Light Adjustable Lens requires patience for best results
Key takeaways:
- Surgeons should differentiate between ideal candidates and those to avoid.
- Extra patient visits are needed with the Light Adjustable Lens.
ORLANDO — The Light Adjustable Lens entails selecting candidates who are willing to take more time to reach the best outcomes, a speaker said at Telling It Like It Is.
According to Sumitra S. Khandelwal, MD, most patients who receive the Light Adjustable Lens (LAL, RxSight) will need two to five light treatments followed by two lock-in treatments, so it is important to consider all factors that may affect their satisfaction.
“With these patients, remember that you are going to see them for 2 to 3 months after their surgery,” she said. “Pick the right patient that you want to see in your clinic and that you want your team to see.”
Patients who are interested in monovision or mini monovision who are glare averse, as well as patients with low myopia, are often good candidates for the LAL.
“I like introducing distance vision in both eyes and walking them toward more near vision or mini monovision and letting them experience what it’s like to have that distance,” Khandelwal said.
She also recommended the lens for patients with low to moderate astigmatism and those who are post-LASIK, post-PRK or post-RK with regular astigmatism. Ideal candidates should have 6.5 mm or more of dilation, and they need the time and motivation to gain the best vision outcomes in multiple extra visits.
“Don’t put this lens in patients who don’t dilate well,” Khandelwal said.
Surgeons should watch out for patients who are more difficult to refract, especially those with ocular surface disease, which can affect tear breakup time.
“It can get a little bit worse after surgery, so you want to aggressively treat that,” Khandelwal said.
While the LAL+ provides an increased depth of focus, it may cause higher-order aberrations in complex eyes.
“We are usually using the LAL standard for most of our patients and our more complex patients,” Khandelwal said. “But if you have a perfect eye, we’ll lean toward the LAL+ for mixing and matching.”
It is important to make sure patients understand that the LAL is not a true trifocal IOL and to set expectations properly.
“If they don’t really tolerate monovision or mini monovision, you cannot tell them they’re going to be spectacle independent,” Khandelwal said.
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Khandelwal SS. Pearls: Light adjustable & small aperture lenses. Presented at: Telling It Like It Is; Feb. 13-16, 2025; Orlando.
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