Grab Your Darts: A New Era in Cataract Surgery
Imagine standing behind the oche in the last round of a dart tournament, and you need to throw a ton 80 (three treble 20) to win, whilst your opponent sits confidently knowing this is nearly impossible. You approach with fearless abandon and hurl three darts as recklessly as a child with a fork full of spaghetti. Seems foolish, but what no one knows is that you get to grab your darts and place them wherever you want after the toss. Match over, you are victorious!
There are very few endeavors in life where we get a do-over, and cataract surgery is not any different, yet the Light Adjustable Lens (LAL) gives us a chance to improve our excellent results even more.
Most current intraocular lens implants (IOL) are made of acrylic or silicone, an inert plastic or polymer. We have extremely sophisticated pre-operative calculations that give excellent outcomes with these IOLs. However, there are many factors that can introduce variations in the final refractive error. This can affect the level of best uncorrected visual acuity (UCVA). These concerns are rendered moot with the LAL.
The LAL composition is different – it contains a silicone elastomer that has light-sensitive macromers embedded within the implant. A light source is used after surgery, which allows the macromers to polymerize and subsequently change the refractive power of the implant to any desired outcome. Grab your darts and move them where you want.
I’ve been thrilled to add this IOL option for my patients, but as with all IOLs, proper patient selection and communication are vital. I also tell them I can’t “un-age” your eye, so if they tell me they are expecting 25-year-old fighter pilot vision, I haven’t done my job of communicating properly. In the absence of other eye pathology that may affect vision, I feel confident telling my patients they will have outstanding vision after surgery.
Like Ponce de Leon, we continue to search for the fountain of youth and fall short, but with each technological leap, our fingers get a little closer.
