Inside the clinic: Surgeon shares real-world experience

One of the most striking results with the Light Adjustable Lens (LAL; RxSight) is how quickly patients achieve excellent vision. With traditional IOLs, vision is expected to stabilize gradually over several days as the eye heals. With the LAL, patients often achieve 20/25 or 20/20 visual acuity on the first postoperative day. Careful patient selection is crucial. Detail-oriented and engaged patients tend to value the technology because it gives them control and flexibility. On the other hand, patients who struggle with adherence and those who may be put off by extra postoperative visits may not be suitable candidates.

I performed one of my early LAL cases on my mother. She had been a high myope for 6 decades and was motivated to minimize her spectacle dependence after cataract surgery. After LAL implantation, she achieved 20/20 uncorrected visual acuity (UCVA) by postoperative day 1. At the time of this article, the patient is 8 months out, remains 20/20, and has not locked in the LAL or needed an adjustment yet.

I have had similar experiences with countless patients. Many had only been offered nonpremium surgical options elsewhere. Patients find it reassuring to know they are not locked into a result on day 1, and adjustments can be made to refine it further if their lifestyle demands even greater precision.

Case 1: Post radial keratotomy

A patient who previously underwent 8-cut radial keratotomy (RK) with a classic type A personality presented for cataract surgery. Preoperatively,
he had a best corrected visual acuity (BCVA) of 20/30. I counseled him that, despite the remarkable capabilities of the technology, his visual outcomes with an LAL could still be limited by his irregular, post–acute RK corneas. To his delight, after just 1 adjustment, his UCVA was 20/20, and he shared that his vision is clearer than it had been in more than 3 decades.

Case 2: History of LASIK and astigmatism

A woman aged 66 years had undergone myopic LASIK 2 decades earlier. Preoperatively, her BCVA was 20/30 with 1.57 D of astigmatism.
A LAL+ was implanted, and the robotic cataract laser system was used to perform an astigmatic keratotomy at 65º, targeting approximately 1.00 D of astigmatism. On postoperative day 1, her UCVA was 20/25-2, and she reported “everything looks amazingly bright, and the colors are so vibrant.” By week 1 and through month 1, her UCVA remained 20/25-2. She had 0.50 D of residual astigmatism. After her first LAL+ adjustment, which addressed the residual astigmatism, she achieved UCVA of 20/20+.

Without addressing astigmatism at the time of surgery, the patient’s initial results would likely have been limited to 20/40 to 20/50 UCVA. She would have reached 20/20+ eventually with postoperative adjustments, but more chair time and hand-holding would be needed to manage expectations. By correcting the astigmatism up front with the robotic cataract laser system, an immediate and impactful postoperative experience was delivered.

Mujahid A. Hines, MD

E: [email protected]

Hines practices at NVISION Eye Center in Roseville and Folsom, California. He did not acknowledge any financial interest.