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Imagine if there was a way to fine tune your vision based on your personal preference after cataract surgery. Imagine if you could maximize your independence from glasses or contact lenses. Well there is no need to imagine any longer. The light adjustable lens implant has arrived to bring LASIK-like outcomes to cataract surgery. What an exciting time it is to be a refractive cataract surgeon! Today, I will review the amazing features of the new light adjustable lens and how we use it to maximize your vision after cataract surgery.
What is the light adjustable lens?
The light adjustable lens (LAL) is a monofocal silicone lens implant made by RxSight. It is designed to replace the natural lens inside your eye during cataract surgery. What makes this lens so exciting and sets it apart from all other lens implants available today is that it is adjustable! The power of the lens implant can be changed in the office using ultraviolet light after recovery from surgery.
All other lens implants for cataract surgery are fixed in their power. That means they can not be adjusted after surgery. If the preoperative data is off or an unexpected shift happens during healing, then you may need glasses or contact lenses afterward.
How does the adjustable lens actually work?
The special lens is made of tiny particles called macromers and after surgery UV light used to manipulate them. The macromers are rearranged in the lens and concentrated in a particular area based on the UV light treatment pattern. The UV light causes the macromers to polymerize which causes a shift in the lens shape and power. The amount of power adjustment is determined based on your vision preference after surgery. The vision will fluctuate and settle over the next 1-2 days after each adjustment.
Once your desired vision is achieved, then 2 final lock-in UV treatments are done to polymerize the remaining macromers. The final lock-in treatments prevent the lens from changing power accidentally in the future. Good dilation of the eyes is needed before each adjustment and each adjustment is painless and only take a few minutes.
Who is a good candidate for a light adjustable lens?
If you desire the highest quality vision and glasses or contact lens independence, then you may be a good candidate for a light adjustable lens. Since the light adjustable lens is fine tuned after surgery, it is excellent if you are very nearsighted (myopic) or farsighted (hyperopic). The light adjustable lens is also helpful if you have had prior refractive surgery (such as LASIK, PRK, SMILE, or RK). These surgeries make it difficult to predict what lens power you need to achieve your vision goal.
Refractive surgeries change the natural shape of your cornea. Unfortunately, the lens power calculations are based on the natural shape of your cornea. To compensate, the formulas make assumptions about the new cornea to estimate the implant power. In these situations, a fixed lens implant may be inaccurate as often as 20-30% of the time. That means 20-30% are at risk of needing glasses or contacts full time after cataract surgery. With a light adjustable lens, we can take the guesswork out of the equation and fine tune your vision accurately after surgery.
Who may not be a good candidate for a light adjustable lens?
If your pupils don’t dilate well enough with the dilating drops in clinic you may not be a good candidate for this lens. The reason dilation matters is because the UV treatment light can’t pass through your iris. If the light doesn’t reach enough of the lens implant because the pupil opening is too small, then we wont be able to change the lens power.
Certain medications may affect the amount your pupils can dilate. Some of the most common meds are alpha-blockers such as tamsulosin and finasteride. These are commonly used to treat benign prostatic hypertrophy. In most cases, stopping the medication will not improve your ability to dilate. Fear not! You may still be a candidate for a light adjustable lens if you take one of these medications. The answer will depend on how well you dilate during your cataract surgery evaluation. For a more complete list of medications that can affect dilation click here.
UV light comes from many places. How do I prevent accidentally adjusting the lens implant after surgery?
In an updated version of the lens, the company RxSight has placed a protective UV blocking coating on the front surface called ActivShield. ActivShield acts like special shutters that can be opened to perform treatments and then close automatically when treatment is done. As another line of defense, you will be instructed to wear special RxSight UV blocking sunglasses at all times after surgery (most importantly when outside). With these 2 protections in place, the risk of inadvertently adjusting the lens power from other UV sources is very low. You will be allowed to stop wearing the protective RxSight UV blocking glasses 24 hours after the second and final lock-in treatment.
How long does it take to achieve final vision with an LAL?
This can vary depending on how quickly you heal. Typically, the first adjustment is planned 3-4 weeks after surgery. If needed, additional adjustments are performed every 3-7 days (up to 2 more times). If you have a complex cornea, such as dry eye disease or prior radial keratotomy, it may take longer for the cornea to stabilize enough to proceed. Once you are satisfied with the vision, then 2 lock-in treatment will be done each a week apart.
For more information and frequently asked questions you can visit the RxSight website by clicking here.
This is such an exciting time to be a refractive cataract surgeon and there are many great lens implant options today. To learn more about other exciting cataract surgery lens implants click here. In terms of being able to fine tune your vision after cataract surgery, the light adjustable lens is truly game changing. If you value your independence from glasses after cataract surgery, then call and make an appointment to see Dr. Kane or talk to your local doctor to see if a light adjustable lens is right for you.
I’m Dr. Kane, and that’s my take on it.
At Tailored Eyes, we perform a thorough evaluation of your eyes and together formulate a customized treatment plan to meet your vision needs.
Steven Kane, MD, FAAO is a Cataract, Cornea, and Refractive Surgery specialist with Tailored Eyes in Sarasota county Florida. He proudly serves the people of Venice, South Venice, Sarasota, Plantation, Osprey, Nokomis, Laurel, Siesta Key, Casey Key, Bradenton, Lakewood Ranch, Anna Maria, Palmetto, Ellenton, St. Petersburg, Englewood, North Port, Punta Gorda, Port Charlotte, Charlotte Harbor, Manasota Key, Arcadia, Fort Myers and Cape Coral.