Eyeworld

46 | EYEWORLD | SEPTEMBER 2022 ATARACT C Contact Fram: info@avceye.com Hoopes: pchj@hoopesvision.com Nikpoor: drneda@alohalaser.com Solomon: jonathansolomonmd@gmail.com more and give us the ability to induce it or take away if we want to." Another exciting future advancement is the potential for the company to create a custom light adjustment profile that would help offset some corneal aberrations, Dr. Nikpoor said. Jonathan Solomon, MD Dr. Solomon was aware of the LAL technology for a number of years before deciding to use it in his practice. "I was eager to get my hands on the technology with the idea that it would be a useful tool for almost all patients," he said. Dr. Solomon stalled his official adoption of the LAL for about 6 months after getting the opportunity to start using it, having some hesitation after looking at the numbers and assessing the effort it would take to incorporate it. Ultimately, he did decide to bring it into prac- tice and was surprised that the adoption was less arduous than he originally thought. Patients also gravitated to the technology with very little effort. "Despite the added work that is associ- ated with it, the patient flow can be effectively streamlined easily, and the patient expectation is met in the overwhelming majority of cases," Dr. Solomon said. With the LAL, Dr. Solomon said the first and second eye are done very close together so their adjustments can be timed according- ly. You have to wait for the tissue to heal, for the corneal edema to resolve, and get a steady refraction, he said. Being able to treat both eyes around the same time for adjustments is im- portant because that's more time in the postop window, and of course there's a lock in where after you've achieved your ultimate refractive outcome, you're going to fix the lens in that current state. There's more work that goes into an LAL patient, and the mindset for the patient needs to be managed ahead of time. "People hear 'adjustment,' and there's a certain mentality that it's infinite, that you can move this around, and that's not the way it works, and you have to set a healthy expectation." "The accuracy and ability to precisely hit targets is impressive," Dr. Solomon said. In the future, Dr. Solomon said one ad- vancement he would be looking for is the option of a multifocal or true EDOF version of the optic itself. the range of vision was similar to an extended depth of focus lens. "The range and quality of vision are excellent, making LAL a great option for any patient," Dr. Nikpoor said. One obstacle to adoption is figuring out the workflow because of the extra visits, and the visits take a while, Dr. Nikpoor said. In her prac- tice, this involved finding time on the schedule to do adjustments twice a week and training technicians. "We would have a specific tech who was good at assessing dilation, getting patients dilated, programming, being with us for the treatments, etc.," she said. "We have patients coming in clusters of three, so we have three patients getting refracted close to each other and getting dilated together, and we found that to be useful." Dr. Nikpoor said the LAL is an "easy sell" with post-refractive patients. "I explain to them that even with all the measurements we take, we're still going to be off 10–20% of the time," she said. "I show them their scans, and I show them why their RK or LASIK makes it challeng- ing to determine the correct lens power." For other patients, Dr. Nikpoor will still explain how it's necessary to enhance any dif- fractive or premium lens 10–15% of the time. Then she explains the alternative of putting a lens into the eye where all the adjustments are built into part of the process and any fine tuning can be done without an additional surgery. She added that the LAL is a desirable option for some patients who don't know what they want and find it stressful to commit. Dr. Nikpoor said the ActivShield technol- ogy has been a helpful advancement. Though she noted that she's only had one patient who was not compliant with the glasses before ActivShield, she did have to end up exchanging that patient because of stray UV light. It was a difficult case, Dr. Nikpoor said, but when she did the exchange, the ActivShield technology was available, so this was one of her first patients with the update. Dr. Nikpoor is eager to see the ability to add or remove extended depth of focus in the future. "Even though it's a monofocal, it gives you a little more extended depth of focus than a typical monofocal, and when you do the first adjustment in a myopic direction with a myopic target, on the near eye, you get even more extended depth of focus," she said. "But I think they will figure out a way to induce even continued from page 44 Relevant disclosures Fram: RxSight Hoopes: RxSight Nikpoor: RxSight Solomon: RxSight

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