EyeWorld India December 2020 Issue

REFRACTIVE 42 EWAP DECEMBER 2020 Dr. Chayet said. He conducts it through a 2-mm incision with the lens implanted through a 3-mm incision at the temporal axis. The Light Adjustable Lens is suitable for most patients, but if there is a risk for the patient needing silicone oil in the future, that could be a possible contraindication, though not an absolute one, Dr. Chayet noted. Dr. Lee listed asteroid hyalosis, inadequate dilation, photosensitizing medications, significant retinal disease, and nystagmus among the contraindications. “Because the wavelength used by the Light Delivery Device could theoretically reactivate herpes simplex, the surgeon should discuss this with a patient with a history of herpes keratitis,” Dr. Lee added. For the young eye surgeon, Dr. Chayet said the technology is easy to learn with a slight learning curve if you’re not used to implanting a three- piece, silicone lens. The UV light treatment is similar to a retina laser or YAG laser treatment, he said. There is a learning curve to setting the patient’s expectations. The patient needs to understand that they’ll need to return to the clinic 2 weeks postop for light adjustment treatments, according to Dr. Chayet. The key to the adjustment is a clean refraction, Dr. Lee said. “I tell all patients to use artificial tears frequently to help stabilize the refraction as soon as possible. Patients should know that they will have to make multiple visits for adjustments and will need to be dilated fully each time,” Dr. Lee explained, noting that he usually does the first adjustment 2 weeks postop but will wait 6–7 weeks for RK patients. “Typically, we get a refraction on the iTrace [Tracey Technologies], then a manifest refraction. Most patients need at least two rounds of dilating drops before they are ready for the treatment. We enter the manifest refraction and the targeted refraction into the Light Delivery Device, then the patient sits at the machine just like a slit lamp. You use a contact lens similar to what you would use for a YAG. Each treatment lasts 2 minutes or less, and the IOL takes about 2 days to finish changing.” Dr. Lee also said he usually recommends that even patients without a history of monovision try slight myopia in one eye. The adjustable lens allows patients to try blended vision at low risk thanks to the ability to adjust them back to plano if preferred. There might be some fears on the surgeon’s and patients’ part regarding UV light exposure until the final treatment is set. Dr. Chayet said the current lens even in ambient light can still be affected and thus requires use of the filtering glasses even inside. A next-generation lens is in clinical trials that will not be impacted by ambient light, he said. Another fear is retina damage from the UV light treatments. Dr. Chayet said in 20 years of research with this lens, retinal damage hasn’t been observed. It is important, however, for surgeons to identify and tell patients to stop any medications or supplements that could cause photosensitivity for several weeks prior to the treatment. “The young surgeon needs to know patients need to be out of those medications to prevent phototoxicity during the treatment,” Dr. Chayet said. EWAP Editors’ note: Dr. Chayet practices at CODET Vision Institute, Tijuana, Mexico. Dr. Lee practices at Altos Eye Physicians, Los Altos, California. Neither declared conflicting interests. Untitled-7.indd 1 02/12/2020 3:40 PM