Pearls of Vision: Light Adjustable Lens Treatment After Light Adjustable Lens Implantation

CECELIA KOETTING, OD: Today, we’re going to talk about the light adjustable lens, and how it’s something that’s really interesting as far as for treatment of cataracts, and a different option that allows us to literally adjust the refractive error of this lens post-implantation.

What I think is also really interesting, and kind of fun, is that optometry can be part of this. I actually will show you myself performing some of the lock-in and LDD treatments for this lens.

First, let’s talk about the surgery. Surgery for LAL lens is not any different than regular cataract surgery. Once the natural lens is extracted, we see that the surgeon is implanting a folded up lens into the eye, into the chamber. The lens is positioned behind the iris and then unfolded. Once the patient’s refractive error is stable, approximately 3 to 4 weeks later, we can begin with the procedures with the light delivery device.

The light delivery device is delivering UV light exposure to a photosensitive material in order to help modify the shape of the lens and correct for the patient’s leftover refractive error from the cataract surgery. The light delivery device is very similar to the setup of a YAG laser, and the patient places their chin into the chin rest, and I place a lens, very similar to a gonioscopy lens, onto the cornea. This lens is filled with a viscous solution, such as GenTeal® (Alcon) or GonioviscTM (Hub Pharmaceuticals).

It is then placed on the anesthetized eye, one eye at a time, while the other eye is covered with a patch, in order to avoid the light scattering into the eye not being treated. The treatments can last anywhere from a few seconds up to about 2 minutes.  

There can be up to 3 initial treatments to adjust the prescription. Then they are followed by 2 lock-in procedures, which are slightly different UV lights delivered to the eye in order to essentially cure the polymers so that they stay in place. In between all of these treatments, the patients must wear UV-protecting glasses in order to avoid any unwanted change to this lens. After the second lock-in procedure, the patient does need to continue to wear the protective lenses for 24 hours. After that, they’re done. Not too bad, kind of interesting, and, I think, very cool that optometry can be a part of this. My patients have been super receptive to having me as part of their cataract surgery journey, and I have also enjoyed this.