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What is a Light-Adjustable Intraocular Lens?

A light adjustable intraocular lens (LAL) is a special type of intraocular lens (IOLs) that allows ophthalmologists (eye care specialists) to design, trial, and customize an individual’s vision following cataract surgery. It is the only type of lens that allows ophthalmologists to make adjustments to the lens power according to each patient's unique needs several weeks after cataract surgery.

A cataract is a condition that causes clouding of the natural lens in the eye, resulting in blurry vision. The only treatment for a cataract is to replace the cloudy natural lens with a new artificial intraocular lens. An Intraocular lens is an artificial lens implanted in the eye typically as part of cataract treatment or for correcting other vision problems such as farsightedness, nearsightedness, or astigmatism.

However, with a standard intraocular lens, you cannot adjust the power of the lens after your procedure if you are not happy with the quality of your vision. On the contrary, the light-adjustable intraocular lens is made of a special photo-sensitive material that changes the power of your inserted lens in response to ultraviolet (UV) light, increasing the chances that you will accomplish your desired vision after cataract surgery. It is the only type of IOL that facilitates customization and optimization of the lens to achieve the desired vision after its insertion in the eye. After implanting the LAL, your physician can show you your precise vision options. This enables you to test what your vision will appear like in real life and alter it to your personal preference before your ophthalmologist locks in your permanent vision correction power, allowing you to enjoy your new vision for the rest of your life.

Indications for Light-Adjustable Intraocular Lens

The light-adjustable intraocular lens is usually indicated for cataract treatment. However, placement of the light-adjustable intraocular lens during cataract surgery can also provide the opportunity to correct other refractive error vision problems a patient may have such as:

  • Hyperopia or farsightedness - A vision condition in which nearby objects look blurry, but far-away objects appear clearly.
  • Myopia or nearsightedness - A vision condition in which nearby objects look clearly, but far-away objects appear blurry.
  • Astigmatism - An imperfection in the curvature of the eye's cornea or lens. This causes blurred vision at all distances.
  • Presbyopia - The gradual loss of the eye's ability to focus on nearby objects. It is a normal part of aging.

The ability to correct these refractive errors enables patients to experience clear vision without glasses after cataract surgery.

How Does the Light-Adjustable Intraocular Lens Work?

The light-adjustable intraocular lens is comprised of molecules that are sensitive to light. Their position and distribution can be altered by an external UV light beam, which adjusts the shape of the IOL without needing additional surgery. As the IOL shape changes, its power changes, which can adjust for nearsightedness, farsightedness, or astigmatism. The postoperative adjustments are pain-free and take less than a couple of minutes. This can be done in your ophthalmologist’s office where a light delivery device is used to send the beam that reshapes the IOL. The first customized treatment is usually carried out several weeks after the cataract surgery when the vision has stabilized. Additional adjustments are performed at approximately weekly intervals as intended by your ophthalmologist. It is possible to make up to three adjustments, although some eyes need only one. When the result has been optimized, two final “lock-in” treatments are carried out, after which the IOL can no longer be adjusted or changed. After lock-in, no additional protection is required for UV light or sunlight, and there is no need for any other special precautions or follow-up.

Preparation for Light-Adjustable Intraocular Lens Placement

In general, pre-procedure preparation for light-adjustable intraocular lens placement includes:

  • A review of your medical history
  • A thorough eye exam to evaluate the overall health of your eyes and to study the shape and features of the eye in general
  • A refraction test to determine the degree of farsightedness, nearsightedness, and/or astigmatism
  • A measurement of the curvature of the pupils and cornea as well as the thickness of the cornea
  • A discussion about any medications or supplements you may be taking as some can complicate your cataract surgery.
  • Informing your doctor of any recent illnesses or other medical conditions you have, such as diabetes or autoimmune conditions 
  • Refraining from eating or drinking at least 6 hours before the procedure. If you are on regular medication for conditions such as high blood pressure, diabetes, or heart disease, you may take it with a sip of water.
  • Arranging for someone to take you home after the procedure
  • Signing an informed consent form after the pros and cons of the procedure have been explained

Procedure for Light-Adjustable Intraocular Lens

The removal of cataracts and implantation of light-adjustable intraocular lens procedure is similar to traditional cataract surgery. In general, the procedure involves the following steps:

  • The surgery eye is cleaned and numbed with anesthetic eye drops.
  • An eyelid holder is placed over the eye to prevent the eye from blinking.
  • A small incision is made through your cornea to access the eye’s natural lens.
  • A high-frequency ultrasound device is used to break up the cloudy natural lens into tiny pieces for easier removal.
  • A suction is used to gently remove the broken cloudy lens pieces from the eye.
  • A light-adjustable intraocular lens made of a special photosensitive silicone material that is halo-free and glare-free is carefully placed behind the iris and pupil in the same place your natural lens had occupied.
  • The incision is then closed, and a protective shield is placed over the eye to complete the operation.

Postoperative Care and Recovery

Your doctor will provide a series of postoperative instructions to be followed for a defined period. These include:

  • You will be prescribed steroid and antibiotic eye drops for a few weeks to minimize the risk of infection and inflammation.
  • You should wear a protective eye shield for at least a week at night or while napping to protect the eye and prevent rubbing it in your sleep.
  • Avoid strenuous activities and heavy lifting for a defined period so that there is no stress on the eye as it heals.
  • Keep away from dusty environments and avoid splashing water into your eyes to reduce the risk of irritation and infection.
  • Avoid hot tubs or swimming and close your eyes while bathing or showering for a week or two.
  • You should wear sunglasses to protect your eyes while outdoors.
  • Do not drive until cleared by your ophthalmologist.
  • You should be able to return to work or resume your normal daily activities in 1 to 3 days.
  • A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Some of the potential risks and complications that may occur after cataract removal and implantation of light-adjustable intraocular lenses include:

  • Bleeding
  • Infection
  • Redness
  • Swelling
  • Retinal detachment
  • Displacement of the intraocular lens implant
  • Remote chance of vision loss