Eyeworld

98 | EYEWORLD | SPRING 2026 G UCOMA by Ellen Stodola Editorial Co-Director Using the Light Adjustable Lens in glaucoma patients About the physicians Christine Larsen, MD Minnesota Eye Consultants Woodbury, Minnesota Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota W ith expanding lens options in cataract surgery and an increase in combined glaucoma and cataract procedures, Christine Larsen, MD, and Deborah Ristvedt, DO, discussed when the Light Adjust- able Lens (LAL, RxSight) can be a good option for glaucoma patients and considerations when choosing it. "We are fortunate to have numerous lens options today that allow for truly individual- ized patient care," Dr. Ristvedt said. "For many years, patients with additional ocular pathology, such as glaucoma, were often excluded from advanced technology options." She added that having cataracts and glaucoma together pres- ents the challenge of how to offer these patients the clearest vision possible with reduced specta- cle dependence. "The LAL is instrumental in optimizing out- comes, even for those with visual field loss due to glaucoma," Dr. Ristvedt said. "It is a positive choice for decreasing the risk of common issues like dysphotopsias and contrast loss, while mini- mizing residual refractive error." In carefully selected glaucoma patients, the LAL can be a great option, Dr. Larsen said. "One of the biggest advantages of the LAL in this population is its ability to fine tune refractive outcomes postop, which is particularly valuable given the higher variability in effective lens po- sition and refractive predictability seen in many glaucomatous eyes." She added that patients with glaucoma often have less tolerance for residual refractive error, especially astigmatism, because reduced contrast sensitivity or visual field loss can magnify the functional impact of even small refractive misses. "The LAL's postop adjustability allows surgeons to optimize uncorrected vision once the eye has stabilized, rather than rely- ing solely on preop biometry that may be less reliable in these patients," Dr. Larsen said. "That said, the LAL should be framed as a refrac- tive-enhancing option that will not reverse the impact of underlying disease. Patient counseling is essential to align expectations." Candidates Dr. Ristvedt said that the LAL works well in most patients with ocular hypertension, as well as mild and moderate stages of glaucoma. "Can- didates are evaluated case by case based on their visual goals, current glasses prescription, potential need for future surgery, and crucially, the ability of the patient to provide a reliable manifest refraction necessary to dial in their vision post-surgery," she said. "Patients I would consider good candidates for LAL implantation would include glaucoma suspects or ocular hypertension, as well as early to mild primary open-angle glaucoma," Dr. Larsen said. "More advanced stages could also potentially benefit from this technology, although it is important that their disease be stable and well-controlled with preserved cen- tral vision. These patients typically retain good contrast sensitivity and central acuity, making them more likely to appreciate the refractive precision the LAL offers." Dr. Larsen said that those with advanced glaucoma, especially those with central field involvement or significantly reduced contrast sensitivity, may derive less functional benefit from premium refractive accuracy. "In such cases, the value proposition of the LAL should be weighed against cost, treatment burden, and visual potential." Dr. Larsen listed several situations where she would advise caution or avoidance: • Advanced glaucoma with significant visual field loss involving fixation • Unstable or rapidly progressing disease, where visual outcomes are less predictable Dr. Larsen discusses options with a patient. "Patient counseling is essential to align expectations," she said. Source: Christine Larsen, MD

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