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April 18, 2022
Contributing Authored: Ayan Chatterjee, M.D.
Cataracts are one of the leading causes of blindness worldwide, and they occur when the body’s natural lenses become clouded over time. The condition is caused by the protein build-up in the lens, preventing it from sending clear images to the retina. The most common cause of cataracts is a change in the tissue that makes up the eye lens due to aging or injury. According to the National Eye Institute (NEI), more than half of all Americans over 80 have cataracts or have had cataract surgery.
Cataracts are traditionally treated by removing the affected lens and replacing it with an artificial intraocular lens (IOL). Standard intraocular lenses help reverse the effects of cataracts and improve the quality of vision. However, most patients who receive standard intraocular lenses during cataract surgery still need glasses or contact lenses to read or treat astigmatism. Thus, more advanced IOLs have entered the market to correct refractive errors and reduce dependence on corrective eyewear. One such premium IOL is the Light Adjustable Lens (LAL).
Approved by the U.S. Food and Drug Administration (FDA) in 2017, the Light Adjustable Lens is the first and only adjustable intraocular lens that can be customized to refine your vision after cataract surgery. It is adjusted through ultraviolet (UV) light treatments and is designed to improve how well you can see without eyeglasses compared to a basic single focus lens implant. The LAL was designed and developed by Daniel Schwartz, MD, an ophthalmologist at the University of California, San Francisco, and Robert Grubbs, Ph.D., a chemistry professor at the California Institute of Technology.
Although cataract surgery has advanced over the years, predicting the refractive outcome of the surgery remains difficult. As a result, only about six out of 10 cataract patients achieve their targeted vision. But with Light Adjustable Lens, the prescription can be adjusted after it is implanted, helping patients achieve the clearest far, near, and intermediate vision possible. Patients with LAL are more likely to achieve an uncorrected distance visual acuity of 20/20 at six months than those with a standard IOL.
The LAL contains light-sensitive molecules whose positions can be changed by an external ultraviolet light beam delivered by a slit lamp-based digital light delivery device (LDD). As the shape of the IOL changes, so does its power and can be adjusted for nearsightedness, farsightedness, or astigmatism correction. Your doctor will temporarily provide you with special UV glasses (protective glasses) to wear outdoors to protect the IOL from too much UV light exposure until the procedure is complete.
Most patients may require four adjustments, although some may require fewer or more. The adjustments are performed in an outpatient setting and generally take about 90 seconds per eye. The first customized light treatment is performed two to three weeks after traditional cataract surgery. And additional adjustments are performed at weekly intervals.
Once your optimal vision is achieved, the final lock-in treatments are performed, after which the IOL can no longer be adjusted or changed. After the lock-in, protective glasses will also not be needed. Since the LAL is adjustable post-operation, most patients opt to have both eyes operated on simultaneously with this option.
Following the cataract surgery to place the LAL, you must wear protective glasses during all waking hours to protect your eyes from UV light. You may remove them when showering, sleeping, or applying eye drops.
As Light Adjustable Lenses are designed to react to UV light during the adjustment process, exposure can cause unintended vision changes that make it difficult to properly adjust the LAL with light treatments. Your eyes will also be sensitive to light during the healing period. Thus, glasses are worn indoors and outdoors until your eyes heal and the doctor permanently locks the lens power during the final refractive adjustment.
The most apparent benefit of LAL is its precise and accurate surgical vision correction. Most surgeons consider LAL to be especially suitable for complex refractive issues in eyes after LASIK. In patients who have had previous refractive surgery, the calculations for appropriate intraocular lens power become very difficult and error-prone, as the cornea has been changed forever and no longer fits our standard power prediction models. But with LAL, we can compensate for these uncertainties in the post-operative period without having to do additional refractive surgery on the cornea. The LAL procedure is also painless and non-invasive, and the results tend to last a lifetime for most patients.
Some of the other advantages of LALs include:
One of the main disadvantages of LALs is the time commitment required. Although the treatments are relatively quick and are done in a minute or two, you will have many post-operative visits and specialized light treatments after surgery. And since you will also need to be refracted and dilated, each visit may also take a while.
Some of the other drawbacks of this advanced intraocular lens implant include:
Most patients with LAL will still need corrective eyewear, especially when reading small prints. And if both eyes are set for distance vision, they will need eyeglasses for other close-up activities. Nevertheless, the LAL improves the depth of focus, implying that it provides more range of vision than the standard single focus lens.
Most patients can obtain a good range of visual acuity with the LAL if they opt to have one of their eyes slightly nearsighted. However, if a patient finds it difficult to adjust to this difference, they can have it reversed with a second UV light treatment. Although the LAL does not provide as much near range as a multifocal lens, it does not cause additional glare, starbursts, or night-time halos as it does not have rings.
Cataract surgery with LAL is perfectly safe and poses no significant medical risks. And up to 4.5 diopters of cylindrical or spherical adjustment can be achieved with the LAL. However, not everyone is suitable for this premium IOL.
Eligible patients for vision correction with LAL include those who:
The best way to determine if LAL is right for you is to discuss your unique goals and concerns with an experienced eye doctor.
The Light Adjustable Lens is a recent development in cataract surgical technique, which has proven to be a safe, accurate, and reliable approach to post-operative, non-surgical correction of residual refractive error. However, how much it affects the delivery of refractive surgery in the U.S. is yet to be seen.
Here at OOMC, our patient’s well-being is our priority. Our dedicated team of surgeons and staff always makes an effort to create a safe and secure environment where you can easily access care comfortably and confidently.
Contact one of our centers nearest to you for further information.
Corneal Associates of New Jersey Kremer Eye Center Ludwick Eye Center
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