Eyeworld

38 | EYEWORLD | JUNE 2019 R EFRACTIVE DEVICE FOCUS by Michelle Stephenson EyeWorld Contributing Writer Contact information Berdahl: john.berdahl@ vancethompsonvision.com Lindstrom: rllindstrom@mneye.com Maloney: rm@maloneyvision.com Miller: kmiller@ucla.edu Waltz: kwaltz56@gmail.com that because that's a huge number for them," he said. If you are planning to add LALs to your armamentarium, Dr. Waltz recommended be- ginning to implant toric lenses now. "This gives you and your staff an entry point to get com- fortable," he said. Once the lens is available, there will be a specific protocol for training surgeons, said Kevin M. Miller, MD. "It's a significant com- mitment of time for surgeons who want to implant these lenses. Patients will get implanted, wear UV-protecting glasses for the next 3 to 3.5 weeks indoors and outdoors, then undergo one or two light adjustments, followed by one lock- in treatments. There are many patient visits," he said. Dr. Miller said that in the clinical trial, LAL patients were targeted for hyperopia so that they could be adjusted toward emmetro- pia. "It's easier to adjust these lenses from the hyperopic direction because you're treating the center of the lens with the ultraviolet light. It's a little harder to treat from the myopic direction, where you have to treat the periphery of the lens. One of the most frustrating aspects of treating these patients is they have to dilate to larger than the diameter of the lens, which is 6 mm. You may find that after a patient has been consistently dilated numerous times, he or she T he Light Adjustable Lens (LAL, RxSight) has been FDA approved for more than a year but has not yet come to the marketplace. Surgeons are anx- iously awaiting its availability, as it will offer a new level of customization for cataract surgery patients. According to Richard Lindstrom, MD, the LAL will create a premium monovision channel. "The LAL will allow for premium monovision, which I think will be popular. In the U.S., ap- proximately 25% of patients choose moderate monovision, and the LAL will allow surgeons to hit the target exactly where the patient wants it," he said. He said there will also be the opportunity for a select group of patients to achieve perfect distance vision as well. "If you're an airline pilot, a golfer, or an elite athlete who is willing to pay extra to have perfect vision in both eyes, there will be that opportunity. I would rather not have to do a laser corneal refractive surgery procedure if I could do an adjustment in the intraocular lens," Dr. Lindstrom said. Precise outcomes According to John Berdahl, MD, the LAL makes very precise outcomes accessible to every surgeon. "We are not changing human tissue; we're changing silicone, which is much more predictable. We can make changes after the eye has healed, so we won't have surprises in effec- tive lens position, in surgically induced astigma- tism, or in posterior corneal astigmatism. The outcome will be primarily dictated by how good of a manifest refraction the surgeon can do," he said. The other advantage is that patients will be able to see what their final visual result will be before locking it in, Dr. Berdahl said. Incorporating the LAL According to Kevin Waltz, MD, it is import- ant to prepare your staff for incorporating the LAL into your practice. "When you start talking about charging $3,000 per eye or more extra for surgery, the staff has to get comfortable with Incorporating the Light Adjustable Lens into a practice About the doctors John Berdahl, MD Vance Thompson Vision Sioux Falls, South Dakota Richard Lindstrom, MD Minnesota Eye Consultants Minneapolis Robert Maloney, MD Director Maloney-Shamie Vision Institute Los Angeles Kevin M. Miller, MD Kolokotrones Chair in Ophthalmology David Geffen School of Medicine University of California, Los Angeles Kevin Waltz, MD Eye Surgeons of Indiana Indianapolis Financial interests Berdahl: RxSight Lindstrom: RxSight Maloney: RxSight Miller: None Waltz: None "In the U.S., approximate- ly 25% of patients choose moderate monovision, and the LAL will allow surgeons to hit the target exactly where the patient wants it." —Richard Lindstrom, MD continued on page 40

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