Moderator
Mark A. Kontos, MD, ABO
Panelists
Mitra Nejad, MD, ABO
Shawn R. Lin, MBA, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Salomon Merikansky, MD
Co-Authors
Lily Zhang MD, Kendall Donaldson MS, MD
Purpose
To evaluate the postoperative time and workload involved in caring for patients who undergo cataract surgery with bilateral light adjustable lens (LAL) implantation compared to bilateral standard monofocal intraocular lens (IOL) implantation.
Methods
We performed a retrospective review of patients who underwent cataract surgery with bilateral implantation of LALs (N=13) compared to standard monofocal IOLs (monofocal group; N=13) at The Bascom Palmer Eye Institute with a single provider. Outcome measures for both groups included the total time the patient spent in the office, number of visits, mean duration of visits, and best corrected visual acuity (BCVA) before and 90 days after the surgery. Additional measurements for the LAL group include uncorrected distance, intermediate and near vision as well as patient satisfaction was evaluated with a survey.
Results
Mean (�SD) time spent in the office during postoperative visits was 18:21 � 6:01 hours over 7.0 � 1.7 visits in the LAL group, compared to 9:10 � 2:53 hours over 3.1 � 0.3 visits in the monofocal IOL group (p <0.0001). mean="" visit="" duration="" was="" 2:39="" �="" 1:08="" in="" the="" lal="" group="" versus="" 1:26="" �="" 0:53="" hours="" in="" the="" monofocal="" iol="" group="" (p=""><0.0001). no="" significant="" difference="" was="" found="" in="" bcdva.="" in="" the="" lal="" group,="" 76.9%="" chose="" blended="" vision="" (30.7%)="" or="" monovision="" (46.2%),="" with="" 23.1%="" selecting="" bilateral="" emmetropia.="" all="" lal="" patients="" were="" highly="" satisfied,="" reporting="" freedom="" from="" glasses="" at="" various="" distances,="" though="" 2="" patients="" (16%)="" reported="" mild="" side="">
Conclusion
Patients with LAL implantation required significantly more clinic time, more visits, and longer visit durations. However, they achieved high-quality vision, spectacle independence, and high satisfaction with customized binocular vision. This is the first study to quantify postoperative time and effort required for cataract surgery with LALs.
Presenting Author
Elmira Baghdasaryan, MD
Co-Authors
Jules Winokur MD, MBA, Isha Cheela DO, Joseph Mootz MD, David Ritterband MD, Anne Steiner MD, Matthew Gorski MD, Richard Braunstein MD, Andrew Bontempo PhD, OD, Scott Sheren MD, Daniel Hamou MD
Purpose
To assess clinical characteristics and postoperative course of the light adjustable intraocular (IOL) lens (LAL) (RxSight Inc., USA) implanted in patients during cataract surgery with various refractive goals.
Methods
Retrospective chart review of 414 LAL implanted eyes targeting emmetropia (E) and myopia (M) from 7 different surgeons. 260 eyes with completed ultraviolet light delivery device treatments (LDT1-3) and lock in (LK1,2) procedures postoperatively were included for analysis. Visual acuity (VA) at distance, manifest refraction, and number of treatments needed to achieve refractive goals were the primary outcome measures.
Results
130 eyes were analyzed in each group. Mean age in both groups: 69 � 8 years (p=0.8). 5% of eyes in the E group required 3 LDTs vs 21% in the M groups (p<0.05). average="" treatment="" length="" was="" 28="" days="" and="" not="" significantly="" different="" between="" the="" two="" groups.="" 70%="" of="" eyes="" in="" the="" e="" group="" had="" uncorrected="" distance="" va="" of="" 0/30="" at="" ldt1="" vs="" 95%="" at="" lk2.="" the="" difference="" in="" spherical="" refraction="" after="" the="" first="" ldt="" to="" the="" final="" refraction="" was="" �0.004�0.3="" in="" the="" e="" group,="" and="" -0.4�0.6d="" in="" the="" m="" group=""><0.001). 100%="" eyes="" were="" d="" cyl="" after="" lk2="" in="" both="" groups,="" while="" 61%(e)="" vs="" 52%(m)="" had="" .25d="" cyl="" (p="0.4)." 87%="" of="" the="" eyes="" in="" m="" vs="" 95%="" in="" e="" group=""><0.05) were="" within="" 0.5d="" of="" their="" target="" spherical="">
Conclusion
LAL�s offer postoperative refractive titration. More treatments were required to reach myopia as compared with emmetropia. This may be due to patients shifting perception of optimal myopia after the first treatment. Favorable final distance vision and refractive outcome were achieved in the vast majority of eyes targeted for emmetropia.
Presenting Author
Tushar Dave, MD
Co-Authors
Kashif Baig MD, MBA, Saama Sabeti FRCSC, MPH, MD
Purpose
To report the 3-month visual outcomes of Light Adjustable Lenses (LALs; RxSight) including near vision, intermediate vision, distance vision and higher order aberrations in patients that have undergone cataract surgery or refractive lens exchange.
Methods
Retrospective, non-randomized, single-centre study of patients undergoing cataract surgery or refractive lens exchange with implantation of the Light Adjustable IOL with the goal of either emmetropia in both eyes or blended vision with a myopic offset in the non-dominant eye. Clinical outcomes will be measured at postoperative visits as per standard of care at 1 day, 1 week, 1 month and 3 months. Primary outcomes assessed included monocular and binocular uncorrected visual acuities at distance (6 m), intermediate (66cm) and near (40cm), and post-operative aberration profiles.
Results
93 eyes were evaluated. Mean monocular uncorrected distance, intermediate and near visual acuities were -0.10, 0.19, and 0.47 logMAR, respectively, in eyes with a refractive target of emmetropia (0.00 D), and 0.32, 0.03, and 0.13 logMAR, respectively, in eyes with a refractive target of mild-moderate myopia. 90/93 (96.7%) eyes achieved their refractive target after final lock-in. LALs also showed expected changes in aberrometry profiles with post-operative changes in lenticular and total spherical aberration ( P < 0.001, P < 0.001), higher order aberrations (P < 0.001), and lenticular modulation transfer functions (spherical aberration, P = 0.02; higher order aberrations ( P < 0.001).
Conclusion
Light Adjustable Lenses provide strong visual outcomes over a range of refractive targets, with 96.7% of eyes achieving their intended refractive target after final lock-in. They also show expected aberration profiles in the domains of spherical aberration, higher order aberrations and contrast sensitivity.
Presenting Author
John A. Vukich, MD
Purpose
The Light Adjustable Lens (LAL) is an IOL that allows non-invasive post-op adjustments to optical power and therefore the patient�s post operative refraction. The new model LAL+ features a modified aspheric anterior surface for extended depth of focus. This study evaluates the visual and refractive outcomes achieved with the new adjustable lens.
Methods
This prospective clinical study, conducted at five sites, collected vision and refractive data during study visits coinciding with each adjustment and after all adjustments were completed. During post-operative visits, patients' vision and refraction were measured, and the IOL power was adjusted according to their visual goals.
Results
Data from 188 eyes of 94 subjects bilaterally implanted with the new model adjustable lens were analyzed. 90.4% of subjects were targeted for blended vision (one eye emmetropic, one myopic). After adjustments, 95.7% of emmetropic eyes achieved an MRSE within 0.50 D of target and ?0.50 D residual cylinder. Additionally, 91.5% and 86.2% of patients had binocular uncorrected distance and intermediate visual acuity of 20/20 or better, respectively. 92.6% achieved binocular uncorrected best focus visual acuity of J1 or better.
Conclusion
The adjustability of this novel IOL provides excellent refractive accuracy leading to visual outcomes suitable for cataract refractive surgery patients. The blended vision strategy, plus the extended depth of focus feature of this IOL, provides good binocular vision at distance, intermediate and near.
Presenting Author
Siddharth Yadav, BSc
Co-Authors
Barry Emara MD, FRCS
Purpose
A review of the literature to determine visual outcomes, effectiveness and patient satisfaction towards implantation of the light-adjustable intraocular lens (LAL) in cataract surgery. To date, there are no known reviews outlining the effectiveness of the first or second generation of LALs used in cataract surgery.
Methods
This was a systematic review of the literature. A literature search was conducted using PubMed, Scopus and Cochrane Central Register of Clinical Trials. Publications dating from January 2003 till September 2024 were included. Inclusion criteria were studies evaluating outcomes and visual performance of patients who had undergone light-adjustable lens implantation. A total of 248 publications were found across three databases, with 77 studies being included for screening.
Results
The search yielded 203 records, with 18 studies included in this review with a total of 819 LAL implantations in 609 patients between 2009 and 2023. Studies included assessment of LAL in patients with previous corneal refractive surgery, and those with residual myopia, hyperopia and astigmatism. Across all 18 studies, an average of 91.5% of patients were able to achieve within �0.50 diopters of target refraction after lock ins, with 85% achieving a UVDA of 20/20 or better. Long term follow up showed good visual acuity and refractive outcomes with good stability even after 7 years.
Conclusion
For patients undergoing cataract surgery, the light-adjustable IOL has shown to achieve high accuracy in refractive outcomes and stability over time. The postoperative adjustability gives the LAL the ability to correct refractive errors accurately, while ensuring high patient satisfaction compared to standard monofocal IOLs available on the market.
Presenting Author
Xuesen Cheng, MD, PhD
Co-Authors
Karim Kozhaya MD, Kusona Fortingo BSc, Li Wang PhD, MD, Allison Chen MD, MPH, Mitchell Weikert MD, MS, Douglas Koch MD, Francisco Mendes MD
Purpose
To evaluate the refractive treatment accuracy with the Light Delivery Device (LDD) in eyes implanted with the second-generation light-adjustable lens (LAL).
Methods
We included all consecutive eyes (both with no prior corneal refractive surgery (CRS) and with history of RK and LASIK/PRK) implanted with the second-generation LALs. Vision and manifest refraction were measured before and after each treatment and each lock-in. The primary outcome was treatment error, which is the difference between the measured refraction after each treatment and lock-in and the target refraction or the locked refraction. Subgroup analyses were performed to compare the treatment accuracy between eyes without prior corneal surgery and eyes with history of RK and LASIK/PRK. Statistical analyses were performed with SPSS and R software.
Results
A total of 121 eyes were included, with 28 in no-CRS group, 67 in LASIK/PRK group (58 myopic and 9 hyperopic), and 26 in RK group. For distance and near target eyes with no CRS, myopic LASIK/PRK, hyperopic LASIK/PRK, and RK, respectively, mean treatment errors were 0.02�0.29 and 0.21�0.49, 0.03�0.35 and 0.20�0.44, -0.16�0.24 and -0.33�0.19, 0.06�0.59 and 0.18�0.41 after the first treatment;-0.09�0.22 (n=10) and -0.03�0.11 (n=10), -0.06�0.25 (n=28) and -0.03�0.20 (n=15), -0.13 (n=1) and -0.13�0.18 (n=2), -0.02�0.11 (n=7) and 0.08�0.07 (n=3) after 2nd lock-in.
Conclusion
More eyes will be added, especially in the lock-in group. Statistical analyses will be performed, and results will be discussed.
Presenting Author
Jonathan M. Davidorf, MD, ABO
Co-Authors
Oliver Davidorf BSc, Michelle Vartanian OD
Purpose
To evaluate binocular uncorrected visual acuity (UCVA) at distance, intermediate, and near ranges in subjects bilaterally implanted with the Light Adjustable Lens (LAL).
Methods
In this prospective, unmasked, nonrandomized study, 30 subjects bilaterally implanted with the LAL will be divided into three groups based on their refractive targets for the myopia-targeted eye: a distance group (targeting ? 0.50 D of myopia), a distance/intermediate group (targeting between -0.51 D and -1.25 D of myopia), and a distance/near group (targeting > -1.25 D of myopia). One eye in each subject will be targeted for distance vision. Binocular UCVA will be measured at distance (6 meters), intermediate (66 cm), and near (40 cm) using standard vision test cards. Results will be analyzed based on the targeted refractive outcomes for each group.
Results
For all patients (N=30), the mean DVA was 20/20 across all refractive target groups. IVA (mean) ranged from J1+1 [J3+2 to J1+] for the 0 to -0.50 D group to J1-1 [J7-1 to J1+] for the >1.25 D group. NVA (mean) ranged from J2-1 [J5+1 to J1+-2] in the 0 to -0.50 D group to J1+2 [J2-2 to J1+] in the >1.25 D group. In patients with BCDVA of 20/20 or better in both eyes (N=19), the median DVA remained 20/20 across all refractive target groups. IVA (mean) ranged from J1 [J3+2 to J1+] in the 0 to -0.50 D group to J1+1 [J2+2 to J1+] in the >1.25 D group. NVA (mean) ranged from J2-2 [J5+1 to J1+-2] in the 0 to -0.50 D group to J1+-2 [J2-2 to J1+] in the >1.25 D group.
Conclusion
Bilateral implantation of the Light Adjustable Lens provides excellent binocular uncorrected visual acuity at distance, intermediate, and near. Visual outcomes varied predictably by refractive target, suggesting the LAL may offer customizable results, especially for patients who can tolerate some refractive discrepancy between eyes.
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