‘Game-changing’ IOL

A light-adjustable IOL (Light Adjustable Lens, RxSight) is game-changing technology that should overcome some of the barriers to greater adoption of premium refractive lenses and create a paradigm shift in refractive cataract surgery, according to David F Chang, MD. Speaking at the 37th Congress of the ESCRS in Paris, France, he outlined benefits of using the light-adjustable lens (LAL) for post-refractive eyes and for presbyopia correction, and ways that it could transform the experiences of patients and surgeons in a win-win situation. Dr Chang said that with the LAL, cataract surgeons will be able to achieve LASIK-like refractive outcomes because the power adjustments are done postoperatively, when the effective lens position and posterior corneal astigmatism no longer need to be estimated. The newly commercialised LAL offers both spherical and toric power adjustment, which renders many preoperative and intraoperative diagnostics superfluous for these patients. He noted that postoperative adjustability is particularly advantageous for post-refractive eyes, in which IOL power calculation is least accurate. Dr Chang added that the LAL provides a premium monovision approach for presbyopia correction, by delivering emmetropia in one eye, and the ability to increase or decrease the amount of myopia in the second eye postoperatively. “Mini-monovision is popular because patients can achieve functional convenience without haloes and starbursts, or loss of contrast sensitivity,” said Dr Chang, clinical professor of ophthalmology, University of California San Francisco, USA. However, it is hard to know how much myopia the patient will want or tolerate in the near eye. “With the LAL, patients can try pseudophakic mini-monovision, and either increase or reverse the anisometropia after trying it,” he explained. This is analogous to the way that contact lens patients can vary the amount of myopia in the near eye. “The light-adjustable lens is a great option for people who prioritise quality of vision, and don’t want the risks of starbursts and haloes”, he said. “We often fail to recognise how stressful preoperative decision-making is for cataract patients, who have no way of previewing different IOLs or trying out different refractive targets,” said Dr Chang. “They are confused by the optical terms we use and by not really knowing how much they will be able to see without eyeglasses. Adjustability allows them to try out different refractive targets postoperatively before selecting the outcome they want.” David F. Chang: dceye@earthlink.net

Tags: light-adjustable lens, premium refractive lenses