Eyeworld

Two surgeons share their clinical experience T wo Europe-based surgeons are finding multiple uses for the Light Adjustable Lens (LAL, Calhoun Vision, Pasadena, Calif.). In addition to locking in cus- tomized vision for standard cataract patients, these surgeons are finding the lens can be used successfully to test monovision and treat post-re- fractive cataract patients. The LAL has been available in Europe since 2008; it has been in clinical trials in the United States since 2009. Tobias Neuhann, M.D., Mu- nich, Germany, has used the lens for more than 2 years and has follow-up from nearly 100 eyes. H. Burkhard Dick, M.D., chairman, University Eye Hospital Bochum, Germany, began to implant the lens 2½ years ago and has implanted 400 lenses on a commercial basis. Of the 350 eyes that have their final vision, 98% were within a quarter diopter of the target refraction, Dr. Dick said. Both surgeons said the greatest strength of the lens is that it can customize vision to each individual patient. This is so powerful, in fact, that Dr. Dick said he has to do his best to keep his multifocal IOL and LAL patients separate; otherwise, the multifocal IOL patients begin to gripe about not having such a cus- tomized product. Here are some more details on how the lens works, what patients think of it, and how Drs. Neuhann and Dick are trying other uses for the lens beyond standard cataract patients. LAL details The LAL is a three-piece, foldable sil- icone lens with 6-mm optics, Dr. Dick said. It is inserted via a 2.5- or 2.75-mm incision. The LAL contains macromers that are sensitive to light of a certain wavelength, according to Calhoun Vision's website. Patients have cataract surgery and take the regular medications they would with a standard proce- dure, Dr. Neuhann said. An LAL that is suited for the patient's refractive error (and astigmatism up to 2 D) is inserted, and patients must wear protective UV glasses for 2-3 weeks. When the patient returns after that time, the surgeon evaluates if the pa- tient needs other visual adjustments. A digital light delivery device is used to deliver light for about a minute to the central part of the lens. This oc- curs in three or four treatments over a week. Once the patient and sur- geon determine the vision is what they want it to be, the lens is again irradiated to "lock in" that vision. Patients most commonly getting the LAL are the ones who can afford it, as it is not covered by private in- surance, said Drs. Neuhann and Dick. "Most of these patients are well established in their community or social life," Dr. Dick said. Patient reaction Overall, patients have been pleased with the results—so much so that they often come back to get their second eye treated before they nor- mally would, Dr. Neuhann said. "I have a female patient [with the LAL in one eye], and she said the quality of vision in the LAL eye compared to the other eye is so different, she wants to have the surgery now. She is just starting to develop a cataract in the second eye and still has 20/30 vision," he said. "Patient satisfaction is ex- tremely high, as is word-of-mouth advertising because of the UV glasses," said Dr. Dick, noting that the UV glasses have space on the side to place the name of the sur- geon or center. Additionally, when patients come back to the office, they tend to chat with each other because they see others with the same kind of UV glasses, Dr. Neuhann said. Wearing the special UV glasses for several weeks is something pa- tients tolerate because they often had been wearing glasses prior to surgery, Dr. Dick said. However, some patients may complain that it takes a few weeks to reach their final vision, Dr. Neuhann said. Patients generally don't like the UV treatment because of its bright by Vanessa Caceres EyeWorld Contributing Editor Evaluating the Light Adjustable Lens T he promise of an adjustable IOL is seductive and potentially very powerful. The ability to consistently deliver the desired refractive result makes lens- based surgery a true refractive procedure. We currently go to great lengths to esti- mate IOL power. The fact is that even using the most carefully collected data and opti- mized formulas, we still encounter refrac- tive surprises. This is especially true in patients who have had prior corneal re- fractive surgery. The results that are being reported from early commercial use of the Light Adjustable Lens seem to be living up to the promise. What surgeon wouldn't want to have 98% of his patients within 0.25 diopter of their target refraction? Im- provements in cataract surgery ultimately have to lead to better visual outcomes. As Burkhard Dick, M.D., points out, the value to the patient is not derived from how the cataract is removed, but in the quality of the refractive outcome once the lens is put in. John Vukich, M.D., international editor International editor's corner of the world EW International 50 October 2011 The LAL implanted in the eye A patient receives a light adjustment treatment to her implanted LAL Source: Arturo Chayet, Codet Vision Institute, Tijuana, Mexico 50-51 International_EW October 2011-DL2_Layout 1 9/29/11 3:46 PM Page 50

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