If you have been researching lens options before cataract surgery, you may have come across the Light Adjustable Lens, or LAL. Unlike a conventional intraocular lens, its focusing power can be adjusted after it has been implanted.
It is an innovative technology, and patients regularly ask us about it. In this article, we explain how the Light Adjustable Lens works, where it may offer an advantage and why Focus Vision does not currently provide it to our Brisbane patients.
Our aim is to offer a fair and accurate explanation.
What is a Light Adjustable Lens?
A Light Adjustable Lens is an intraocular lens made from a specialised photosensitive silicone material. Like other intraocular lenses, it replaces the eye’s cloudy natural lens during cataract surgery.
With a conventional intraocular lens, the appropriate lens power is selected before surgery using detailed measurements of the eye. This process is known as optical biometry.
With the Light Adjustable Lens, the initial lens power is still selected before surgery. However, after the eye has healed, the lens can be adjusted to refine the patient’s distance prescription and astigmatism.
Once the patient and surgeon are satisfied with the result, final light treatments permanently lock in the lens power.
How does the Light Adjustable Lens work?
The lens contains photosensitive molecules within its silicone material. After surgery, a dedicated Light Delivery Device applies a carefully controlled pattern of ultraviolet light to the lens.
This initiates a process within the lens material that changes its shape slightly, altering its focusing power.
Patients generally undergo one to three adjustment treatments, depending on their initial result and visual goals. These are followed by two final lock-in treatments. The complete adjustment process takes place over several weeks.
The attraction is easy to understand. Instead of relying entirely on measurements and calculations performed before surgery, the surgeon can refine the result after seeing how the eye has healed.
Who may benefit from a Light Adjustable Lens?
Postoperative adjustability may be particularly valuable when the result of conventional lens calculations is more difficult to predict (PMC11338023).
This can include people who have previously undergone:
These procedures change the shape of the cornea, which can make intraocular lens calculations less predictable.
Patients with specific visual targets or those who want to trial different focusing arrangements may also find the adjustment process appealing. The LAL can be adjusted to correct residual short-sightedness, long-sightedness and astigmatism within its approved treatment range.
For selected patients, this is a genuine and potentially valuable advantage.
Why doesn’t Focus Vision currently offer the Light Adjustable Lens?
Our decision is not a criticism of the lens or its manufacturer. The technology works, and published results have demonstrated good refractive accuracy in appropriately selected patients (FDA, 2017).
Our current position reflects how we balance the potential benefits against the additional treatment burden, limitations and alternatives available to our patients.
Several factors influence our decision.
1. Patients must follow strict UV-protection requirements
The same photosensitivity that allows the lens to be adjusted also means it must be protected from uncontrolled ultraviolet exposure until the treatment process is complete.
Patients must wear the manufacturer-supplied UV-protective glasses during all waking hours, both indoors and outdoors. They are generally required from the time of surgery until 24 hours after the final lock-in treatment (RxSight FAQ).
This period commonly lasts several weeks.
The glasses may be removed for sleeping, showering and washing the face, provided the patient is not exposed to direct sunlight. Otherwise, careful compliance is essential because unprotected UV exposure could cause an unintended change to the lens before it has been locked in.
This requirement can be inconvenient for anyone, but it may be particularly burdensome for Brisbane patients with active or outdoor lifestyles.
2. The process requires several additional appointments
A conventional cataract surgery pathway includes postoperative reviews, but the Light Adjustable Lens requires further visits for refraction, adjustment treatments and final lock-in treatments.
Depending on the number of adjustments required, patients may need three to five light-treatment appointments in addition to their usual surgical care.
This may be manageable for patients who live close to the clinic, but it can be more difficult for people travelling from regional Queensland, interstate or overseas.
The potential improvement needs to justify this additional commitment.
3. Modern lens calculations are already highly accurate
The problem the Light Adjustable Lens aims to address—an unexpected prescription after cataract surgery—has become less common as cataract technology has improved.
Modern optical biometry, corneal measurements and advanced calculation formulas such as Barrett Universal II and Kane provide excellent predictability in routine eyes.
No calculation method is perfect, and we are always upfront about that. Healing differences, corneal shape, previous surgery and other anatomical factors can still affect the final result.
However, for most routine cataract patients, careful measurements and appropriate lens selection allow us to achieve a result very close to the intended target without requiring postoperative lens adjustments.
4. Australia has an extensive range of toric lenses
Toric intraocular lenses are designed to correct regular corneal astigmatism during cataract surgery.
In Australia, we have access to a broad range of toric lenses, including monofocal, enhanced monofocal, extended depth of focus and multifocal options.
For appropriately selected patients, accurate measurements, modern toric calculations and careful lens positioning can correct astigmatism at the time of surgery.
A conventional toric lens cannot be adjusted after implantation, which remains an advantage of the LAL. However, many patients can achieve an excellent result without undergoing a prolonged postoperative adjustment process.
5. It does not provide the same near-vision range as a multifocal lens
The conventional Light Adjustable Lens is based on a monofocal optical platform. It does not contain the multiple focal zones used in multifocal or trifocal lenses.
The LAL can be used to create blended vision or monovision, where the two eyes are targeted slightly differently. For example, one eye may be adjusted primarily for distance while the other contributes more to intermediate or near vision.
This approach can reduce dependence on reading glasses for some patients, but it involves different compromises and does not provide the same type of binocular range as a multifocal or trifocal lens.
Many Focus Vision patients are interested in reducing their dependence on glasses across distance, intermediate and near vision. Depending on their eye health and visual priorities, an extended depth of focus, multifocal or trifocal lens may be more closely aligned with those goals.
What does Focus Vision recommend instead?
Our approach is to develop a personalised surgical plan before the procedure using:
- Detailed optical biometry
- Corneal topography and tomography where required
- Modern intraocular lens formulas
- Careful assessment of astigmatism
- A comprehensive range of monofocal, toric, enhanced monofocal, EDOF and multifocal lenses
- A detailed discussion about your lifestyle and visual priorities
There is no single “best” intraocular lens for every patient. The right lens depends on your eye health, corneal shape, prescription, occupation, hobbies, tolerance of visual side effects and how much you would like to reduce your dependence on glasses.
Our goal is to select the most appropriate lens and refractive target from the outset.
What if the result is not exactly as planned?
Even with excellent measurements and careful surgery, no surgeon or lens calculation can guarantee a particular refractive result.
If a small prescription remains after cataract surgery, it may not require any treatment. Some patients are comfortable using glasses for particular activities.
When further correction is appropriate, the available options may include:
- Prescription glasses
- Contact lenses
- Corneal laser vision correction
- An additional intraocular lens procedure
- Lens repositioning or exchange in selected cases
The right approach depends on the amount and type of residual prescription, the health of the eye and the patient’s visual needs. Not every patient will be suitable for laser enhancement or additional surgery.
When might adjustability still make sense?
We want to be fair to the technology. There are selected cases in which postoperative adjustability may have genuine value.
This may include eyes with previous LASIK, PRK or radial keratotomy, where preoperative lens calculations can be less predictable. It may also appeal to patients who value the ability to experience and refine their visual target after surgery and who are comfortable with the additional visits and UV precautions.
Focus Vision does not currently provide the Light Adjustable Lens, but we are happy to discuss the technology honestly. If we believe it may be particularly beneficial for an individual patient, we can discuss their options, including referral where appropriate.
Technology continues to evolve, and we will continue to reassess the platform as new lenses, clinical evidence and treatment protocols become available.
Choosing the right lens for your cataract surgery
Choosing an intraocular lens is one of the most important parts of planning cataract surgery. The right option depends on much more than the name or technology of the lens—it depends on your eyes, measurements, lifestyle and expectations.
At Focus Vision, we take the time to explain the available options, their potential benefits and their compromises so you can make an informed decision.
Book a consultation with Focus Vision in Brisbane to discuss cataract surgery and the lens option most appropriate for your vision.
References
- Therapeutic Goods Administration. Sponsor: MDSS AU Pty Ltd (ARTG entries, including RxSight Light Adjustable Lens and Light Delivery Device System). tga.gov.au/resources/sponsor/mdss-au-pty-ltd
- U.S. Food and Drug Administration. FDA approves first implanted lens that can be adjusted after cataract surgery to improve vision without eyeglasses in some patients. Press announcement, 2017. fda.gov
- U.S. Food and Drug Administration. Summary of Safety and Effectiveness Data, PMA P160055 (RxSight Light Adjustable Lens and Light Delivery Device). accessdata.fda.gov/cdrh_docs/pdf16/P160055B.pdf
- RxSight. Frequently Asked Questions - Light Adjustable Lens. rxsight.com/faq
- RxSight. UV-Protective Glasses: Best Practices and FAQs. rxsight.com/blog/uv-protective-glasses-faqs
- Clinical outcomes of the light-adjustable lens in eyes with a history of prior corneal refractive surgery. PMC11338023. pmc.ncbi.nlm.nih.gov/articles/PMC11338023