Eyeworld

FALL 2026 | EYEWORLD | 55 R He also described how he illustrates the ex- perience of rings, spider webs, or starbursts that can occur with diffractive, full range of vision IOLs. Some patients will say, "I never want to see that" or "That's what I came here to get rid of." This is Dr. McKee's cue to bring the conver- sation back to monofocal or monofocal toric options or the LAL. While the LAL is considered a monofocal IOL (though the LAL+ can slightly extend depth of focus), Dr. McKee discussed how he often uses a blended vision strategy to provide greater range of vision with these lenses. "If you were to slightly defocus the non-dominant eye by –0.5 D or –0.75 D, the distance might drop to 20/25 instead of 20/20 or from 20/15 to 20/20, but it's still very good … and suddenly you're at a –2 focal plane, in other words, a half a meter," Dr. McKee explained. "When you use both eyes together, the visual summation gives you better results than you would have mathematically predicted for this. You can absolutely get full range of vision with the LAL." This strategy is something 60–75% of his LAL patients select. Douglas Koch, MD, still prioritizes the LAL for eyes with corneal optics that are significantly altered by prior LASIK or PRK. "In my practice, the LAL is almost exclusively used for irregular eyes, specifically post-LASIK, post-PRK, SMILE, and post-RK," he said. "I tend to go that direc- tion just from the standpoint of patient and physician effort." Dr. Koch will also use the LAL for patients who are asking for it specifically and/or for those who seem "obsessed with the idea of having a very accurate outcome." He has had success with setting one eye with the LAL for distance and the other for slightly near, howev- er, if the patient seems averse to monovision but still wants as much spectacle independence as possible, a discussion about EDOF or trifocals is in order. Dr. McKee also advises the LAL for patients who've had prior refractive surgery. "What I tell patients is, 'I have a 65–70% chance of hitting the correct refractive endpoint with a multifo- cal lens because you've had LASIK; are you OK with that?' Most people say, 'No, I'm not.' So, then we're not talking about a multifocal lens anymore," Dr. McKee said. "They want a very reasonable chance, 90–95%, of not needing glasses for good distance vision at the end of cataract surgery, then we're considering the LAL, if they're a good candidate for it." Why many surgeons favor full range of vision IOLs While the ability to adjust refraction postop— with or without use of a blended monovision continued on page 56 Postop experience influences IOL decisions Both LAL and full range of vision IOL strat- egies require patients to understand the postoperative experience before surgery, not just the expected visual outcome. With full range of vision IOLs, patients may experience a neuroadaptation period as they adjust to optical phenomena, such as glare and halos. This adaptation typically improves over 3–6 months, but patients must be counseled that visual disturbances may persist or, in rare cases, require lens exchange. "The postoperative experience is critical," Dr. Koch said. Dr. Koch also uses virtual reality simulation preoperatively to help patients understand potential visual tradeoffs and dysphotop- sias associated with different lens designs. In contrast, the LAL requires a structured postoperative commitment. Patients must wear UV-blocking glasses until final lock-in and return for multiple adjustment visits, which may include temporary blur, dilation, and mild discomfort. "It's getting dilated every time they come in for adjustments … plus, a lot of our patients travel to see us, so that can push them away from the LAL," Dr. Meghpara said. Ultimately, patient willingness to engage in the postoperative process is a key factor in lens selection and satisfaction.

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