EyeWorld India December 2021 Issue

CATARACT 14 EWAP DECEMBER 2021 lock-ins,” he added. “With the IOL’s ActivShield technology, we’re doing two adjustments and one final lock - in,” he said. Previously, it was two adjustments and two lock-ins, which Dr. Loden said dramatically increased postop time, including traveling to and from the doctor’s office, being dilated each visit, etc. This was a negative part of the experience for the patient, he said, so this update makes the process a little easier. Dr. Ristvedt noted that with the LAL, there is more chair time post-surgery than pre-surgery. “Postoperatively is where the real work comes in because these patients are coming back more often,” she said, adding that it’s usually after 3–4 weeks that manifest refraction will stabilize. “You want stability before you start to change the lens,” she said, adding that it’s important to make sure the patient understands his or her goals. “Once we start to adjust the lens, they’re coming in every 5–7 days for a recheck,” she said. “It can bog us down a little bit when it comes to doing a precise manifest refraction, checking lifestyle, and dilating enough to make sure we can get a good treatment from the Light Delivery Device (LDD).” Dr. Ristvedt added that there are usually 2–3 treatments before the lock-in occurs. “I think patients are happy because they have that great vision afterward,” she said. “But it can be a little taxing.” Diagnostics Dr. Loden said he doesn’t do anything different in terms of diagnostics for the LAL, noting he obtains Pentacam (Oculus) and IOLMaster (Carl Zeiss Meditec) measurements on every patient. He said it’s also important to know the basic corneal curvature, if the patient has regular or irregular astigmatism, and if they have a healthy retina. Similarly, Dr. Naids said his preoperative testing is the same for patients who want the LAL. It includes biometry, an OCT of the macula, and corneal topography. There are some patients— perfectionists and engineers, for example—who agonize preoperatively over what specific refractive target they want, Dr. Chang said. “With the LAL, they can wait to try out their binocular pseudophakic vision postoperatively and confirm or modify their refractive preference based on their daily experience,” he said. “This, and the fact that they won’t have diffractive ring halos, dramatically relieves the anxiety for this type of patient.” Learning curve and tips When starting to use the LAL, Dr. Naids said it’s important to be comfortable placing a three-piece lens, and he noted that the injector system is a bit different. He suggested using an eye model to get used to it. Postoperatively, you have to reassure these patients that their vision is usually not where they want it to be at first and it won’t be for a number of weeks, he said. Dr. Chang said to think of the LAL as a customizable toric IOL, and the majority of patients will end up with some amount of micro-, mini-, or full monovision. He also suggested that if you don’t want to offer ISBCS, try to do the surgeries close together. The ability to base adjustments on the patient’s binocular, pseudophakic vision is one of the biggest advantages of this technology, Dr. Chang explained. “This is an easy implementation to pick up,” Dr. Loden said. With the surgery itself, there is basically no learning curve if you’re comfortable implanting a three-piece lens, he said. The only thing that requires a slight learning curve is doing the adjustments. Recent updates According to Dr. Loden, a big breakthrough is the ActivShield technology, which is a new UV protective layer built into the LAL. This new UV protective layer is automatically opened by the LDD, allowing precise lens adjustments. When the adjustments are complete, the ActivShield is automatically engaged again to protect the lens from accidental sun exposure. Dr. Loden thinks The RxSight light delivery system makes precise changes in the shape of the IOL optic. To demonstrate the precision, it has been used to inscribe the RxSight logo onto the IOL optic in vitro. Source: RxSight