The LAL is the only intraocular lens (IOL) placed at the time of cataract surgery that can be adjusted after surgery. It is the most precise way to have cataract surgery. The lens has been in development for over 20 years and is based on noble prize winning polymer chemistry research from CalTech. The lens is manufactured by RxSight, which is based in Orange County California. The LAL was approved by the FDA in 2017 and became available for practices to use in 2019. To date, over 20,000 lenses have been implanted.
With all other IOLs used in cataract surgery we try to provide the best possible vision we can. However, there are limits to how accurate we can be because we are making estimates based on your pre-operative testing. Remarkably, the LAL’s shape is changed in your eye after surgery by using a specific frequency of UV light. By changing the shape of the lens in your eye after surgery, we are able to customize your vision after surgery.
After surgery a patient will have 3 to 5 light treatments over 2 to 3 weeks to change the power of the lens and lock-in that power in their eye. The treatments average 90 seconds, but the visits can last 1 hour as they require a refraction and dilation. This treatment takes place in our office, where we have a light delivery device that can change the lens power. Leading up to a patient’s final treatment (lock-in), patients will need to wear UV protecting eyeglasses, that the company provides, to prevent changing the power of the lens from inadvertent UV light exposure.
Customized vision is important because it allows us to provide the most precise post operative vision without glasses and also to customize how a patient wants to see. With traditional intraocular lenses (IOLs), a patient is relying on their surgeon to predict how they want to see after surgery. With the LAL, a patient will tell us how they want to see and what they want to see without glasses. It shifts the control of uncorrected visual acuity from the doctor to the patient. If a patient wants more uncorrected distance, intermediate, or near vision they can control that. Another way of thinking about the LAL, is that it is the difference between an off the shelf suit versus a tailored suit.
For patients who want spectacle independence after cataract surgery in both eyes, the LAL system is very compelling. Greater than 80% of patients report that they do not need glasses after surgery. This precision approaches the results found with LASIK. The outcome results are higher than the 40 to 50% of patients who have eyeglass independence when traditional intraocular toric lenses are used.
Eyeglass independence is achieved through four mechanisms. First, the lens itself has an extended depth of focus, especially when adjusted with light to a near target. Secondly the lenses are adjustable in your eye. Thirdly, the lenses are typically adjusted to a small degree of monovision, which means that your dominant eye is set for distance and your non-dominant eye is set for intermediate/near. The degree of this difference is customized by the patient their visual preferences. Lastly, the lenses can be adjusted in 0.25 diopter steps vs a traditional intraocular lens that can only be chosen in 0.5 diopter steps. This leads to greater precision.
The LAL offers spectacle independence to more patients that may not qualify for a multifocal lens due to pre-existing disease or that may want to avoid some of the night-time symptoms experienced with multifocal lenses.
Anyone who is very motivated to have the most precise and clear vision after cataract surgery without glasses.
A patient’s pupil needs to dilate large enough for light treatments. This is generally 6 mm. Unfortunately, some patients will not dilate enough and will not qualify. Also, patients who may have previously had certain viral corneal disease or on photosensitizing medications that cannot be stopped should avoid the light treatment process. Most importantly, anyone who feels that they will not comply with wearing UV protection glasses at all times after surgery until their final light treatment, should not have the intraocular lens placed. Some patients may also have transportation issues and the increased number of post-operative visits and time may be difficult.
Fortunately, all is not lost if a patient forgets to wear their glasses for short periods of time. This is due to a special UV blocking layer on the lens called Optishield. This does provide protection, but until there are formal changes in protocol, we still recommend that patients wear their post-operative glasses at all times. Hopefully, as more data is collected about Optishield, we may be able to avoid wearing UV glasses indoors after surgery.
We charge $3,900 an eye for the lens. The lens costs more because it costs more than a traditional lens from the manufacturer. We also have to purchase the light delivery device for the office to treat the lenses. Lastly, there are multiple additional post-operative visits that must be scheduled with doctors and staff.
