16 EyeWorld Asia-Pacific | March 2025 ASIA-PACIFIC PERSPECTIVES The article describes the experiences of four US-based ophthalmologists who have adopted LAL in their surgical practice. I do not have personal experience with this IOL technology, but am looking forward to its availability. This unique technology enables the ophthalmologist to adjust the refractive outcome postoperatively to achieve almost 100% refractive precision. While this may not be required by all patients, it will fulfill the unmet need when managing refractive outliers and demanding patients. When practicing monovision, it allows the patient to experience and adjust the extent of monovision, enabling a personalized refractive outcome. However, there are also concerns regarding LAL. This is a 3-piece IOL which may change its effective position over time as the capsular bag contracts, altering the refractive outcome. In addition, the silicone material may opacify if silicone oil is used in retina surgery. Furthermore, LAL is monofocal and non-toric. The increase in DOF with adjustment is small, matching that of a monofocal plus IOL. The newer LAL+ has a small central area of increased lens power, providing it a slightly greater DOF than the LAL. The DOF achieved after light treatment is purportedly similar to current EDOF IOLs, but more data is needed. The small advantage that LAL+ provides in achieving excellent distance and intermediate, but not near vision, would likely place it on par with EDOF IOLs, which have a flat landing zone on the defocus curve. Furthermore, astigmatism correction is delayed until the first treatment, which is typically done 2 or more weeks later, missing out on the wow factor. Yet another concern is that, in eyes with heavily pigmented iris, postoperative pupil dilation may not reach 6mm and it may be difficult to predict who the poor dilators are. Today, our refractive outcomes have significantly improved, with newer biometry tools and formulae. Thus, the demand for this IOL technology, which started its development more than 10 years ago, is less impactful than was anticipated. Nonetheless, the LAL technology does add to our armamentarium for the treatment of a subgroup of patients who demand refractive precision and the option of adjusting their refractive outcome postoperatively. However, the cost and time spent in patient counseling to treat this select group of patients may put this technology out of reach for many surgical practices in Asia, considering the incremental benefit. Editors’ note: Prof. Soon-Phaik Chee is a consultant for Alcon Laboratories, Inc. and Ziemer Ophthalmics AG, but has no financial interests related to the comments. CATARACT Soon-Phaik CHEE, MD Senior Consultant, Eye & Retina Surgeons 1 Orchard Boulevard, #13-03 Camden Medical, Singapore 248649 cheesp313@gmail.com
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