Comparing the Clinical Performance of Two LAL Models

Cataract surgery continues to evolve with the introduction of new IOL technology and advanced diagnostics. However, despite these developments, many patients still experience postoperative refractive surprise. In this episode, Dr. Doane discussed the benefits of light adjustable lenses (LALs) and highlighted trial data on the clinical performance of two models of the light adjustable lens: LAL and LAL+ (RxSight).

The key advantage of LALs is that they are adjustable monofocal IOLs that can be “tuned” postoperatively with UV light. With the LAL platform, patients are not locked into a refractive outcome immediately postoperatively; instead, patients can trial their new vision in real-world scenarios and then return to their surgeon for further refinement.

“That's where it becomes customizable, each eye for each patient,” said Dr. Doane, “and that's where the art (and fun) of what we do comes about.”

While the two models of LALs are quite similar, the “Plus” version (LAL+) has a modified aspheric anterior surface that slightly extends depth of focus before any light treatments—whereas the original LAL does not.

During the episode, Dr. Doane shared results from a study comparing the clinical performance of the LAL to the LAL+. In the prospective, nonrandomized, nonmasked, multicenter study, 50 and 100 patients were implanted bilaterally with the LAL and LAL+, respectively.¹ Outcome measures included subjective manifest refraction; monocular and binocular best-corrected distance, intermediate, and near visual acuities; and binocular uncorrected best focus acuity at differing contrast levels. Results demonstrated that 91.1% and 93.5% of LAL and LAL+ eyes had a mean refractive spherical equivalent (MRSE) within 0.50 D of target, respectively (Figure 1). Notably, the LAL+ provided patients increased intermediate and distance vision compared to the base LAL model, thus confirming the benefits of the modified aspheric anterior surface (Figure 2).

The data showed that both the LAL and LAL+ lenses achieved excellent refractive and binocular visual outcomes at distance, intermediate, and near. The broadened depth of focus of the LAL+ was clinically evident and led to less anisometropia.¹ This study further demonstrates the unique therapeutic approach for refractive cataract patients as they can select and adjust their refraction according to their visual goal.