Restoring Refractive Predictability In Challenging Corneas Using The Light Adjustable Lens

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT574 | Type: Poster | DOI: 10.82333/d5wv-0z41

Authors: Dr Florence Valcourt ¹ , Dr Mazen Choulakian* ¹

¹Ophtalmologie,Université de Sherbrooke,Sherbrooke,Canada

Purpose

Refractive surgery has gained popularity alongside the evolution of technologies that make it safer and more predictable. However, the resulting corneal changes complicate accurate lens power calculation. This study aimed to evaluate visual and refractive outcomes after light adjustable lens (LAL) implantation in patients with atypical corneal tomographic profiles. The primary outcome was to compare the final postoperative refraction with the predicted refractive target. Secondary outcomes included uncorrected distance, intermediate and near visual acuity, and the number of treatments required to achieve the targeted refraction.

Setting

This retrospective study was conducted at a refractive surgery center in Sherbrooke, Québec, Canada.

Methods

Retrospective single-center cohort study of all patients who underwent LAL implantation between December 2023 and August 2025 were included. All surgeries were performed using the RxSIGHT LAL with a standard phacoemulsification technique using the femtosecond Catalys laser. Final outcome data, including subjective refraction and uncorrected visual acuity, were collected at least 5 weeks after the second lock-in treatment. Patients without available postoperative measurements were included in the secondary outcome analysis only.

Results

A total of 81 eyes from 41 patients (mean age 65.8±8.1 years) were analyzed. Q values were outside normal limits in 60.5% (mean –0.06±0.41), and mean Km was 42.38±2.15 D. Prior refractive surgery was positive for 43.2% of eyes. Mean absolute error between predicted and final refractive error was 0.23±0.25 D (spherical equivalent). Overall, 42.3% of eyes were within 0.25 D of target, and 28.2% achieved exact emmetropia; no deviation exceeded 0.88 D. Uncorrected distance and intermediate visual acuity reached 20/20 or better in 80.8% and 76.2%, while 91.3% achieved near acuity of J2 or better. Mean treatments numbered 1.96±0.73, with no significant difference between virgin and post-refractive corneas.

Conclusions

LAL implantation demonstrates high refractive accuracy and excellent uncorrected visual outcomes in eyes with corneal topographic features that reduce refractive predictability. The monovision strategy allows these patients to gain independence from glasses, which may be less predictable or carry higher refractive risk with other types of lenses. This approach appears to be a reliable alternative for optimizing refractive outcomes in irregular corneas.