Eyeworld

36 | EYEWORLD | WINTER 2024 ATARACT C EVOLVING by Liz Hillman Editorial Co-Director About the physicians Sumitra Khandelwal, MD Professor Department of Ophthalmology Baylor College of Medicine Houston, Texas Bryan Lee, MD, JD Altos Eye Physicians Los Altos, California Neda Shamie, MD Maloney-Shamie Vision Institute Los Angeles, California Taylor Strange, DO Alliance Vision Institute Fort Worth, Texas maybe we didn't think they were a great candi- date for a presbyopia-correcting lens." From a clinic flow standpoint, Dr. Khandel- wal said it's been helpful to have their research optometrist trained in refractions and the Light Delivery Device adjustments, but the ophthal- mologist is still who pushes the foot pedal. From a surgical standpoint, Dr. Khandelwal said the rhexis is very important with this lens. "The rhexis needs to be an appropriate size, covering the optic all the way around," she said, adding later that it's also a silicone lens, which has a bit of a learning curve. "First of all, it's a learning curve to load it. Any scratch on the IOL has to come out, and it comes out fast from the injector." Dr. Khandelwal advised being careful with patients who have a lot of fluctuations with refractions, such as with OSD, which she said needs to be optimized before surgery. Finally, she offered that surgeons should guide the pa- tients to their realistic postop goal rather than allowing patients to take the lead. "This is not a trifocal lens. Patients need to understand they may not get the near vision they were thinking they were going to get, and they may not get the trifocality in both eyes. I think telling them that upfront and getting them locked in in a timely manner is helpful," she said. "Patients with decision-making challenges should be guided away from this lens." 'Lock in … at the end of OR days' Dr. Lee began offering the LAL in 2019 and has found it to be his preferred lens for patients with a history of refractive surgery and those who want monovision. Clinic flow was one of the main adjust- ments his practice identified when onboarding this lens. "Patients may require multiple rounds of di- lation, and they need refraction and discussion of the plan for each treatment as well," he said. "I think the combination of doing so many over the years and the wonderful staff in our office has made it work. We try to spread patients out evenly between clinic days, and it is helpful to have lock-in treatments at the end of OR days. Latest lessons learned with the Light Adjustable Lens W ith its approval in late 2017, many physicians have several years of lessons learned under their belt with the Light Adjust- able Lens (LAL, RxSight). And with the more recent commercial launch of the LAL+, which has a modified aspheric surface to extend depth of focus slightly, ophthalmologists have even more to talk about with this lens platform. EyeWorld spoke with Sumitra Khandelwal, MD, to learn how an academic center brought on the LAL, and Bryan Lee, MD, JD, Neda Shamie, MD, and Taylor Strange, DO, private practice ophthalmologists, for their diverse per- spectives on and experiences with this lens. 'It's a learning curve to load it' There were a few reasons that the ophthalmolo- gists at Baylor were interested in the LAL. "At Baylor, we do a lot of research in IOL calculations and various formulas, … but the results are still not perfect. … Formulas are around 75% at best, and we have outliers. I really want [LASIK-like outcomes] for our patients. We see a lot of post-refractive patients now, and their expectations are very different," Dr. Khandelwal said. The academic practice didn't join the LAL bandwagon right away, however. It was the second iteration of the lens that included ActiveShield, which reduces issues with acciden- tal UV light exposure before lock-in, that made them more comfortable with offering the tech- nology. But it still came with a learning curve. "The real questions when we started to analyze this technology were 1) how were we going to incorporate it in our practice, which is different than a private practice, and 2) is this technology going to cannibalize some of the premium technologies we already use?" she said. "Those are two questions I think everyone has to ask themselves about the Light Adjustable Lens. … I've been pleasantly surprised about both." Dr. Khandelwal said the LAL hasn't taken away from other advanced-technology lens- es, rather it's augmented their offerings. "It's opened up the space for patients who before

• Blank Page
• Blank Page (1)