Winter 2026 distributed quarterly to 2900 optometric physicians
Ami Halvorson, OD
PCLI—Portland, OR
From the EDITOR As more cataract patients expect LASIK-like results, the ability to fine-tune vision after surgery is increasingly valuable. In this issue, Debi Patch shares case studies showing how the Light Adjustable Lens enables us to tailor outcomes through collaboration with patients. She also emphasizes the importance of setting expectations, choosing suitable candidates, and engaging them as active partners in achieving their best vision.
By Debi Patch, OD | PCLI—Bellevue, wa
Light Adjustable
Case Studies
Today’s cataract patients often approach surgery with expectations similar to those of refractive surgery—assuming they will no longer need glasses. While advances in IOL technology have improved accuracy, residual refractive error remains common, and most patients without a presbyopia-correcting IOL continue to require reading glasses.
The Light Adjustable Lens changes that equation, especially for patients seeking a solution that provides both precision and flexibility in visual outcomes. By allowing post-operative adjustments, this lens provides a truly customized result.
Customized Vision
The Light Adjustable Lens (LAL) by RxSight, FDA-approved in 2017, is the first and only IOL that can be customized after implantation. Following surgery, we use a computer-controlled ultraviolet light to activate photosensitive macromers within the lens to reshape it and fine-tune the refractive outcome.
Vision Test-drives
After healing, patients can “test-drive” their vision through a series of light treatments over several weeks. Each adjustment brings them closer to their preferred outcome, followed by a final “lock-in” treatment that permanently stabilizes the lens.
Patient Selection
Careful selection is critical. Contraindications include ocular herpes, macular disease, and poor pupil dilation. Candidates must be committed to multiple visits, staying actively engaged, and wearing UV-blocking eyewear throughout the process.
Three Case Studies
The following cases illustrate how the LAL’s flexibility enabled us to tailor outcomes to meet specific needs for several of my patients.
Lens:
CASE 1
Post-RK
A 58-year-old male was referred for bilateral cataract surgery with plano targets. He had undergone RK in the 1990s and wore glasses for both distance and near.
Because of his irregular astigmatism, presbyopia-correcting and toric IOLs were not recommended. Options included a monofocal IOL or the LAL; he elected LALs. Given the diurnal fluctuations common after RK, I advised scheduling light treatments at his “best” time of day. I counseled that he might still need light distance correction if the fluctuation persisted.
Pre-op Pentacam showed central flattening and irregular astigmatism.
POST-OP FINDINGS:
Day 1 Post-op
Week 1 Post-op
First Tx
Second Tx
Third Tx
Final Lock-in
OD VA sc
OD VA cc
OD Rx
20/60-2
20/30-2
+3.00-2.25x061
20/50
20/20-2
+0.50-1.50x072
20/100
20/20
plo-1.50x085
20/30+1
20/20-1
+0.75-1.00x110
20/30+1
20/20
+1.25-0.75x097
20/25-1
20/20
plo-0.75x125
OS VA sc
OS VA cc
OS Rx
20/40-2
20/40-2
+1.00-1.00x113
20/30
20/20-2
plo-0.75x083
20/50+1
20/20
plo-1.25x100
20/25+1
20/20
+0.25 sph
MY TAKE-AWAY:
Complex corneas once destined for glasses can benefit from LALs. Emphasize patience, as RK eyes often stabilize slowly, and set realistic expectations about residual fluctuations.
CASE 2
High astigmatism
A 65-year-old female presented for a second opinion for cataract surgery. She had prior LASIK OU (2000) and was motivated to reduce her dependence on distance glasses. Her topography was relatively regular. Because the option of a single focus IOL OD and toric IOL OS could result in a refractive surprise due to her prior LASIK history, the patient chose the LAL.
Since RxSight reports correction up to 2D of astigmatism, I counseled that her left eye’s cylinder exceeded that range. It would be improved, but complete elimination was unlikely.
Pre-op Pentacam showed central flattening OS consistent with myopic LASIK and astigmatism.
POST-OP FINDINGS:
Day 1 Post-op
Week 1 Post-op
First Tx
Second Tx
Third Tx
Final Lock-in
OD VA sc
OD VA cc
OD Rx
20/25
20/20-1
+0.25-1.25x056
20/25
20/16
plo-1.00x083
20/30-2
20/20
+0.50-1.00x085
20/16-2
20/16
+0.25-0.25x175
OS VA sc
OS VA cc
OS Rx
20/400
20/40+2
+1.50-4.75x046
20/80
20/16
+1.25-4.00x046
20/60-2
20/20
+1.00-3.75x046
20/40
20/20
plo-2.00x045
20/30+1
20/15-2
+0.50-1.00x052
20/25+1
20/16
+0.25-1.00x052
MY TAKE-AWAY:
The outcome exceeded expectations. This patient was asymptomatic from residual astigmatism and reported equal vision in both eyes. Underselling the likely result made the final success more rewarding.
CASE 3
Avoiding IOL Exchange
Pre-op Pentacam showed central flattening, although surprisingly regular given multiple corneal procedures.
A 74-year-old male was referred for cataract surgery OS with a history of PRK OU, two enhancements OU, and thermal keratoplasty OU. He had cataract surgery OD in 2015 with a hyperopic refractive surprise that required an IOL exchange. This unfortunate experience delayed his OS surgery nearly a decade. Given the high risk of another refractive surprise, he opted for the LAL.
POST-OP FINDINGS:
OD VA sc
OD VA cc
OD Rx
Day 1 Post-op
20/50-2
20/25-2
+1.25-0.75x164
Week 1 Post-op
20/50+2
20/25
+1.00-0.75x151
First Tx
20/25-2
20/25+2
+1.00-0.75x143
Final Lock-in
20/20-2
20/16
plano sph
MY TAKE-AWAY:
After delaying surgery for years, this patient valued having some control over the adjustments and was delighted with the outcome.
ABOUT THE AUTHOR
Debi Patch
PCLI BELLEVUE, WA
Friendly, compassionate and relatable, Debi Patch has a quick wit, engaging personality, and a caring heart. Born in Maryland, Debi grew up in southern California. Outside of work, she enjoys reading, crosswording, baking sourdough bread and studying the science behind all things culinary. She also loves to travel and explore new places. Debi and her husband, Sean, a teacher, live in Bellevue, Washington. They have a daughter and son—Zoe and Charlie.
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Pearls I Have Learned
Working with the LAL has reinforced several important lessons:
- Set expectations early — Patients value realistic discussions about what the LAL can and cannot deliver.
- Avoid overpromising — Even with post-op flexibility, results aren’t always perfect.
- Plan for delays — Healing, weather, or vacations can push back light adjustments.
- Don’t assume cost is a barrier — Many patients are willing to invest in better vision.
Conclusion
As these cases illustrate, the LAL represents a meaningful step forward in refractive cataract surgery. For patients with complex corneas, prior refractive surgery, or those simply seeking the best possible uncorrected vision, it offers an opportunity to fine-tune outcomes that once depended solely on pre-operative calculations.
The LAL is currently available at these PCLI locations: Anchorage, Bellingham, Bellevue, Tacoma, Chehalis, and Portland.
LAL patient and professional education resources are available in our materials catalog at odpcli.com.
Questions If you have questions, feel free to contact any of our optometric physicians. We’re always happy to help.