An expert ophthalmologist presents patient cases from her practice, demonstrating how light adjustable lenses have achieved remarkable outcomes for those with diverse corneal topographies.
Sharon Richens, MD, FACS: In looking at the light adjustable lens technology, we were all impressed that it opens up premium lenses to a segment of our patients that previously we would have been reluctant to have used them for. Of course, the multifocal lens might not be a great choice with anybody with corneal pathology or retinal pathology, but with the light adjustable lens, you are not struggling with the dysphotopsias, the night vision issues. We looked at several patients with corneal pathology…starting with this first case,…a patient who had full-thickness corneal transplants, PKP [penetrating keratoplasty], back in 2001 due to keratoconus in both eyes. And now many years later, he [has] visually significant cataracts. He is [of] working age and still working in an occupation that involves both computer work and near work as well as electronics. And we were totally thrilled with the clarity and quality of his vision when we finished. We did postpone his first treatment by about 6 weeks longer than we would have to make absolutely sure that we had consistent Pentacams and consistent CCT [central corneal thickness] and that his cornea had really stabilized after surgery. And with 20/25 in one eye and 20/20 in the other, he’s very…happy.
The next situation that we chose to address was patients who had had significant myopic LASIK many years ago when flaps were not laser flaps––they were keratome and they were deep and you sometimes had central islands and irregular astigmatism, especially many years on. And the result here with 20/15 in the dominant eye and 20/60 uncorrected in the distance with J2 at near [was that] the patient was over the moon––very, very healthy.
Last but not least, [we looked at] our patients with RK [radial keratotomy], AK [astigmatic keratotomy], many years ago, irregular astigmatism, some significant depth of field to begin with because they’re myopic eyes and they have multifocal corneas, and patients who can be very eager for an excellent refractive result but also really difficult to handle, and this patient did really beautifully. One of the things that came out in the conversation was that delaying the light adjustments for patients who’ve had previous refractive surgery can definitely get you a better result. So rather than following a standard protocol where the first light adjustment is done at, say, 4 weeks or a month, you might want to significantly extend the period to the first light adjustment in order to be absolutely sure that you’ve got the best possible stability in the cornea and to verify that, not just with refractions but also with your Pentacam and topography, to be certain that that is in fact the case.
Also, for myself, I live in the desert, as did several of the other doctors who were involved in this seminar, and really careful attention to dry eye issues helps a lot, I think, to get the very best possible results here. And with some patients, a contact lens trial helps them to be sure[r] of the decision because you are really making a permanent decision. You don’t want to make an adjustment on the assumption that you can reverse that if they don’t like it. We, of course, have had the majority of patients who have had no prior refractive surgery or corneal transplantation and those patients tend to do very, very well. Again, the common theme among all the participants seemed to be take your time, let the patient really figure out what it is they want, use the loose lens trial lenses, do contact lens trials if that’s going to give them a greater measure of comfort and certainty in their decisions.
Transcript is AI-generated and edited for clarity and readability.