15 EyeWorld Asia-Pacific | March 2025 The Light-Adjustable Lens (LAL) is an innovative intraocular lens (IOL) option. It features photosensitive macromers embedded in a silicone matrix, allowing the lens curvature to be precisely customized when exposed to the appropriate UV light. The upgraded ActiveShield technology further minimizes the risk of unintended UV light exposure, reducing the dependence on UV-blocking glasses during the initial postoperative period. The LAL is a monofocal lens, which does not correct presbyopia unless monovision is planned. Therefore, it is not intended to replace advanced-technology presbyopiccorrecting IOLs such as extended depth of focus (EDF) lenses or trifocals. The primary advantage of the LAL lies in its post-implantation adjustability, which allows for more accurate vision correction than just relying on preoperative IOL calculations. Presently, IOL power calculations achieve 90% accuracy within 0.5D for normal eyes. The LAL is particularly beneficial when IOL power calculations are challenging or still evolving, such as in eyes that have undergone corneal refractive surgery, or where the IOL cannot be implanted in its physiological position because of compromised capsular bag such as polar cataracts or subluxated cataracts. It is also a suitable option in cases of secondary IOL or IOL exchange for postoperative subluxated IOLs where the capsular bag is absent or compromised when IOL power cannot be calculated with certainty. Editors’ note: Dr. Fam Han Bor is a consultant for Alcon, Johnson & Johnson Vision, Rayner, and Zeiss, but has no financial interests related to the comments. CATARACT The use of LAL requires more patient visits, typically involving 3-4 additional appointments. This change in postoperative clinic flow includes frequent refractions, discussions on target planning, pupil dilations, and laser adjustments, The laser adjustment procedure takes approximately two minutes each time. Adjustments are typically made around one month postoperatively. During that time patients may experience blurred vision, particularly those with astigmatism. Patients who have undergone corneal refractive surgery may need to wait longer for their corneas to stabilize before adjustments can be made. It is important to note that LAL is not recommended for patients with irregular corneas, high higher-order aberrations, or expected postoperative inconsistent refractions. Patients with poor pupillary dilation of less than 6 mm may not be suitable candidates for this technology. As with all medical procedures, the LAL has a learning curve. The precise nature of the adjustments and the need for thorough preoperative planning and postoperative follow-up make it a specialized procedure that requires careful consideration and planning. Nevertheless, the LAL represents an advancement in customizable vision correction, offering patients an opportunity for more accurate and tailored mono-focal outcomes. FAM Han Bor, MD Senior Consultant, Tan Tock Seng Hospital 11 Jalan Tan Tock Seng, Singapore 308433 famhb@singnet.com.sg About the Physicians Rosa Braga-Mele, MD | Professor of Ophthalmology, University of Toronto, Toronto, Canada | rbragamele@rogers.com Kendall Donaldson, MD, MS | Medical Director, Bascom Palmer Eye Institute, Plantation, Professor of Clinical Ophthalmology, Rodgers Clark Endowed Chair in Ophthalmology, Plantation and Miami, Florida | kdonaldson@med.miami.edu Jonathan Rubenstein | Chairman and Deutsch Family Endowed Professor, Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois | jonathan_rubenstein@rush.edu Relevant Disclosures Braga-Mele: Alcon Donaldson: AbbVie, Alcon, Bausch + Lomb, BioTissue, BVI, Carl Zeiss Meditec, Dompe, Eyevance, Glaukos, iOR, Johnson & Johnson Vision, Kala, LENSAR, Lumenis, Novartis, Omeros, Oyster Point, Quidel, PRN, Rayner, Science Based Health, Sun, Tarsus, Versea Rubenstein: Alcon This article originally appeared in the December 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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