Clinical And Refractive Outcomes Of The Light Adjustable Lens In A Tertiary Referral Practice

Published 2026 - 44th Congress of the ESCRS

Reference: PP15.09 | Type: Free paper | DOI: 10.82333/h6rf-tr76

Authors: Dr Nathamon Sasiprapha* ¹ , Ms Dana Toameh ² , A/Prof. Gregory Moloney ³

¹Ophthalmology and Visual Science,University of British Columbia,Vancouver,Canada;Ophthalmology,Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy,Bangkok,Thailand, ²Faculty of Medicine,McGill University,Montreal,Canada, ³Ophthalmology and Visual Science,University of British Columbia,Vancouver,Canada

Purpose

Cataract surgery has evolved into a refractive procedure demanding high postoperative precision. Despite advances in optical biometry and intraocular lens (IOL) calculation formulas, refractive predictability remains challenging, particularly in eyes with prior corneal refractive surgery and extreme axial lengths. The Light Adjustable Lens (LAL; RxSight Inc.) enables postoperative adjustment of spherical and astigmatic power, offering individualized refractive optimization. This study evaluates the real-world refractive accuracy, visual outcomes, and patient satisfaction following LAL implantation in a tertiary referral practice.

Setting

Single private ophthalmology tertiary referral practice

Methods

This retrospective, consecutive case series included 145 eyes of 93 patients implanted with the first-generation LAL between November 2023 and January 2026. The study evaluated eyes without prior refractive surgery and those with a history of radial keratotomy (RK), photorefractive keratectomy (PRK), or LASIK. Postoperative light adjustments (up to three treatments and two lock-ins) were initiated following refractive stabilization. Primary outcomes included the proportion of eyes within ±0.50 D and ±1.00 D of the refractive target, uncorrected distance visual acuity (UDVA), and residual cylinder. Outcomes were stratified by prior refractive history and intended target. Patient-reported outcomes were assessed using the PDQ-6 questionnaire.

Results

Overall, 95.9% (139/145) of eyes achieved a spherical equivalent within ±0.50 D of the target, and 98.6% (143/145) were within ±1.00 D. Refractive accuracy (±0.50 D) was high in both eyes without prior refractive surgery (97.2%; 70/72) and post-laser refractive surgery eyes (96.9%; 62/64), but was lower in eyes with prior RK (77.8%; 7/9). Among eyes targeted for emmetropia (n=68), 93.0% achieved a UDVA of ≥20/25, and 66.3% achieved ≥20/20. Postoperative residual cylinder of ≤0.50 D was observed in 91.0% (132/145) of eyes. The mean number of adjustments was 1.89 ± 1.0 per eye, with no loss of corrected distance visual acuity (CDVA) reported. PDQ-6 scores indicated minimal dysphotopsia and high overall satisfaction (mean score: 8.9/10).

Conclusions

In this real-world clinical series, the LAL demonstrated reliable refractive predictability and a favorable safety profile across diverse cataract populations, including eyes with prior laser refractive surgery. Although clinical outcomes were acceptable in post-RK eyes, refractive predictability was lower compared to other groups. The substantial proportion of eyes achieving their refractive target, combined with low residual astigmatism, corresponded with good uncorrected visual acuity and positive patient satisfaction, with minimal dysphotopic symptoms.