Visual And Refractive Outcomes Of Glaucoma Patients Undergoing Cataract Surgery With Light Adjustable Lens Implantation

It is estimated that 7% of patients undergoing cataract surgery have glaucoma. With increasing expectations for spectacle independence, advanced technology IOLs (ATIOL) have been increasingly adopted. Despite their benefits, many exercise caution in implanting ATIOL in glaucoma patients due to concerns about contrast sensitivity loss, glares, haloes, effect on visual field tests and optical effects on OCT.

The light adjustable lens (LAL) is a non-diffractive IOL with the unique ability to adjust the postop refraction to meet the patient’s visual goals. It could be the ideal ATIOL for patients with ocular comorbidity.

This paper reports visual and refractive outcomes of glaucoma patients that underwent cataract surgery with LAL implantation.

High-volume, private-practice in Canada, with an ethnically diverse patient population.

After receiving approval from the Research Ethics Board, a retrospective collection of clinical data was conducted. Patients with a diagnosis of any form of glaucoma who underwent lens surgery and implantation of LAL, and had complete post-operative data were included.

Data collected were: ocular history, biometry, VA (uncorrected, corrected, distance, near, monocular, binocular) after implantation (before adjustments) and after adjustments, manifest refraction before and after adjustments.

54 patients were included in the analysis. 45 patients had bilateral surgery and 9 had unilateral, total of 99 eyes. 24 patients were targeted for blended vision. 29 eyes were targeted for distance vision.

60.9% and 92.9% of eyes were within 0.5D of target MRSE before and after adjustment. K Cyl was ≤0.5D in 39.3% of eyes preop. MR Cyl was ≤0.5D in 41.4% of eyes before adjustment and 91.9% after adjustment. 33.3% and 82.8% of distance eyes had UDVA 20/20 or better before and after adjustment, respectively. 16.9% and 75.0% of near eyes had UDVA 20/40 (J3) or better before and after adjustment, respectively.

Among patients targeted for blended vision, 100% had 20/20 UDVA and 91.3% had 20/40 UNVA.

The LAL demonstrated improvement in refractive and visual outcomes after adjustments. Its non-multifocal optic makes it ideal for patients with glaucoma and other ocular comorbidities (e.g. macula) that may compromise vision. Its approach for presbyopia mitigation through blended vision and refractive customization is a separation from other presbyopia correcting IOLs, but nonetheless effective in delivering excellent uncorrected distance and near VA.