19 EyeWorld Asia-Pacific | March 2025 CATARACT ‘Wait a month’ Dr. Strange currently performs 15+ LAL implants per week. He implemented LALs into his busy surgical practice back in 2021. “LALs were intriguing to me because we have a lot of post-refractive patients, people who have had RK, LASIK 20+ years ago, and now they’re here for cataract surgery. It’s hard to hit the target on these patients more than 80% of the time, so I needed something that would allow me to adjust the patient’s vision after the surgery, rather than doing a lens exchange or PRK or LASIK enhancement, which is not ideal on top of prior refractive surgery,” he said. One lesson Dr. Strange learned early on using the LAL was to not perform the postop adjustment too early. “We have since learned to wait a month in order for the cornea and all the different healing factors of the eye postsurgery to get settled and not moving,” Dr. Strange said. Dr. Strange said he has also evolved from spacing his cataract surgery with LALs 2 weeks apart to now just a day apart so the patient’s postop light adjustments are in the same timeframe. He said he’ll do refractive lens exchanges involving the LAL on the same day. This shift reduced postoperative visits and allowed patients to get to their endpoint satisfaction faster, he explained. “Something else we do differently is we do YAGs early on now. I do them as early as 1 month postop because if a PCO is starting to form early, and that does happen earlier in silicone lenses like the LAL, you don’t want to be adjusting in a PCO. We YAG them early, and we found that to be better for accuracy and their adjustment period,” Dr. Strange said. Rosa Braga-Mele, MD, Cataract Editorial Board member, shared what evolving treatments and techniques in ophthalmology she is excited about: • New phaco technologies that allow for more precise fluid control and better cutting power and efficiency • New IOL technologies within the trifocal arena that are being designed to help minimize dysphotopsias • New diagnostics and biometry that will capture images more efficiently and thoroughly and optimize IOL choices for patients About the Physicians Sumitra Khandelwal, MD | Professor, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas | sumitra.khandelwal@bcm.edu Bryan Lee, MD, JD | Altos Eye Physicians, Los Altos, California | bryan@bryanlee.pro Neda Shamie, MD | Maloney-Shamie Vision Institute, Los Angeles, California | ns@maloneyshamie.com Taylor Strange, DO | Alliance Vision Institute, Fort Worth, Texas | tbstrange1@gmail.com Relevant Disclosures Khandelwal: None Lee: None Shamie: RxSight Strange: RxSight 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. Additional pearls from Dr. Strange are: • Use the regular LAL on higher aberrated corneas. If the patient has had good LASIK and aberrations are under 0.3, he is comfortable offering the LAL+ to give the patient more near vision. • Avoid the LAL in 16- and 32-cut RKs. “You can’t use the LAL on just any post-refractive patient,” he said. • Don’t use this lens in patients whose pupils dilate to less than 6 mm; it makes it harder to do adjustments. • A medical ophthalmologist or knowledgeable OD team can make the surgeon’s practice with the LAL more efficient. • Have a thorough discussion with the patient to set appropriate expectations for the postop commitment with this lens (expect 3–4 extra visits). • Have a longer discussion with high myopes who might try to get more near vision with this lens at the sacrifice of good distance vision. “In these cases, you may want to lean toward a multifocal lens with more near power,” he said. • Don’t feel like you have to do an adjustment just because it’s there. • Make sure the cornea is clear and stable before performing adjustments; outcomes can change if the ocular surface isn’t tuned up.
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