Light Adjustable Lens: Your Guide to Recovery and Customization

To be prepared for cataract surgery recovery, it helps to know what to expect. If you’ve chosen the Light Adjustable Lens (LAL) technology, you are taking advantage of the most advanced technology to personalize vision correction with your cataract surgery. 

The Light Adjustable Lens represents a significant advancement in cataract surgery, as it is the only adjustable intraocular lens that optimizes the patient’s vision after the lens is implanted. Unlike traditional fixed intraocular lenses (IOLs), the LAL can be customized after surgery to address your specific vision needs. This remarkable outcome is possible because LALs are made from a special photoreactive material that, when exposed to specialized UV light, changes the shape of the lenses after cataract surgery. 

The surgery is just the first step. Here is what you can expect during the recovery and adjustment process.

Phase 1: Recovering From Surgery

Immediately after surgery, your vision will likely be blurry or hazy as your eye heals and the dilation drops wear off. You may feel some irritation. It is a normal part of the healing process. There will be a protective shield over your eye. That should stay in place until your follow-up appointment the next day.

Important UV Protection 

Following cataract surgery with Light Adjustable Lenses, it is very important that you shield your eyes from UV light (including sunlight). This means wearing protective glasses during all waking hours. You will be given three pairs of UV protective glasses: a clear pair for wearing indoors, a tinted pair to wear outside during the day, and a bifocal pair for reading and other near-vision tasks.

This protection is absolutely critical to your successful outcome. These lenses are designed to react to ultraviolet light to customize their ability to correct your vision. Exposing your eyes to UV light may cause changes to the lens and your vision. Unintentional UV exposure may make it impossible to properly adjust the Light Adjustable Lens with light treatments. Bottom line: you need to protect your eyes from UV light throughout the recovery and adjustment phase of your cataract surgery which can take several weeks.

During this period, you’ll also need to:

• Use prescribed eye drops to prevent infection and reduce inflammation
• Avoid activities that could harm your eye like heavy lifting, swimming, or rubbing your eye
• Attend your follow-up appointments to monitor healing

There are several variables with surgery. It’s important to discuss specific postop restrictions with your eyecare team. 

Collaborative Care 

Your recovery from cataract surgery and the Light Adjustable Lens adjustment process may involve both your ophthalmologist (who performed the surgery) and an optometrist (who may perform your light adjustments). Both types of eye care providers are highly skilled and certified to perform the light treatments. They – and you – are supported by a team of eye care professionals including technicians, surgical, and support staff.

While the surgical implantation of the lens is performed exclusively by an ophthalmologist, the post-surgical light adjustments may fall within the scope of practice for optometrists depending on your state’s regulations. Each state has different scope of practice laws for optometrists, which determine what procedures they are legally permitted to perform. In most states, optometrists can perform LAL adjustments, while in others, treatments must be performed by ophthalmologists.

When the LAL adjustments are within an optometrist’s scope of practice in your state, this collaborative approach can allow for flexible scheduling with specialized care throughout your treatment journey. Your eye care team will inform you about who will be performing your adjustments based on the expertise available in your area.

Phase 2: Vision Customization 

About 2-3 weeks after your cataract surgery with Light Adjustable Lenses, your eyes will have healed and you will be ready for your first light treatment. Importantly throughout the recovery phase you will be wearing UV protection throughout the day. 

The Adjustment Process

Your adjustment treatments will be performed by either an ophthalmologist or an optometrist (depending on your state’s scope of practice laws) who has received specialized training in using the Light Delivery Device (LDD). You will return to your eye care provider’s office, where your doctor will test your vision. Together, you will decide on the ideal vision outcome to suit your lifestyle, personal preferences, and goals before beginning light treatment.

Here’s what happens during a light adjustment appointment, which typically takes 60-90 minutes:

1. Pre-appointment preparation: Arrange for someone to drive you home, as your pupils will be quite dilated. You should also take some time to think about your vision and what specific activities you enjoy that are made that much better by not needing to wear glasses or contacts to see well. Having clear goals for your vision correction is important to achieving a great outcome with your Light Adjustable Lenses.
   
2. Vision assessment and goal setting: A technician will check your visual acuity and take a brief history. Then your eye care provider will perform a refraction and discuss the day’s treatment plan. This collaborative discussion is the time to share your vision goals in detail. Your input is what drives the adjustment process leading to your satisfaction with your results.
   
3. Trial lenses for vision simulation: If you’re considering blended vision (one eye for distance, one for near), your eye care team might have you wear special lenses temporarily to simulate this visual experience before committing to that approach.
   
4. Dilation process: Eye drops will be used to dilate your pupils. The drops can take up to an hour to take full effect. This is a necessary step for the treatment.
   
5. Light treatment: You will be placed in front of the Light Delivery Device (LDD), which will deliver the UV light to your LAL and allow the doctor to adjust your vision. Treatment lasts up to two minutes and is painless and non-invasive.

During the treatment, you’ll be instructed to focus on a green blinking light. Fixating on this light is important. Your provider will talk you through the treatment. While it only lasts for 90 seconds, if you need a break, let them know—your comfort is important.

What to Expect After Light Treatments

Your eye care team should function as your partner guiding you through this process and setting appropriate expectations:

• Vision changes aren’t immediate – It can take 12-48 hours following an adjustment for your vision to fully change. 
• Dry eye symptoms are common – Many patients experience dry, gritty eyes and light sensitivity after the UV light treatments. Use all prescribed drops and artificial tears as directed to help manage these symptoms and keep you comfortable.
• What to watch out for – Pain that lingers past the day of adjustment, dramatic unintended vision shifts, severe redness, discharge or significant visual disturbances warrant a call to your doctor.
• Brain adjustment is part of the process – Especially if you’re getting blended vision, your brain needs time to adapt. Your provider may recommend “homework” like trying to read without reading glasses to help your brain adapt.
• Don’t compare eyes – If you’re having both eyes treated, avoid comparing them. They’re intended to work together as a team, not individually.
• Individual experiences vary – Avoid comparing your progress with others, as each person’s healing and adjustment process is unique.
• Pay attention to your vision – Try out your vision in different situations and environments – at home, at work, during your favorite activities. Make notes about what you like about your vision along with any struggles you are experiencing.
• Be patient with the process – it can take up to 3 light treatments over several weeks to reach your vision goals. Sometimes more time is warranted in between adjustments to ensure adaptation.
  

REMINDER: You need to continue to protect your eyes from exposure to UV light throughout the adjustment and lock in process. Wearing your UV glasses indoors and outdoors during daylight hours is important to protect the lenses and maintain their integrity for customization.

Treatment Schedule and Expectations

Most patients require between 3 to 5 total visits which includes 1 to 3 adjustments followed by two mandatory lock-in appointments to fine-tune their vision with Light Adjustable Lenses, with visits scheduled roughly 1-2 weeks apart. Your doctor won’t rush this process, as each adjustment should be purposeful and necessary to assess and refine your vision to your specifications.

Phase 3: Lock-in Treatments

Once your optimal vision is achieved, your doctor will lock the lens power permanently into place. You’ll receive two “lock-in” treatments that permanently fix your customized vision correction.

The lock-in treatments may appear brighter than previous treatments and may cause a temporary pink or red tint to your vision (called erythropsia). This is generally normal and typically fades within a few days. Once your ideal vision has been achieved and the lens power is permanently locked during your final light treatment, protective glasses will no longer be required.

The LAL system is designed for precision, however as with all surgical procedures and medical devices there are limitations:

• Each lens has a finite amount of light sensitive material (macromers), which limits the total correction possible.
  
• If vision isn’t as expected after all adjustments and lock-ins are complete, solutions may include glasses, additional procedures like LASIK, or (rarely) lens replacement.

Questions to Ask Your LDD Provider

Here are important questions to ask your eye care team:

Before Beginning Adjustments:

• What vision goals can we realistically achieve with my particular eye conditions?
• How many adjustment sessions will I likely need, and how far apart will they be scheduled?
• What activities should I avoid before and after treatments?
• If I’m considering blended vision, can we test it before committing to that option?

During the Adjustment Phase:

• Can we adjust my vision for specific activities I enjoy (like reading, computer work, or driving)?
• What compromises, if any, might we need to make?
• How will we know when we’ve achieved the best result?
• What should I do if I experience discomfort after a treatment?
• What can I do between appointments to help my brain adapt to my vision?

About the Lock-in Phase:

• How will I know when we’re ready for the lock-in treatments?
• Could my vision change in the future, and would I need glasses later?
• When can I stop wearing the UV-protective glasses?

After your final lock-in treatment and removal of your UV-protective glasses, you can fully enjoy your customized vision. The entire process from surgery to final lock-in is often completed within a couple of months.

The Light Adjustable Lens gives you the opportunity to preview and fine-tune your vision after cataract surgery. Maintaining open communication with your eye care team throughout this process is essential for achieving your best possible outcome.

Remember, achieving your vision goal is a collaborative process between your eye care team and you. Your active participation—following instructions, communicating your experience, and being patient with the process—is essential for success.