EyeWorld India December 2020 Issue

REFRACTIVE EWAP DECEMBER 2020 41 A rturo Chayet, MD, has been working with the Light Adjustable Lens (RxSight) for nearly 20 years, implanting the first iteration of the lens in 2002. So, he has a pearl or two to offer young eye surgeons when it comes to this technology, which, though FDA approved in 2017, only began its commercial launch in the U.S. in September 2019. The Light Adjustable Lens is a three-piece, silicone lens that is approved currently for patients with 0.75 D or more of corneal astigmatism and without preexisting macular disease. Outside the U.S., the lens can be for presbyopia- correcting purposes. The lens is adjusted postoperatively in an in-office procedure with a Light Delivery Device that applies a customized UV light treatment to the reactive lens, with up to three treatments possible. A final procedure “locks in” the treatment. In the time between lens implantation and the “lock- in” procedure, the patient needs to wear UV light-protective glasses that are provided by the surgeon. “This is a lens that you can adjust once the intraocular lens is inside the capsular bag. Usually we adjust it after 2 weeks. The benefit is we can achieve emmetropia,” Dr. Chayet said. “We don’t need to worry about IOL placement in terms of a toric lens that you might need to place in the axis of astigmatism. Obviously, we need to do good calculations, but if we miss by 0.5 D or 1 D, we’ll be able to adjust that.” Dr. Chayet said this lens achieves the highest percentage of eyes within ±0.5 D of target, with more than 95% of eyes achieving this. “That’s something you don’t get with any other IOL,” Dr. Chayet said. According to the FDA pivotal clinical study that confirmed safety and efficacy of the Light Adjustable Lens, it “achieved higher ‘percent reduction’ in postoperative manifest cylinder and MRSE [manifest refraction spherical equivalent], respectively, than the control” and it “demonstrated the rotational stability.” A press release from RxSight at the time of the IOL’s FDA approval stated that patients with the Light Adjustable Lens, compared to control, were twice as likely to achieve 20/20 UCVA or better at 6 months postop. “This is the first time in IOL history that we get that kind of LASIK result, which is 93% within 0.5 D of intended correction,” Dr. Chayet said. Dr. Chayet also noted being able to avoid some higher order aberrations, such as glare and halo, that can occur with other lenses. Bryan Lee, MD, JD, who has been using this lens since October 2019, has been happy with his results and has observed high patient satisfaction. He said he is implanting it in about 10% of eyes, with high interest in the post-refractive patient population. “Many of the patients opting for this IOL are the toughest to achieve a good refractive outcome in because of irregular corneas and difficult power calculations, and I am comfortable offering it to them because I think this is the best available technology for them,” he said. Cataract surgery with the Light Adjustable Lens is the same as with a standard IOL, Insights on the Light Adjustable Lens by Liz Hillman Editorial Co-Director Contact information Chayet: arturo.chayet@gmail.com Lee: bryan@bryanlee.pro Office-based IOL light adjustments using the Light Delivery Device. Source: Arturo Chayet, MD This article originally appeared in the August 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.