Light adjustable Lens™ from RxSight®.  The perfect IOL?

The past three decades has seen a spirited, noble race to intraocular lens perfection. Is RxSight’s new customizable IOL the winner?

Prominent Tampa eye surgeon, Craig Berger, MD has just become one of a handful of Florida ophthalmologists to offer the new Light Adjustable Lens™ from RxSight®. The LAL is the world’s first intraocular lens implant (IOL) that allows cataract surgeons to tailor the lens power to suit the patient’s lifestyle — after surgery.

Cataracts are the 2nd most common cause of vision impairment in the world and they can develop in one or both eyes. Once a cataract advances, surgery is the only effective treatment. Cataract surgery is the most common operation performed by ophthalmologists and has a very high rate of safety and effectiveness.

Surgery involves removing the eye’s cloudy natural lens and replacing it with an artificial intraocular lens, or IOL. In their first two decades, IOLs were implanted into millions of eyes and delivered lifechanging functional vision to patients who had suffered through their vision slowly deteriorating with age, medical conditions or injury.

The first IOL implants were monofocal, meaning the IOL has a fixed focal point. Though they can provide pristine visual acuity, their single fixed focusing point requires the patient to wear reading glasses after cataract surgery because the recommended lens power facilitates mid-range or distance vision, not close up.

In an effort to circumvent most the inflexibilities of fixed-distance vision, Dr. Berger and other cataract surgeons use a technique called “monovision”, or blended vision. With monovision, the vision in a patient’s dominant eye is corrected for distance, while the other eye is intentionally tuned for somewhat shorter focal point in order to allow functional vision for close objects. Monovision is a viable option to provide decent near acuity without compromising appearance and comfort. However, reading glasses are still needed in most cases.

The Multifocal IOL

Multifocal IOLs debuted in the 1980s. These lenses provide both near and far vision in an individual eye. While not perfect, they offer a better option than monovision, especially when implanted in both eyes. Throughout the 1990s, many types of multifocal IOLs came and went, with several models being shelved due to flaws and complaints from frustrated patients. Cataract surgeons, always striving for that perfect outcome, quickly learned that they needed to be very selective when deciding which patients would receive which model lens. Fast forward to present day, there are dozens of multifocal “premium” IOL options on the market. Some correct both nearsightedness and farsightedness while others add astigmatism correction for those patients who want to avoid a separate surgery for that condition.

Dr. Berger performs precise testing prior to cataract surgery and choosing the right IOL. These tests may include measuring the curvature of the cornea and the size and shape of the eye. This exam information helps him choose the best type of IOL, tailored for the lifestyle of his individual patient. A golf enthusiast needs a different IOL power and functionality than an accountant. Someone who does a lot of night driving may need a different lens model than an avid fisherman.

“To improve is to change; to be perfect is to change often.” ~Winston Churchill

Multifocal IOLs provide glasses-free lifestyle in some patients, though many find they need minor fine-tuning with light reading glasses when doing activities requiring sharp close up vision. Even with these state-of-the-art multifocal IOLs, it is still a challenge for surgeons to predict how an eye will heal after cataract surgery.

Introducing the Light adjustable Lens™ from RxSight®

In their mission to eliminate many of the uncertain outcomes of IOL implants, RxSight®, an ophthalmic medical technology corporation headquartered in Aliso Viejo, California, has engineered an adjustable lens implant that allows the cataract surgeon to fine-tune its power after surgery.

How does the Light Adjustable Lens work?

Using a special lens material designed by a Nobel Prize winning scientist, the Light Adjustable Lens (LAL) enables the cataract surgeon preview and dial-in a patient’s vision until it meets their personal desires and lifestyle requirements.

This post-operative optimization is done by Dr. Berger after lens implantation through a series of office-based light treatment procedures that take only a few minutes each. The lenses are adjusted to fit vision requirements of each eye, much like tailoring a custom suit.

Light adjustable intraocular lens implant in Tampa Bay, Florida

In one patient’s case, after her cataract surgery with LAL implants, Anna decided that she wanted a little more intermediate vision. Anna is an optometrist and she often finds herself examining patients while turning to look at medical chart notes on the exam computer screen five feet away. Though she can see and read the notes, the words aren’t perfectly in focus and she finds herself slightly adjusting her position to make the letters on the screen sharp. This is an activity that Anna performs dozens of times every day and she prefers that her vision at this in-between distance be optimized.

Anna is due for her post-operative IOL light treatment procedure exam. This is the day her ophthalmologist will adjust and refine her lens implants to optimize their focusing power. Prior to cataract surgery, Anna and her surgeon sat down and discussed which IOLs would be best, based on her lifestyle activities. Together, they chose the RxSight® adjustable lenses because they would afford her that “wiggle room” in adjustability after cataract surgery. Anna gets to “preview” the lens implant vision outcomes before selecting a permanent prescription. She told her doctor that, after surgery, she wanted to go to work and try out the IOL lens powers, then make adjustments based on what she experienced in her every day activities.

What to expect after LAL cataract surgery

Since surgery, she has been wearing the required and provided special ultraviolet (UV) protective glasses and sunglasses that limit her UV light exposure that can cause uncontrolled changes to the Light Adjustable Lens. She’s looking forward to locking in her IOL power so she can rid herself of glasses.

At her post-op appointment, Anna describes her exam room scenario at work and explains her desire to be able to examine a patient and see notes across on the adjacent desktop at the same time. Each eye’s lens now being individually adjustable, she and her doctor agree on the perfect focal distance for both.

How are the light treatments performed?

Using an office Light Delivery Device (LDD), her doctor shines a light into her eye and asks her to focus on a dot inside the light. The painless, non-invasive treatment precisely reshapes her implanted lens to the refractive power that is needed to target her custom prescription by changing the shape and power of the IOL’s special photosensitive material in response to the ultraviolet (UV) light being output by the device. The procedure takes 90 seconds. She is told it may take 3-4 more light treatments to reach her desired vision goals. Her lens’ prescription powers will then be “locked in” and made-to-order for her vision needs.

Like many patients, Anna ended up with better, more functional vision than she had with her glasses and contact lenses. She has no problem reading distant road signs or small writing on medicine bottles, without glasses.

In a study of 600 subjects, those who received the Light Adjustable Lens followed by adjustments were twice as likely to achieve 20/20 distance vision at 6 months without glasses as those who received a standard monofocal IOL. In addition to nearsighted and farsighted correction, the U.S. Food and Drug Administration has approved the Light Adjustable Lens and Light Delivery Device for patients with pre-existing astigmatism of 0.75 diopters or more who are undergoing cataract surgery. As with any surgical procedure, there are risks associated with cataract surgery and IOL implantation. Dr. Berger discusses these risks with all his patients. Potential risks associated with LDD light treatments include mild alterations to color perceptions; temporary scratchiness, irritation, or dryness to the front part of your eye and other risks associated with pre-existing conditions or medicine usage.

If you suspect cataracts or if you’ve been diagnosed with cataracts, make an appointment today to discuss the Light Adjustable Lens™ from RxSight®, the first and only lens that can be optimized by Dr. Berger after cataract surgery. He is one of a select few in Florida using this new technology. Dr. Berger was the first surgeon to perform Bladeless Femtosecond Laser Assisted Cataract Surgery (FLACS) with the Lensar femtosecond laser in Tampa. He is currently accepting new patients at his Tampa practice, Bay Area Eye Institute, for consults and second opinions with available appointments within 2-3 days.

Bay Area Eye Institute understands that there are many ophthalmologists and optometrists in the Tampa bay area to choose from. Their practice focuses on patient satisfaction. Their philosophy is to put the patient first, provide physical and emotional comfort, and strive for the highest care possible. Your time and comfort are paramount. They make patient education an important aspect of your treatment and will take the time to explain your ocular conditions.

Bay Area Eye Institute is conveniently located in north Tampa and is easy to get to from all Tampa Bay area counties. They are open 8:00 a.m. to 5:00 p.m. on Monday-Thursday and 1:00 to 5:00 on Friday. Call them today and ask about setting up a cataract surgery evaluation with Dr. Berger. (813) 265-6940