EyeWorld India March 2020 Issue

FEATURE 12 EWAP MARCH 2020 Overall, patients appear to be pleased with results from the LAL, said the surgeons interviewed by EyeWorld , all of whom were part of the trials done before the LAL was approved. One advantage that both patients and surgeons like is being able to try out monovision before it is locked in—in fact, patients who like monovision often are a good match for the LAL, Dr. Slade said. This is in contrast to patients in the past who received monovision with their IOLs and were unhappy with their vision. Surgeons were always left to wonder if the patient was unhappy with their actual vision or with monovision itself. Another good group of patients for the LAL are those with previous refractive surgery—in fact, there is a trial now for this patient group, according to RxSight. “Someone with previous LASIK has already said with their pocketbook that they find their vision important,” Dr. Waltz said. Poor candidates for the LAL There are a few medical reasons why someone may not be a candidate for the LAL. For instance, a patient who has a small pupil that does not dilate well is not a good LAL candidate. “The pupil has to be larger than 6 mm to achieve the light adjustments,” Dr. Wiley said. If a patient has astigmatism that is greater than 3 D, the lens may not be ideal, Dr. Wiley added. Another limitation is if a patient takes photosensitizing medications; this could include patients on various types of diuretics, Dr. Slade said. However, patients can still use the lens if they can discontinue photosensitizing medications during the light adjustment process, Dr. Doane said. LAL pearls With all the excitement over the LAL, it could be easy to dive in without much thought. However, surgeons share a few pearls to help potential users better plan for their LAL experience. 1. Do a site visit. Just as you would with many other types of new surgical technology, plan a site visit with someone already using the lens, Dr. Waltz advised. The cataract surgery itself is the same, but surgeons and staff will want to see the light adjustments and patient education as well as review scheduling nuances. 2. Consider scheduling. A key consideration with the LAL is the light adjustments that are done, Dr. Waltz said. For each cataract patient you treat who will get an LAL, there’s the potential for up to three separate light adjustments per patient. “That’s a lot of time and effort, and it’s a lot of coordination with you, your office, and patients,” Dr. Waltz said. To help manage this, have key staff come along during a site visit to see how experienced offices schedule those light adjustments. Also, consider offering more than one day or afternoon a week for those light adjustments, to help meet patients’ busy schedules. It may be helpful to have a partner who also offers the LAL to help broaden the adjustment schedule. 3. Plan the light adjustments around your peak concentration time. “Using the light delivery process is not hard, but it takes an incredible concentration,” Dr. Waltz said. “It’s a minute or two of holding something exactly center with an eye that is moving, and that takes some real concentration. If you do 10 in one afternoon, that’s 20 minutes of intense concentration. You can do it, but it’s a unique skill.” Plan with your staff when to best schedule light adjustments to take advantage of your peak concentration. 4. Make sure to follow the recommended protocols from the FDA trials regarding the light adjustments. You want to perform the light adjustments on an eye that has a stable refractive state to assure you are not treating a moving target. EWAP Editors’ note: Dr. Doane practices at Discover Vision Center, Kansas City, Missouri. Dr. Slade practices at Slade & Baker Vision Center, Houston. Dr. Waltz is a partner at Whitson Vision, Indianapolis. Dr. Wiley practices at Cleveland Eye Clinic, Cleveland. All have relevant financial interests with RxSight. How the Light Adjustable Lens works. Source (all): Stephen Slade, MD Adjustment beam A B C D Photo polymerization Diffusion and power change Lock-in beam Final result Method of action Light from the RxSight LDD is directed by the surgeon to the RxLAL Macromers in the path of the light are photopolymerized Unpolymerized macromers move into the exposed area, casing precise shape and power change The entire lens is exposed to light to polymerize all the remaining macromers The outcome is a precise change in the RxLaL power to match the patient's individual prescription