Light adjustable lens

[PikminOC]

Lal success rates. Anywhere I can find this?

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[Dusn]

what’s the draw to using this lens? Are you all really missing your refractive target very often?

 

[hello lady!]

what’s the draw to using this lens? Are you all really missing your refractive target very often?

It's just another bat to beat the patient like the money-filled pinata they are.

 

[dantt]

It's just another bat to beat the patient like the money-filled pinata they are.

Here's an interesting question perfect for this semi anonymous forum. Is there any role for optometry comanagement for this lens? How are they taking getting cut out of this? Or are they still charging for postop care even though all of the postop care is being done at the MDs office/

 

[Rhexis]

I'm pretty comfortable with the rate at which I hit my refractive target, and haven't incorporated the LAL in my practice. If we miss the refractive target with a typical IOL - I'd be usually offer PRK/LASIK at a discounted rate to get them to that refractive target (cheaper than the LAL).

LAL I would find useful for post-RK, post-LASIK with irregular corneas where accuracy of current IOL calcs isn't as accurate. I have referred some people out who wanted the LAL and asked for it, but to be honest these people in general have been extremely type A/picky and I don't mind them going elsewhere.

I do think the LAL is here to stay - and there will be improvements over time (maybe a multifocal/EDOF version). I'm sure I'll be using some version of it in the future.

Those that use it seem to like it, and success rates are high to hit the target initially (refraction can drift over the years so initial perfection doesn't mean long-term perfection). Takes much more postop time - so helps to have an optom assisting.

 

[eyeguyhopeful]

I mean the 2018 Lindstrom paper of almost 300,000 eyes showed that ~30% are not within +/- 0.5D of target after cataract surgery.

Agree - LALs are amazing technological improvements and here to stay. Also - lot of times patients don't know exactly what they want. It helps that they can "try out" their vision before committing to it.

 

[Rhexis]

I would have to say that my experience is vastly different than the 2018 paper. IF 30% of my eyes were not within 0.5 diopters after cataract surgery I'd jump on the LAL and offer it to everyone.

But my experience is different. With top of the line machines (I use IOL master and Pentacam), modern IOL formulas (Barrett. Hill-RBF. etc.), and using toric IOLs I'd say accuracy is quite high. There are certainly variables that decrease accuracy of calcs and you mention that to patients (RK, LASIK, Keratoconus, scarring). Ocular surface issues also cause accuracy issue but you can treat those and have them repeat measurements and get good results.

I do ~750 (+/- 100) cataract surgeries a year. I do usually 0-2 post-cataract surgery LASIK touch-ups per year. That doesn't mean my results are perfect and all within 0.5 diopters. but for those that do end up -0.75 off or something, many of them still see well enough to be content. It's hard to justify to people that they need to spend $3000 per eye on a LAL when my results are already solid without it using a lens their insurance completely covers. And if they're not happy, I do a LASIK enhancement at my cost that is far less than the LAL.

That being said- the LAL is here to stay. I've referred some people out for the LAL who I think it would help due to their expectations and irregular measurements, usually these are post-refractive surgery patients with weird astigmatism. Will be interesting what improvements are made there over time in terms of EDOF. multifocal, etc..

 

[Openglobetrotters]

There’s definitely a role for LAL. However the FDA results for LAL are surprising. I believe about only 92% were in 0.50 diopters.

Over the last few years, IOL formula and understanding of ocular surface impact on biometry have improved. I also do about 1000 cases a year and according to Veracity, 91% are within 0.5D.

It’s difficult to comanage LAL with OD unless you mean in house OD.

 

[Dusn]

Has anyone using the LAL seen cases of
Premature polymerization or signs of possible UV-light phototoxicity (ie complaints
if red-tinged vision or color changes after the UV treatments)? Any other issues?

 

[Hanky]

Something shared at ASCRS that I hadn't considered was the chance to trial monovision with LAL. If they hate it after a month, you just reverse it. The other benefit is that it has more EDOF effect than I'd recognized.

I still don't offer LAL because 1) LASIK is cheaper and 2) the main reason my patients choose monovision over multifocal is the cost. No room for an even more expensive monovision option.

 

[Dusn]

Something shared at ASCRS that I hadn't considered was the chance to trial monovision with LAL. If they hate it after a month, you just reverse it. The other benefit is that it has more EDOF effect than I'd recognized.

I still don't offer LAL because 1) LASIK is cheaper and 2) the main reason my patients choose monovision over multifocal is the cost. No room for an even more expensive monovision option.

How accurate is the reversal? And the IOL polymerization process doesn’t create any higher order aberrations?

 

[Hanky]

How accurate is the reversal? And the IOL polymerization process doesn’t create any higher order aberrations?

Others with more first-hand experience can comment, but my understanding is that it is quite accurate. Not sure about HOAs, but I'd imagine better than Vivity with less EDOF effect. The numbers shared were -1.25 targets with 20/30 J1 in non-dominant eye.