Eyeworld

28 | EYEWORLD | SEPTEMBER 2020 by Liz Hillman Editorial Co-Director R YES CONNECT EFRACTIVE Thank you to Julie Schallhorn, MD, and Claudia Perez-Straziota, MD, who managed the YES Connect column for the past year. Michael Patterson, DO, and I, as the new co-editors of the column, look forward to guiding topics of interest and importance to the young eye surgeon audience. For our first column, we recognize that a critical part of being a successful refractive cataract surgeon is keeping up with the latest and greatest refractive options for our cataract patients as the technologies available continue to evolve. Today's world of increased patient demands for predictable and accurate postoperative outcomes as well as an expectation for spectacle indepen- dence has created much interest in learning more about technologies such as the Light Adjustable Lens (LAL), which is discussed in this month's YES Connect column. We asked two experts to share their thoughts and expe- riences with the LAL. I have learned so much from our discussions with these two and hope you will find their insights useful in staying up to date. —Soroosh Behshad, MD YES Connect Co-Editor A rturo Chayet, MD, has been work- ing with the Light Adjustable Lens (RxSight) for nearly 20 years, implanting the first iteration of the lens in 2002. So, he has a pearl or two to offer young eye surgeons when it comes to this technology, which, though FDA approved in 2017, only began its commercial launch in the U.S. in Sep- tember 2019. The Light Adjustable Lens is a three-piece, silicone lens that is approved currently for pa- tients with 0.75 D or more of corneal astigma- tism and without preexisting macular disease. Outside the U.S., the lens can be for presby- opia-correcting purposes. The lens is adjusted postoperatively in an in-office procedure with a Light Delivery Device that applies a customized UV light treatment to the reactive lens, with up to three treatments possible. A final procedure "locks in" the treatment. In the time between lens implantation and the "lock-in" procedure, the patient needs to wear UV light-protective glasses that are provided by the surgeon. "This is a lens that you can adjust once the intraocular lens is inside the capsular bag. Usually we adjust it after 2 weeks. The benefit is we can achieve emmetropia," Dr. Chayet said. "We don't need to worry about IOL placement in terms of a toric lens that you might need to place in the axis of astigmatism. Obviously, we need to do good calculations, but if we miss by 0.5 D or 1 D, we'll be able to adjust that." Dr. Chayet said this lens achieves the high- est percentage of eyes within ±0.5 D of target, with more than 95% of eyes achieving this. "That's something you don't get with any other IOL," Dr. Chayet said. According to the FDA pivotal clinical study that confirmed safety and efficacy of the Light Adjustable Lens, it "achieved higher 'percent reduction' in postoperative manifest cylin- der and MRSE [manifest refraction spherical equivalent], respectively, than the control" and it "demonstrated the rotational stability." A press release from RxSight at the time of the IOL's FDA approval stated that patients with the Light Adjustable Lens, compared to control, were twice as likely to achieve 20/20 UCVA or better at 6 months postop. "This is the first time in IOL history that we get that kind of LASIK result, which is 93% within 0.5 D of intended correction," Dr. Chayet said. Dr. Chayet also noted being able to avoid some higher order aberrations, such as glare and halo, that can occur with other lenses. Bryan Lee, MD, JD, who has been using this lens since October 2019, has been happy with his results and has observed high patient satisfaction. He said he is implanting it in about 10% of eyes, with high interest in the post-re- fractive patient population. "Many of the patients opting for this IOL are the toughest to achieve a good refrac- tive outcome in because of irregular corneas and difficult power calculations, and I am Insights on the Light Adjustable Lens About the doctors Arturo Chayet, MD CODET Vision Institute Tijuana, Mexico Bryan Lee, MD, JD Altos Eye Physicians Los Altos, California Relevant disclosures Chayet: None Lee: None

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