Eyeworld

50 | EYEWORLD | SEPTEMBER 2021 ATARACT C by Ellen Stodola Editorial Co-Director About the physicians David F. Chang, MD Clinical Professor of Ophthalmology University of California, San Francisco San Francisco, California James Loden, MD Loden Vision Centers Nashville, Tennessee Steven Naids, MD Advanced Vision Care Los Angeles, California Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota T he Light Adjustable Lens (LAL, RxSight) offers the unique opportunity to lock in the preferred vision after surgery. With recent updates, the technology can be an attractive option for a variety of refractive cataract patients. Several surgeons discussed how they use this IOL in their practice. Which patients should the LAL be used for? As an adjustable toric monofocal IOL, the LAL can be used for any patient who does not want to compromise night vision or contrast sensi- tivity, and it is particularly well suited for the most challenging refractive patients, said David F. Chang, MD. "These include post-refractive or refractive lens exchange patients, those with unpredictable astigmatism (e.g., mild corneal scars), uncompromising personalities demanding a specific outcome (e.g., no dis- tance [compromise] or no reading glasses), and those who've never needed glasses thanks to rigid contact lens monovision and expect this to continue." James Loden, MD, said he considers the LAL to be an "upgrade product" in his practice, so the patient pays extra for it. He combines it with one of the femtosecond laser packages in his practice, but he noted that physicians do not need to have a femtosecond laser to be able to use the LAL. "It's a way that you can upgrade to a refrac- tive product without having to have the capacity to do corneal relaxing incisions," he said. "You don't need a femtosecond laser, and the vast majority of the time, you don't need an excimer laser to do any fine turning or adjustments of the patient." Dr. Loden said it will depend on the practice to see how the LAL fits into the treatment para- digm. He has a large refractive practice and said that this is "absolutely the best technology out there for adjustable monovision." You can fine tune the patient to exactly what they want with their monovision. "If someone is thinking about monovision and not sure if they'll tolerate it, you can give them the monovision effect, and if they don't like it, you can take it away without having to do an invasive surgical procedure." He also said that the LAL is a "game changer in operating on prior LASIK eyes and PRK eyes" because you don't have to overthink the lens implant calculation. You just have to get close with the IOL and let the adjustments do the rest. "It's dramatically improved patient satisfaction for us in post-LASIK eyes," he said. "It used to be that on a prior LASIK eye, if the patient wanted a premium product, we had to tell them the chance of having to go back in and do a touch-up was 50–80%, we're not doing the touch-up until 2 months out, and it would have to be PRK rather than LASIK." Deborah Ristvedt, DO, thinks that the LAL came at "a great time where we're really focusing on precise results and good outcomes for patients." She uses the lens frequently in post-refractive patients. "It's nice with this technology where we're doing all the treatments post-healing," she said. Additionally, she said it's a great option for patients with astigmatism. Torics correct astigmatism, but there is still some variability with corneal healing and effec- tive lens position. "I've found that to be able to really dial in astigmatism, knowing exactly what axis we're treating, gave me more confidence that I was going to nail the target every time," Dr. Ristvedt said. "I've found that I'm doing a lot of mini-monovision as well to give patients more extended range of vision." Patient discussion When discussing the LAL as an option with pa- tients, Steven Naids, MD, focuses on a couple of things. First, he explains that while the surgery is the same as with regular cataract surgery, the recovery is quite different. "I always tell patients that before this, the lens that was put in the eye is what you got, and the recovery was just drops," he said. "Now, compliance is what matters with the UV glasses. It's an enormous commitment for the patients to wear the glasses for 6–7 weeks." You have to get a good feel for the patient and their lifestyle, he said. Dr. Naids noticed that with more people working from home during the pandemic, they Using the Light Adjustable Lens in practice

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