he addressed my problem).

And taking my refresh tears to keep my eyeballs cleansed and moist forever. I walk 3-5 miles every morning, get plenty of rest.


I hope my story helps you.

Hello my friend - please do not take the following as any sort of criticism of you. I know we are all trying to assess as much info on these subjects as we can and we are not eye surgeons.

But the linked site seems to me to do two things....1) list a lot of benefits/risks for cataract surgery in general and not bene's/risks specific to multifocal lenses and; 2) they sure seem to be pushing the multifocal lenses pretty hard.

This is a link and citation from NIH Medical Library which I think is very fair and even handed and doesn't seem to have a position they are advocating:

Conclusions: Multifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and quality of vision outcomes, with less risk of halos than older diffractive lenses and refractive lenses. (PROSPERO registration CRD42017069949).​

​

Effectiveness of multifocal and monofocal intraocular lenses for cataract surgery and lens replacement: a systematic review and meta-analysis - PubMed

Multifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and...

pubmed.ncbi.nlm.nih.gov

Now, my aversion to multi-focals is definitely not without any bias. A dear friend of mine insisted that he wanted them....he often acted like his body was an auto and all you need to do is bolt on a new part and its good as new....and never could drive at night again afterwards due to terrible flares/glares.

Does this happen to everybody.....of course not. It appears that the vast majority of people do fine with these type of lenses. But having seen the negative outcome first hand, I wanted nothing to do with that particular risk. Just not worth it in my calculations.

But we are all different individuals with different priorities and we all need to make our own individual decisions on things like this.

Cheers and best of luck to everybody.

 

[Convex]

"Hello my friend - please do not take the following as any sort of criticism of you."........

Again, a personal issue on my end isn't there/isn't in this. You've brought up the personal angle a 2nd time, this doesn't have anything to do w/me, or whether I have a thick skin, just the procedure, and whether Carbonbased is getting the info he needs to help himself.


This suggestion by you.....

"......they sure seem to be pushing the multifocal lenses pretty hard......"



Is something I don't see, in fact this alternative is offered at the bottom of the article....

"......If you don’t mind using glasses after the procedure, then a monofocal intervention could be a cheap and effective way to maintain your lifestyle......."



The above quote I think indicates they're willing to respect/suggest alternatives.



I meant what I said about this article being one of many I went over, and going over some articles several times, because I'm not interested in any one article pushing anything, and I don't believe this article is doing that. It took me 6 wks. of reading EVERY ARTICLE I could get my hands on til I was BLUE in the face.

FUCK one article, and to Carbonbased, READ 'EM ALL, and then read some more, and I believe you're a smart guy, smart enough to distill from all these articles enough data to serve your agenda and not the agenda of someone else regardless of whether this article or any other article is pushing hard whatever.


My including this article here was w/my emphasis on the quotes re points #4 and #5 about the surgery not curing the problems that might have caused the problem in the first place, the fact that as you get older your eyes become more fragile, and that you need to take care of yourself long term.


Baron 23; You have an aversion/bias to going in the direction of multifocal lenses and part of it is that after your friend had surgery, I gather his ability to drive at night after the procedure was a disaster. I hate hearing that, truly.

The FACTS ARE..

His surgery, including the brand of lenses he chose, implanted by the surgeon who did the procedure, and his physical condition, that combination produced an outcome for him that DIDN'T WORK.


My surgery, re my physical condition, including the condition of my eyes, and the surgeon who did my surgery implanting the lenses I chose
DID WORK.


I don't know if there's enough space here to have a case study w/specifics of just why your friends outcome was different than mine, and having said that, I would love to know,

Do I have the answer for what happened to your friend, no, but I believe that who does your surgery has a GREAT DEAL to do w/the outcome of this not just the lenses themselves. My surgeon was 46, had done the procedure for 18 yrs. and had done as many as 15 procedures a day for long periods of time during his career.

So Baron 23, if you haven't considered this already, then consider the skill of the surgeon doing the procedure among all the other variables that affect the outcome of this procedure, not just the lenses themselves.

Human beings are imperfect, they make mistakes, and so do eye surgeons, no one wants that to be true, but it is, so when that happens, that may be more of a factor in the outcome of a surgical procedure than what lens was being implanted.


I believe that there's more risk to having multifocal/toric lenses implanted in a surgical procedure but I don't think having a bad outcome should sway anyone from having the procedure any more than my having a successful outcome should hold sway, what should hold sway is that you try to research all this for yourself and of course make your own decision.

 

[Hobo Hilton]

I had cataract surgery done (both eyes) 3 months ago.
Some considerations other than what you stated above.
How is your heart and brain health ? I have had open heart surgery and one stroke.
Had issues seeing with prescription glasses after my surgery. Strange things going on.
My eye Dr is old school, 40 years of experience. He looked at my history and is leaning towards brain issues rather than eye issues.
You are describing a ton of "changes". Is your brain going to be able to adjust / compensate for all of those changes ?
Best of luck

 

[Convex]

Yes, yes......ageed. There's a galaxy of variables that affect these procedures and the ultimate outcome.

 

[carbonbased]

So, here’s a follow up.

I had my surgery done at the end of January. Each eye was one week apart. Everything went swimmingly, very easy.

I chose toric lenses to correct for astigmatism.

I had monovision done as before surgery I tolerated that fine with some trial contacts simulating that. Monovision is when they have one eye (in my case, the right or “scope” eye) set for distance and the other for up close. 20% of people have brains that can meld the images together.

The upshot is one’s vision can be similar to how your eyes worked when you were young. You have close-up and far vision without glasses. Well, almost! Not quite as close up, but I don’t need glasses for day-to-day and office work tasks or reading my phone. And I might get a pair of contacts & glasses that correct the left eye for distance when shooting or driving all day.

When I really notice the monovision acting up is driving at night. That’s also when I would probably wear glasses to correct the left for distance. The effect then is a bit like have one dry contact. Something isn’t quite right with your vision and you keep wanting to rub the “sleep” or dryness out of the left eye. Of course you cannot.

This effect didn’t show up with the trial run of the monovision-like contacts before surgery. Doc said that given the contact’s position vs the replacement lens’ position in relation to the retina, there will be some discrepancy in the result.

But, my eyes are still healing. I’ll know how everything sorts out in a month or two.

Upshot is to weigh you options carefully. Ask your optometrist their opinion. In my case, he had invaluable experience in seeing others’ mistakes and gave me great advice. For example, I was really leaning towards the light-adjustable lenses but he pointed out that there would be, “too many balls in the air” given my family history of retinal detachments.

 

[carbonbased]

Also, during the one-week period in which I had only one eye fixed, I noticed that this thing called “snow” was much much whiter in the fixed eye. The unfixed eye rendered snow a bit browner, like slightly coffee-stained.

But I didn’t notice everything getting hugely brighter, like some people. The effect of other people’s damn LED headlights got worse, however! So many of them are on the edge of sliding into the purple side of color temperature. I’m talking about the factory LEDs, not the gang-banger wannabes that simulate LEDs.

It could be just my new lenses, but I dunno. The old yellow headlights are a better compromise for the driver and oncoming car. It’s really a safety issue, I believe. The LEDs don’t need to be so white. The glare intensity is a killer.

 

[carbonbased]

A small clarification:

I should note I don’t mean to imply that the LED headlight glare is different than before I had cataract surgery and got toric lenses. I hated the oncoming ultra white LED headlights years and years before I ever had issues with my eyes. I think in this situation the right term is not glare, like a sunburst glare or a flaring. It’s more like the white LEDs ramp the intensity of the light way way up.

And since my new lenses are clearer than my old biologic lenses, that intensity shines through more strongly.

 

[pell1203]

I'd be interested in hearing other's experiences that have opted for the light adjustable cataract lenses and have not yet commented. I ask because I am in need of cataract surgery on my right eye and have had a prior roller coaster experience with eye surgeries and am thinking the light adjustable option may be a good choice for me.

My previous surgeries have included PRK surgery done in the early 1990s in Canada. This was about the time the very first laser surgeries were being approved in the USA, hence the visit to Canada where they had several years of prior experience. Unfortunately, to the surgeon's surprise, my eyes healed close to a +2 diopter correction out of plano requiring two additional minor corrective laser surgeries to achieve the 20/20 far vision I've enjoyed for 20+ years.

Fast forward to 2015 when I had my left eye cataract surgery done in USA opting to use a standard far vision lens. Again to the surgeon's surprise, the initial surgery left me over 1+ diopter farsighted and after waiting 30 days post surgery with minimal change, it was decided the best course of action was to surgically replace the prior implanted lens with one having the newly indicated correction.

This brings me to today and my need for cataract surgery on my right eye. Presently, I am seriously considering the RxSight light adjustable lens as on paper there does not seem to be any downside other than the higher initial cost and out of pocket expense. While it does seem prudent to go with the adjustable lens instead of the standard fixed power lens to best cover my options, I would appreciate hearing from those with real world experience as your impressions and experiences are far more valuable than the information and hype contained in the glossy brochures.

Thanks for any and all comments you may have.

 

[carbonbased]

How poor were your eyes before the original lasik? How old are you? Any health issues?

Whatever you do, tell the doc about your prev two experiences.

 

[pell1203]

How poor were your eyes before the original lasik? How old are you? Any health issues?

Whatever you do, tell the doc about your prev two experiences.

My eyesight 30 years ago was originally -3 to -6 diopters of nearsightedness with some astigmatism. I was in excellent health back then. My eyes just did not heal according the predictive data they had back then. I was ultimately corrected to 20/20 vision.

Present day I am 72 and health is not as good as it used to be. As mentioned previously, my prior cataract surgery did not respond according to their predictions either and left me farsighted enough for my surgeons to replace the lens with one of a different power.

My docs are aware of my past history and I am curious as to how they would want to handle the cataract on my right eye. I have an evaluation appointment coming up in late April and want to find out what other folks experience has been with these relatively new light adjustable lenses as they appear to be tailored made to deal with my healing patterns.

 

[DownhillFromHere]

Interesting discussion here, particularly wrt PVS (posterior vitreous separation) risk factors associated with nearsightedness. The following simply recounts my experience with cataract surgery for anyone who might be approaching that part of life. I didn't have the option of light-adjustable lenses, but I did have "standard complications" post-surgery.

I had cataract surgery about eight years ago. I was already in my 60s, so the normal aging process wherein the lenses essentially becomes crystalline (thereby incapable of focusing) was complete. I had been -4 diopters or so nearsighted since early grade school, with significant astigmatism. This raised my likelihood of PVS, but I was otherwise in very good health.

I elected to have toric lenses to correct the astigmatism, with both eyes corrected for distance as depth of field perception for shotgun sports was important to me.

Surgeries uneventful. With the first one, my wife says that, when I woke up and the nurse was disconnecting the monitors, I was still a little out of it. When the beeping stopped, I opened my eyes and said, "Did I just die?"

Anyway. That evening, when I turned lights out at bedtime, I noticed orange flashing in the surgery'ed eye's periphery when I moved my eyes. No pain. Next morning, the surgeon's practice got me in immediately and diagnosed PVS. No additional action was needed but there were a few more floaters than before.

The afternoon after the early-morning second surgery, I looked out the back door at a sunlit backyard and realized it looked like I was seeing through a cloud of sand from the newly-cut eye. This time, the PVS had torn the retina, and the "sand" was shadows of red blood cells cast on the retina. The tear was stitched closed with a laser (painful).

END RESULT of all of this: 20/20 or better vision (I could read some or all of the 20/15 line on good days). Frustration because the floaters can occasionally be intrusive - especially the "sand" in the right eye, which can suddenly be noticeable when I'm looking through a riflescope at a brightly-lit target. While my vision is great in well-lit conditions, it's a normal part of aging that acuity falls off rapidly in dim light. No problems driving at night. The biggest daily-life impact has been the necessity of keeping reading glasses close at hand - my wife would tell you that, especially in the first weeks/months after surgery, the cry of "Where are my #!^%#!! glasses" will be heard loud and often. I tried the lots-of-cheap-readers-laying-around approach which didn't work at all. I have one pair of quality progressive-lens readers that stay somewhere on my person 95% of the time and nearby the rest of the time.
----

Again, I recount all this for people who may be contemplating cataract surgery. I can't speak to the part about variable-light lenses as that wasn't an option for me, but my outcome, even with PVS and a retinal tear, has been quite optimal.

 

[carbonbased]

My eyesight 30 years ago was originally -3 to -6 diopters of nearsightedness with some astigmatism. I was in excellent health back then. My eyes just did not heal according the predictive data they had back then. I was ultimately corrected to 20/20 vision.

Present day I am 72 and health is not as good as it used to be. As mentioned previously, my prior cataract surgery did not respond according to their predictions either and left me farsighted enough for my surgeons to replace the lens with one of a different power.

My docs are aware of my past history and I am curious as to how they would want to handle the cataract on my right eye. I have an evaluation appointment coming up in late April and want to find out what other folks experience has been with these relatively new light adjustable lenses as they appear to be tailored made to deal with my healing patterns.

I’m no doctor, but since you don’t have a huge rx (back then) it sounds like your eyeball isn’t super long (like mine). High rx eyeballs stretch your retina thin and increase the odds of a retina detachment.

So I say go for it. You have to wear dark wraparound Bassmaster (ha) type sunglasses even indoors if you have a window open for, 6 weeks or something? And keep them on for the 5 or so treatments thereafter (three months?).

I cannot remember the exact therapy timeframe. But you get the idea. You have a very good chance of getting a perfect rx at the end.

Side note: I’ve had tons and tons of floaters my whole life, like starting in grade school. You guys just getting a few at 70+ years are lucky.