EyeWorld India December 2018 Issue

EWAP FEATURE 13 December 2018 are identical to typical cataract surgery.” During the trial, Dr. Chang implanted the first 16 LALs in the U.S. as a Phase 2 investigator. “The adjustment and lock-in pro- cedures are quite straightforward. Like a YAG capsulotomy, they are performed in the office with a slit lamp delivery system using a con- tact lens to focus the treatment,” he said. Dr. Chang said that refractive accuracy has improved thanks to advances such as intraoperative aberrometry, improved biometry, and better calculation methods, but these are all still different methods for IOL power predic- tion. “They improve the mean but don’t eliminate the standard deviation, especially in challeng- ing eyes post-refractive surgery, or with unusual keratometry or axial lengths,” he said. Dr. Chang added that the EU- REQUO study reported refractive results from more than 280,000 patients from 100 clinics. This “real world” data set reported that 27% of eyes failed to land within 0.5 D of the spherical refractive target. 1 “Although I currently employ corneal topography and wave- front aberrometry, swept-source OCT biometry, multiple advanced formulae, intraoperative aber- rometry, and digital intraoperative axis localization, an ophthalmolo- gist right out of residency should achieve better refractive outcomes with an adjustable IOL than I currently do using all of these technologies for my toric monofo- cals,” he said. Adjusting implant with light versus PRK or LASIK Dr. Doane said after 22 years in practice, he would rather adjust the IOL than the cornea. “Involv- ing the cornea adds another layer of healing and tissue biology that we can avoid when we deal with the lens and light adjustment,” he said. “The older the patient, the more important this concept is to understand.” Dr. Maloney said he thinks pa- tients would much rather have the implant adjusted than have corne- al adjustment with PRK or LASIK. “We think of refractive surgery as no big deal,” he said. “No matter how we explain it, patients think of LASIK and PRK as having their eye sliced and zapped.” Dr. Waltz, who implanted the first lens in the FDA PMA trial, said that either option would work, but he thinks the LAL can give better results than PRK or LASIK. He added that patients also have variability in how their epithelium and stroma heal. There’s not much variability in how the LAL heals, he said, so you don’t get the surprises that you get with other technologies. “I think if you knew you had to do it, most everyone who could afford it would do the light ad- justable lens,” he said. “The cost would be a negative, but the qual- ity will be better with the light adjustable.” Accuracy of the LAL Dr. Maloney said that 92% of LAL eyes are within 0.5 D of target. “The best number for every other lens is about 70%,” he said. “That doesn’t include astigmatism cor- rection, which is better with the [LAL] also.” Dr. Doane added that this is the “most accurate refractive procedure I have been involved in” with respect to outcomes with ±0.25 and ±0.5 D. He added that since such a high percentage of eyes were ±0.5 D, they looked at ±0.25 D, which is one level more accurate than corneal laser vision correction. Dr. Waltz said that he has found the LAL to be “shockingly accurate.” He added that the trial included patients with only cer- tain amounts of astigmatism. He said the results of the trial were the best trial results he has seen. “In a typical U.S. trial, you’ll have about 40–50% of the patients be 20/20 uncorrected,” he said. “In this trial, which was more difficult because you had to be astigmatic, LAL eyes achieved 20/20 or better uncorrected vision in more than 70% of eyes, which was approximately two times the rate of the control group. Addi- tionally, approximately a third of the LAL patients were 20/16 or better.” Since distance was so good, it improved the intermediate and near as well, Dr. Waltz said. He added that the process for the LAL is a bit more complex, re- quiring multiple light treatments before it’s locked in. This tech- nology also comes with an extra fee for the work that is involved, which Dr. Waltz estimated could be US$5,000–8,000 per eye. Correction permanence Dr. Maloney said that after the ad- justment of the lens is completed, it is locked in to ensure that the lens doesn’t change in the future. “Humans are living biological tis- What to know – from page 9 continued on page 14