Our guest surgeon today is Dr Steve Safran who has great surgical talent for complex revision cases especially with IOL exchange. He has noted multiple patients with the RxSight Light Adjustable Lens (LAL) who have developed haze within the optic causing vision degradation after the lock-in treatments.
Recent reports from both surgeons and patients indicate that in some cases the Light Adjustable Lens (LAL) from RxSight may develop a true optical haze within the lens material itself which is distinct from transient postoperative visual effects. This haze appears to stem from irregularities in the polymer matrix, possibly related to the UV light–induced photopolymerization process or perhaps unintended UV exposure. Clinically, patients may present after the lock-in treatment with decreased visual acuity, reduced contrast sensitivity, glare, halos, or a general decline in visual quality. Slit-lamp examination has revealed physical changes within the lens, such as raised zones or subtle opacification, sometimes described as “zones of polymerization” that scatter light. These changes are often irreversible and, in cases like the one shown here today, have required IOL explantation and exchange. The exact mechanism is not fully understood but may involve incomplete or unstable polymer changes after the lock-in phase.
If you have found any patients in your clinic with optic haze and decreased vision, especially after the lock-in treatment, please comment below so that we can harness the power of large group data to further understand this issue.
disclosure: Dr Safran has no relevant disclosures. Dr Devgan was involved in the 2009 FDA trial of the older generation LAL when the company was called Calhoun Vision, but has no relevant disclosures since that time.
I have seen the same pattern of optic degradation. Looks like the sun at the slit lamp and patient has poor vision and sees the same “sun” type pattern.
Dr. Devgan – Really appreciate the tremendous service you provide with this site. Time for an iol (or 2) for this 62y/o with otherwise healthy and not previously operated eyes, and the omakase option from my surgeon (in Boston) is LAL. Makes me nervous, both because of reports like this (and the relatively more complicated extraction if that is needed) and just generally in that another way of looking at the adjustability is that it means more ways for things to go wrong. While being mostly spectacle free would be great, not my highest priority – want best vision possible even if it means glasses.
Wondering if LAL’s are on your menu in LA?
Thanks!
Michael
sounds like you need a monofocal IOL
Thanks Doc, most grateful for your perspective.