RxSight Light Adjustable Lens
Imagine an implant that can be fine-tuned after cataract surgery. An intraocular lens that can be precisely adjusted to your refractive needs. The Light Adjustable Lens is the breakthrough technology patients and surgeons have been demanding for years. A 90 second in-office “tune-up” eliminates astigmatism and customizes the lens to a perfect focus. This implant is ideal for post-LASIK patients, those who prefer monovision, and individuals who want the sharpest possible vision.
The specialized silicone of this implant can be modified using medical grade Ultraviolet (UV) light. Any deviation from target can be corrected after the eye has healed. Furthermore, you can test drive the refractive results and choose the endpoint that satisfies your visual needs.
Three Light Adjustable Lens (LAL) Patients
AR was a near-sighted engineer whose cataracts were making driving difficult at night. He longed to eliminate his glasses but wanted to avoid the haloes experienced by his friend who had had a multifocal implant. He choose perfect distance vision in both eyes without glasses using a LAL. After his first adjustment he was thrilled with “the best distance vision he had ever experienced” but wanted more near. The second adjustment gave him freedom from glasses for almost all activities and he elected to lock-in. He had un-compromised distance vision for all activities and was glasses-free for all near tasks except for the reading of technical manuals. The LAL allowed this patient to refine his goals and achieve his best result.
LM enjoyed glasses free vision with monovision contact lenses until her cataracts developed. She elected to continue her monovision when a PanOptix was ruled out when her macular pucker was identified. Following her first adjustment LM wanted even more reading vision than she had enjoyed with her monovision contacts. After her second adjustment she said, “perfect, now… lock me in”.
CV required glasses for distance and near once she reached middle age. After her cataracts developed she sought freedom from glasses. Her astigmatism made a LAL her best option. After her first adjustment her distance and intermediate vision were excellent but she wanted more clarity for reading. After her second adjustment she requested “just a little bit more reading”. She achieved her ideal personalized refractive solution following her third adjustment and now enjoys reading and driving without glasses.
Unlike any previous intraocular lens, the LAL gives surgeons the ability to achieve their patient’s refractive goals precisely. The LAL gives patients the ability to design and re-design their refractive endpoint.
Monovision Contacts versus the Light Adjustable Lens (LAL)
Until now, surgeons been unable to achieve the accuracy of monovision after cataract surgery that patients enjoyed before their cataract developed. Despite the most advanced pre-operative and intra-operative techniques, the best cataract surgeons can not calculate an implant power with the same accuracy as contact lenses.
The LAL gives doctors and patients the same accuracy as contact lenses with a non-surgical opportunity to experiment and finally select the ideal reading distance. Many surgeons also feel the LAL provides an extended depth of focus that outperforms contact lens monovision.
For monovision patients who develop cataracts, nothing can compete with the safety, flexibility, and precision of the LAL.
Former LASIK patients and the Light Adjustable Lens (LAL)
Cataract patients who have had previously LASIK surgery are less likely to achieve 20/20 glasses-free vision than cataract patients who never had LASIK. This discrepancy arises from the inability of modern implant calculation formulae to precisely determine the correct implant power in the post-LASIK eye. The LAL addresses the unique challenges of former LASIK patients. In fact, patients with an LAL are twice as likely to achieve 20/20 glasses-free vision as patients with any other intraocular implant.
We prefer the LAL in patients with previous LASIK because we can match and often exceed their refractive expectations
Our RxSight LDD (light delivery device), shown below, resembles a standard office slit-lamp. It is computer driven and comfortably adjusts the Light Adjustable Lens to your specifications.
Our best pre-operative intraocular lens power calculation techniques are woefully inadequate. The graphic below, from an award winning paper, shows deviation from the ideal implant power using scattered error values. The innermost sphere encloses calculations whose power is off by less than 0.5 diopters. Greater than 15% of cases are greater than 0.5 diopters from optimal.
The graphic below shows 1000 patient calculations and their resulting deviation from optimal. Nearly 5% of patients are more than 1.0 diopters from ideal. The Light Adjustable Lens allows all patients to be enhanced and the scatter to be dramatically tightened and their refractive errors reduced. The RxSight Light Adjustable Lens should correct all patients to +/- 0.25 diopters from target. Furthermore, this technology eliminates errors from residual astigmatism.
While normal eyes generate a scatterplot like the one shown above, patients with a more complex cornea (LASIK, dry eye, longstanding contact lens wear, and irregular astigmatism) have even less predictability. Because the Light Adjustable Lens can minimize these errors, it is ideal for these special cases.
Toric Versus Light Adjustable Lens
The Light Adjustable Lens (LAL) provides a more exact refractive result than a TORIC implant. Even the best surgeons will fail to correct all of your astigmatism with a TORIC. Pre-operative calculations are imperfect, intra-operative measurements are suboptimal, implants can rotate, and your eye’s healing is not always predictable. What is considered a success in a TORIC implant is the starting point for refinement with a LAL. Furthermore, this new technology can help patients in which the magnitude and direction of astigmatism is more difficult to determine pre-operatively. While more expensive, the LAL provides a more rewarding solution for our cataract patients.