17 EyeWorld Asia-Pacific | March 2025 CATARACT refractions and the Light Delivery Device adjustments, but the ophthalmologist is still the one who makes the active decision. From a surgical standpoint, Dr. Khandelwal said the rhexis is very important with this lens. “The rhexis needs to be an appropriate size, covering the optic all the way around,” she said, adding later that it’s also a silicone lens, which has a bit of a learning curve. “First of all, it’s a learning curve to load it. Any scratch on the IOL has to come out, and it comes out fast from the injector.” Dr. Khandelwal advised of being careful with patients who have a lot of fluctuations with refractions, such as with OSD, which she said needs to be optimized before surgery. Finally, she offered that surgeons should guide the patients to their realistic postop goal rather than allowing patients to take the lead. “This is not a trifocal lens. Patients need to understand that they may not get the near vision they intended to, and they may not achieve their desired trifocality in both eyes. I think telling them that upfront and getting them locked in in a timely manner is helpful,” she said. “Patients with decisionmaking challenges should be guided away from this lens.” ‘Lock in … at the end of OR days’ Dr. Lee began offering the LAL in 2019 and has found it to be his preferred lens for patients with a history of refractive surgery and those who want monovision. Clinic flow was one of the main adjustments his practice identified when onboarding this lens. “Patients need to understand they may not get the near vision they were thinking they were going to get, and they may not get the trifocality in both eyes. I think telling them that upfront and getting them locked in in a timely manner is helpful.” Sumitra Khandelwal, MD “Patients may require multiple rounds of dilation, and they need refraction and discussion of the plan for each treatment as well,” he said. “I think the combination of doing so many over the years and the wonderful staff in our office has made it work. We try to spread patients out evenly between clinic days, and it is helpful to have lock-in treatments at the end of OR days. By that point, we know how long those patients take to dilate, and they do not need refraction or the same type of counseling.” When it comes to patient selection, Dr. Lee said he’ll discuss the LAL with all patients who are candidates, even if they are not classic post-refractive or monovision patients. Many patients, he said, have specific refractive goals and are attracted to the increased accuracy offered by the LAL. Some have also decided to try monovision with the LAL and found out that they really enjoy it. “I do mention to those patients that if they don’t like monovision, they will not have a full range of vision to try to make sure they aren’t surprised or disappointed,” Dr. Lee noted. For the surgeon who is already experienced with the LAL, Dr. Lee said a more advanced use of the lens presents in cases where the capsule is not intact, such as post-YAG IOL exchange cases. “I also mention it as a back-up option for patients who prefer a different IOL as plan A, but have a higher risk for intraoperative issues, such as a posterior polar cataract,” he said. When it comes to the latest iteration, the LAL+, Dr. Lee said it has increased the number of patients considering this lens in his practice. He noted that the additional range is not the same for every patient, though this is the case with any IOL. “Just as important is the fact that the LAL and the LAL+ are available down to +4.0 D, which allows offering the IOL to very high myopes who appreciate that their IOL calculations are more challenging but are used to the accuracy of a contact lens,” Dr. Lee said. Kristin Barnes, OD, of Maloney-Shamie Vision Institute, performs a non-invasive light adjustment on a patient 3 weeks following his Light Adjustable Lens procedure. Source: Maloney-Shamie Vision Institute
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