Beyond Cataract Surgery 

With Light Adjustable Lens (LAL), we can guarantee successful spectacle freedom. 

Written by Melissa Bean Sterzick 

Advancements in cataract surgery during the last decade have improved outcomes for many patients. The latest development—the Light Adjustable Lens (LAL) by RxSight—results in better vision, offers customized vision prescriptions and is effective for those who’ve had previous eye surgeries such as LASIK and radial keratotomy (RK).

Damien Goldberg, MD, is a Torrance Memorial Physician Network ophthalmologist and eye surgeon. He says patients can discuss newer cataract treatments with their doctor to decide what’s best for their vision.

Recent Advances in Treatment

Traditional techniques for removing cataracts came out in 1967 and have involved using an ultrasound probe to break up and remove the cataract followed by the insertion of the intraocular lens (IOL) to restore vision. The LAL, approved in 2020, is the latest development to change the way cataract surgery is carried out. With the LAL, the cataract is removed and the lens is inserted, but the lens’ prescription is not set until after surgery.

“The LAL is the only FDA-approved intraocular lens that can be adjusted postoperatively. Vision after surgery isn’t dependent on making predictions or variations in the individual’s healing,” Dr. Goldberg says.

The LAL Process

The LAL is made of a special photosensitive material that changes the shape and power of the lens in response to ultraviolet (UV) light. Several weeks after surgery, the LAL is exposed to a specific pattern of UV light that alters the curvature of the lens.

Instead of needing glasses to fine-tune vision after cataract surgery, the patient undergoes a series of 90-second, in-office UV light treatments to apply a customized prescription directly into the adjustable IOL.

The treatments are directed by the surgeon and guided by the patient’s visual needs. Patients have the chance to preview their vision before it’s applied. They can “design” their vision for all distances—near, middle, far—and treat astigmatism.

The LAL process usually takes about eight weeks to complete. Three weeks after surgery, patients have their first light adjustment treatment. Typically, patients need two adjustments and two “lock-in” treatments. During the process they wear specialized, protective sunglasses and use eye drops every day.

Bill Holmes was one of Dr. Goldberg’s first LAL patients. Holmes began wearing corrective contacts at age 10 and has a long history of vision issues and surgeries (Radial Keratotomy (RK), Photorefractive Keratectomy (PRK) and LASIK). He had LAL surgery on his right eye a year ago. His left eye had cataract surgery with a traditional IOL. At age 80, Bill can finally see without glasses or contacts and favors his right eye.

“I can’t say enough about Dr. Goldberg. He’s really competent and his staff is great,” he says. “As far as I am concerned, Goldberg and his team are fantastic, and I wouldn’t go anywhere else.”

Holmes said the process took some time. He used his prescribed eye drops as recommended and returned to the doctor for all adjustments. He says he couldn’t be happier with the result. “You have to have patience and stick with it—and trust the doctor.”

Outcomes and Advantages

“With previous cataract surgery methods, we would be thrilled if we accomplished 20/40 vision outcomes,” Dr. Goldberg says. “Now, with LAL, we can get a 20/25 vision outcome over 90% of the time.”

For those who have had previous surgeries to correct their vision, the LAL can do what traditional cataract surgery can’t. “Around 25 million Americans have had LASIK in the last 30 years, and 2 million have had RK. They are coming in now with eyes traditional cataract surgery can’t quite correct. With this many people out there, we needed a solution.”

In addition, the LAL’s light adjustments to the lens after surgery optimize vision and give the patient more choices and more control. “Do you want great vision for distance or for close up—or a combination? The LAL empowers the patient,” Dr. Goldberg says. “The true advantage is you can test-drive the lens. It lets you choose your vision.”