Dr. Jeff Wong is excited to offer the latest innovation in intraocular lenses for cataract surgery – the Light Adjustable Lens. This revolutionary lens can be adjusted in the office after your surgery to ensure your vision is as clear as possible. Unlike traditional IOLs, the Light Adjustable Lens can be adjusted without further surgery, using specialized light treatments to enhance and fine tune your vision. This is the world’s first lens implant that can be customized for your eye after surgery.
With the Light Adjustable Lens, you will have the unique opportunity to preview different possible vision outcomes with your cataract surgeon before you establish your final vision. Essentially, this allows you to “test drive” and fine tune your vision before deciding on your final choice.
Traditional cataract surgery involves pre-surgery eye measurements to estimate the power of the intraocular lens (IOL) that will provide you with the best vision after surgery. However, every patient’s eye heals in its own, unique way. This healing process can affect the final resting position of the IOL in the eye. If the eye heals with the IOL more towards the front of the eye than average, the eye can end up slightly nearsighted. Similarly, if the eye heals with the IOL more towards the back of the eye than average, the eye ends up slightly farsighted.
Despite the high quality of the technology used to measure the eye and select the best IOL power to design the visual outcome, it is still just an estimate for any given patient. And because every eye heals slightly differently after surgery, getting ‘close’ to the predicted outcome is often the best result a patient can expect. If the visual target is not achieved, sometimes glasses, contact lenses, or additional surgery (LASIK or IOL exchange) may be required.
The Light Adjustable Lens (LAL) is the only IOL that enables you and Dr. Wong to design, trial, and customize your vision after cataract surgery. Adjustability takes cataract surgery to the next level by giving you a lens customized specifically for your eyes.
In an FDA study of 600 subjects, those who received the LAL were twice as likely (as those who received a standard monofocal IOL) to achieve 20/20 vision without glasses.
The Light Adjustable Lens is made of a special photo-sensitive material that changes the power of your implanted lens in response to UV light, increasing the likelihood that you will achieve your desired vision after cataract surgery.
If you select the Light Adjustable Lens, the first step is to have your cataract safely removed and the adjustable IOL implanted. The cataract removal and IOL implantation procedure are the same as if you selected a standard (non-adjustable) IOL.
After your eye heals, you return to have your vision tested. Based on this exam, you and Dr. Wong will select a custom prescription for your adjustable lens based on your own eyes and unique lifestyle requirements.
To receive the light treatment, you will be placed in front of the Light Delivery Device, which will non-invasively deliver UV light to your Light Adjustable Lens. This will modify the shape of the lens, and customize the focusing power.
A minimum of 2 light treatments—each lasting approximately 90 seconds are required. The total number of light treatments is based on the achievement of the desired vision outcome that you and Dr. Wong selected.
Once you have achieved your final optimal vision, the lens power is permanently locked in with a final light treatment to prevent any further changes.
The Light Adjustable Lens works by utilizing UV light rays to adjust the polymers within the optic of the lens, which creates customized vision targets after surgery. The cataract surgery itself is the same; the cataract is removed and replaced with a new intraocular lens. What makes the Light Adjustable Lens unique compared to other lens options is the polymer material within the lens. These photosensitive polymers allow us to imprint the residual refractive error into the lens, which will maximize clarity for either distance or near vision. This allows the lens to be adjusted after surgery to your vision goals for the clearest vision possible.
After traditional cataract surgery (with a standard intraocular lens), patients will likely wear glasses for many activities. With Light Adjustable Lenses, the prescription can be adjusted after the procedure to the patient’s desired vision goals. Once the eye is healed, a prescription measurement will be taken and imprinted into the lens with a proprietary light treatment. Over the course of a few sessions, patients can try different prescriptions and adjust their preference, before the final “lock-in” treatment. This ability to customize the lens power, test drive different vision types, and select a final vision after surgery was not possible before the advent of Light Adjustable Lenses.
In the weeks following surgery with the Light Adjustable Lens, patients will be provided UV-blocking glasses to protect the lens from sunlight. These are recommended to be worn during all waking hours until the last light treatment is complete. The patient and their doctor will work through a few light treatment sessions to achieve the desired visual outcome. The lens will be customized at each light session, which allows the patient to decide what prescription works best for them.
Generally, the initial light treatment will occur 2–3 weeks after the cataract surgery is complete. The follow-up light treatments are usually scheduled every 3 days after the first treatment, with most patients receiving a total of 2-4 light treatments. Once the desired prescription is achieved, the doctor will use a final light treatment to lock the lens, so its prescription never changes.
Since this technology incorporates both the pre-operative measurements of the eye and the post-operative healing into the final prescription, the need to delay and separate the surgery between the two eyes is less important. Many patients planning to have surgery in both eyes are offered the option of same-day bilateral cataract surgery, so both eyes can be adjusted with the light treatments simultaneously. Please discuss this with your surgeon to see if you are a candidate.
Yes, the Light Adjustable Lens can be a great option for patients who have been diagnosed with astigmatism. Most patients with less than three diopters of astigmatism would be excellent candidates for this lens. It is especially useful for patients with a previous history of LASIK surgery, as they have elevated expectations for excellent vision, and sometimes the ability to optimize vision with older cataract lens technology is limited in a post-LASIK eyeball as the LASIK surgery induces subtle changes in most corneas.
Wonderful vision! Patients with the Light Adjustable Lens can see distance to drive, read the dashboard of their car, and then pick up items in the grocery store to read the labels. While patients may prefer a light pair of reading glasses when reading very fine print, most daily activities will be free of glasses or contacts for Light Adjustable Lens patients. In addition, this technology does not use trifocal rings to generate sweet spots in the vision, so the Light Adjustable Lens has minimal risk of post-surgical glare and halos.
A great candidate is anyone wanting the widest range of functional vision with the least amount of glare and halos after surgery. Many LASIK patients who are told they are not great candidates for Trifocal Lens Technologies, or other Advanced Package Technologies, may be candidates for a Light Adjustable Lens, as it can compensate for some LASIK-induced changes created in the cornea during LASIK surgery.
In 2012, Dr. Jeff Wong became one of the first surgeons in Hawaii to perform FDA-approved CATALYS Laser Cataract Surgery. This is a revolutionary technology that provides a gentle, highly customized cataract procedure with precision not achievable with traditional manual techniques.
CATALYS is an FDA-approved state-of-the-art laser with advanced 3D imaging, that has taken cataract surgery to the next level. With unparalleled precision, it creates incisions without damaging the healthy surrounding tissue. Laser surgery is gentler than manual cataract surgery and results in a less-invasive, safer cataract procedure.
Every eye has a unique size and shape. CATALYS’ advanced 3D imaging technology builds a 3D map of each eye and tailors the treatment to that map. This enables Dr. Wong to create a customized treatment plan that matches the uniqueness of each eye.
Next, Dr. Wong uses CATALYS to create a circular opening for accessing and removing the cataract. Clinical studies have shown that this opening is approximately 10 times more accurate when performed with CATALYS than what is achievable by hand.1,2 CATALYS then softens and breaks up the hard cataract into tiny pieces, allowing for gentler, easier cataract removal.3
Depending on the patient’s pre-operative vision and desired visual result, Dr. Wong may recommend a tailored treatment plan that could include creating ultra-precise laser incisions in the cornea and a specific clear lens type, such as a multi-focal lens. This tailored treatment may reduce a patient’s need for glasses or contacts after surgery.
“Dr. Jeffrey Wong performed cataract surgery on my left eye in 2011, using a special toric intraocular lens which corrected all of my astigmatism in that eye. Without glasses, my left eye can see 20/20, unaided! The entire experience of having cataract surgery with Dr. Wong, from the first consultation to the post operative follow up exam was one I wholeheartedly recommend as everything was first class!”
Dr. Wong offers the most advanced options to customize your vision after cataract surgery, based on your individual lifestyle needs. We hope that the following information will help you understand the different options available to you.
Dr. Wong will help you decide on the type of lens implant that will replace your cataract. There are lenses available to treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Lens implants usually provide either near or distance vision: these single focus lenses are called monofocal IOLs. Some newer lens implants can provide for near, intermediate, and distance vision: these multiple focus lenses are called Multifocal IOLs. Lens implants that treat astigmatism are called Toric IOLs. You can also have one eye corrected for near vision, and the other for distance vision, a choice called monovision.
Patients who have cataracts have, or will eventually develop presbyopia, which is a condition caused by aging that develops when your eye loses its ability to shift from distance to near vision. Presbyopia is the reason that reading glasses become necessary, typically after age 40, even for people who have excellent distance and near vision without glasses. Presbyopic individuals require bifocals or separate (different prescription) reading glasses in order to see clearly at close range. There are several options available to you to achieve distance and near vision after cataract surgery. This is probably the most important decision you need to make about your cataract surgery, so please take the time to review your options and ask questions.
GLASSES. You can choose to have a monofocal (single focus) lens implant for distance vision and wear separate reading glasses, or have the lens implant for near vision and wear separate glasses for distance.
MONOVISION. Dr. Wong could place lens implants with two different powers, one for near vision in one eye, and one for distance vision in the other eye. This combination of a distance eye and a reading eye is called monovision. It can allow you to read without glasses. Many patients who wear contacts or who have had refractive surgery have monovision and are happy with it. Dr. Wong may discuss and demonstrate this option to see if it might work for you.
MULTIFOCAL IOL. Dr. Wong could implant a “Multifocal” IOL. This is a newer, “deluxe” type of lens implant that provides distance vision AND restores some or all of your eye’s ability to focus. It corrects for both distance vision and other ranges, such as near or intermediate. Choosing this option will usually lead to higher out-of-pocket expenses since most insurance companies only pay for a monofocal (single focus) lens.
FDA-approved in 2005, the ReSTOR lens is “apodized”, giving good distance and good near vision without glasses. Some patients may experience night time halos around lights, which typically becomes less of an issue with the passage of time. The ActiveFocus is a newer version FDA-approved in 2017, and provides better distance and intermediate vision without glasses, and can also correct astigmatism with its toric version.
Tecnis Multifocal lenses have been FDA-approved since 2009. This lens provides vision correction at multiple distances under low, medium and brightly lighted conditions. Over 90% of patients with a goal to be independent from glasses or contact lenses report that they have achieved their goal.
TECNIS® Symfony IOL is the first in a new category of intraocular lenses that provide a full range of continuous high-quality vision following cataract surgery, while also minimizing the effects of presbyopia by helping people focus on near objects. This highly advanced IOL approved by the FDA in 2016, is designed to allow excellent vision at all distances – near, intermediate and far. With the Tecnis Symfony IOL, there is no worry of choosing one distance for the other. The FDA approval includes a version of the lens for patients with astigmatism, the Tecnis Symfony Toric IOL.
Patients with nearsightedness and farsightedness often also have astigmatism. Astigmatism is caused by an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. In addition to Toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI), which can be done at the same time as the cataract operation, or as a separate procedure. A limbal relaxing incision (LRI) is a small cut or incision the ophthalmologist makes into your cornea to make its shape rounder. Any attempt at astigmatism reduction could result in over- or under-correction, in which case glasses, contact lenses, or another procedure may be needed.
This lens is used for the majority of patients. It gives excellent quality of vision but it has a fixed focal distance. This means that you will need eyeglasses to correct your full range of vision after surgery. If your preference is to have your best vision without glasses for far vision, then you will need glasses for most near-vision activities after surgery, even if you do not wear near vision glasses now. These activities include reading, applying makeup, shaving, sewing, reading your watch and dialing a cell phone. If your preference is to have your best vision without glasses for near vision activities, then you will need glasses for far vision activities, such as watching T.V. and driving. The focal distance preferred is a personal decision based on which types of activities you would most like to perform with reduced dependence on eyeglasses. If cataract surgery is needed for only one eye, some patients may prefer to wear glasses for all focal distances in order to maintain balance with the unoperated fellow eye. The monofocal implant is best suited for people who do not mind wearing glasses or people who have certain eye diseases that may limit their vision after surgery. Medicare and most private insurers will pay for the cataract surgery and the cost of this implant.
The following are options that are considered premium surgical options. Medicare and commercial insurance carriers will pay for the cost of the surgery but the cost of premium implants and surgical techniques for astigmatism are not covered by insurance.
A toric implant reduces astigmatism and can help provide either good far vision or near vision without glasses; but not both. Astigmatism is a common irregularity of the front surface of the eye (cornea) that creates a blurred image. If you would like to maximize your uncorrected vision after cataract surgery, a toric implant can be used to reduce astigmatism. Incisions in the cornea (LRIs) can also be performed at the time of surgery and represent another option to treat astigmatism.
References
1 Friedman, NJ, et al., “Femtosecond Laser Capsulotomy,” Journal of Cataract & Refractive Surgery, 2011 July; 37(7): 1189-1198
2 Palanker, D., et al., “Femtosecond Laser-Assisted Cataract Surgery with Integrated Optical Coherence Tomography,” Science Translational Medicine, Vol 2 Issue 58: 1-9 (2010)
3 Burkhard HD., “The synergy of MICS and femtosecond lasers: The future of small incision cataract surgery” Ophthalmology Times Europe, 2012 April; Vol 8 Issue 3
4 Burkhard HD., “Femtosecond cataract surgery outcomes: an advance or not?” Proceedings from the XXX Congress of the European Society of Cataract and Refractive Surgery in Milan, Italy. September 2012.