Seeking Personalised Vision

Adjustable IOL technology may offer a shift towards personalised medicine, especially in avoiding refractive surprise, according to H Burkhard Dick MD, PhD.

Despite the optimisation of biometry across formulas and AI support, residual refractive error remains a problem for many patients. According to Professor Dick, the predictive models are excellent, but many other aspects come into play, such as technical, biological, procedural, and mechanical issues. Adjustable IOL technology is a response to the increasing number of post-keratorefractive eyes seeking freedom from spectacles and to the low tolerability of postoperative refractive errors.

“I think we are about to have a paradigm shift,” Prof Dick said. “The old model was measure, calculate, implant, and hope. Over the next few years, the new model will be measure, implant, heal, adjust, and personalise.”

There are different modalities: IOLs requiring secondary procedures for power adjustment, those that do not require it, and, finally, noninvasive IOL power adjustment.

The multicomponent approach includes platform support, making the IOL easily exchangeable. Early results from 12-month follow-up data are promising, and, as Prof Dick noted, these lenses are useful when secondary IOL intervention is more likely, such as in paediatric patients, progressive corneal pathologies, toric IOLs in high myopes, and in eyes requiring tamponade agents during vitreoretinal surgery.

The mechanically adjustable lenses contain springs activated by heating with a green continuous laser (e.g., argon), enhancing the anterior and posterior movement of the optic or facilitating rotation. Human trials have just started for this technology.

Noninvasive IOL power adjustment approaches, such as laser-induced refractive index change (LIRIC) with a femtosecond laser, are driven by multiphoton absorption of ultrashort laser pulses and can be performed intracorneally and in the lens material. Multiphoton absorption enables local modification of the refractive index. In RIS (Perfect Lens), light (520 nm low-energy laser) breaks ester molecules within the polymeric material and creates polar hydrophilic molecules within the IOL. Another project by the University Eye Hospital of Bochum and Schwind Eye Tech Solutions, supported by the German Ministry of Education and Research, demonstrated good first results in the cornea.

As for light-adjustable lens technology, Prof Dick has 17 years of experience, with 3,000 light-adjustable lenses implanted in various conditions, demonstrating long-term stability. What patients really appreciate about this lens, according to Prof Dick, is the ability to adjust their vision postoperatively with a precision of 0.25 D, ideally for minimonovision. These lenses offer new presbyopia solutions, including individually adjustable monovision and simultaneous vision profiles, as well as negative asphericity.

Light Adjustable Lens 2.0 (RxSight) has good results, with intermediate vision of 20/30 or better in more than 90% of patients and particularly good uncorrected near vision acuity. They are safe and of high quality, offer a wide range of vision solutions, and have no photic phenomena. Gaining momentum in Europe, the Light Adjustable Lens 2.0 is already successful in the US and Canada.

“I think the future lies in personalised medicine,” Prof Dick concluded.

Prof Dick spoke at the 2026 ESCRS Winter Meeting in Helsinki.

H Burkhard Dick MD, PhD, FEBOS-CR is professor and chairman of the Ruhr University Eye Hospital in Bochum, Germany, and ESCRS president. dickburkhard@aol.com