CATARACT EWAP DECEMBER 2022 13 Dr. Fram performs the lock-in treatment with the Light Delivery Device (RxSight). Source: Nicole Fram, MD Contact information Fram: info@avceye.com Hoopes: pchj@hoopesvision.com Nikpoor: drneda@alohalaser.com Solomon: jonathansolomonmd@gmail.com T he Light Adjustable Lens (LAL, RxSight) is still a relatively new IOL technology, offering the ability to adjust the refractive settings of the lens after implantation with “lock-in” treatments. In this article, several physicians discussed their decision to bring it into practice, implementation considerations, and overall impressions. Nicole Fram, MD Dr. Fram decided to bring the LAL into her practice when she realized she had a more than 20% post-LASIK/PRK patient population needing cataract surgery. Even the best formulas reach a refractive target +/–0.50 D 69–79% of the time, she noted.1–5 “The promise of a technology that we could adjust after surgery Adopting the Light Adjustable Lens: Implementation and personal experiences by Ellen Stodola Editorial Co-Director to meet the refractive goals was exciting,” she said. “In addition, our primary strategy for independence from glasses in this patient population was mini-monovision, as the EDOFs and multifocals on the market at the time had significant diffractive dysphotopsia.” Dr. Fram said workflow adjustments to accommodate the LAL were relatively easy. The patients had all appointments scheduled from the start and understood how long they would need to be in the office. It is important to explain upfront that this technology is not for all patients, particularly if they are from out of town or have a low threshold for wait times. Dr. Fram said she had no reservations about implementation, except that prior to the ActivShield This article originally appeared in the September 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. technology, she had one patient develop a central zone and poor vision due to non-compliance with the protective glasses. “Fortunately, the development of ActivShield has decreased this risk, and we have not seen a single case since its implementation.” It’s important to tell the patient that the strategy for more spectacle independence is blended monovision. “They need to understand the 80/20 rule—80% of what they do on a day-to-day basis will be spectacle-free. However, this is still monovision, and when driving at night or reading a medicine bottle, they may need glasses.” Monovision in the pseudophake is different than monovision with LASIK/ PRK or contacts, as their natural crystalline lens may allow for some accommodation. Dr. Fram explains to patients that the LAL technology can more effectively hit targets and customize vision, particularly in the post-corneal refractive surgery population. Dr. Fram noted there is not currently an IOL that exactly counterbalances the higher order aberrations of the cornea and/or accommodates. “This is the missing advancement in the world of lens replacement,” she said. “This technology may solve the effective lens position issue by providing postoperative
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