BLOG: Tunable IOLs will end exchanges
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Through their careers, most cataract surgeons become extremely comfortable with and adept at performing phacoemulsification, removing even the most challenging lenses and placing lens implants with little stress.
As their comfort in this procedure grows, their comfort often decreases with other procedures performed less frequently, such as IOL exchange. For some, the prospect of having to perform such an exchange is concerning enough that they would rather not offer a patient a refractive lens implant that runs the risk of an undesirable outcome, whether a refractive miss or unwanted visual phenomena. For them, it’s simply not worth the trouble. Market research shows that fear of an undesirable outcome is the No. 1 reason many surgeons do not use premium lenses.
Still, according to MDbackline, 83% of our patients report they are at least somewhat interested in refractive lens options when considering cataract surgery. What is a surgeon to do who wants to serve patients’ desires but do so within his or her personal comfort zone? I believe the Light Adjustable Lens (LAL, RxSight) or other future tunable lens implants may be the answer. We have used the LAL commonly in our practice for the past year, and without question, it provides the highest, most consistent satisfaction of any refractive IOL option we offer.
While the LAL does not have labeling as a presbyopia-correcting lens, it does provide some extended depth of focus properties. Whether it’s used for monovision or binocular distance, it reliably gets every patient on target. Its role in post-refractive patients or those with irregular corneas is vital; I have said before it takes the hardest-to-please patients and makes them the happiest. Moreover, its role in our practice has grown. No longer is it for just post-refractive patients. While we achieve excellent predictability with other lenses, both our patients and we can be confident that an adjustable lens will give patients the best vision their eye can provide. That confidence — that the patient will be satisfied — may be the most important feature of the LAL technology. For surgeons who are on the sidelines of refractive cataract surgery to avoid IOL exchanges, it could make all the difference.
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