Monovision With the Light Adjustable Lens for Presbyopia ... - Iogen

TAKE-HOME MESSAGE
• Photosensitive macromers in the LAL are distributed
through the lens and are polymerized when they are
irradiated with UV light.
• Diffussion of the remaining, unirradiated macromers induces
a change in the lens shape, the refractive index, or both.
• Patients can be adjusted to emmetropia in both eyes if
they do not tolerate monovision.
lens matrix. Diffusion of the remaining, unirradiated
macromers into the irradiated areas induces a change in
the lens shape or refractive index, or both, to produce a
predictable power change. Every adjustment procedure
allows 2.00 D correction of myopia, hyperopia, and astigmatism.
It is important that all photoreactive macromers
are polymerized, and every patient has to undergo two
lock-in procedures (Figure 1).
The LAL may be used during cataract surgery or for
refractive lens exchange. Currently for monovision, the
correction in the dominant eye is aimed for distance
emmetropia; the other eye is aimed for -1.00 D. Two
weeks after surgery, we evaluate patient satisfaction. If
the patient is doing well with monovision, the correction
is locked in. If the patient does not tolerate monovision,
he is adjusted for emmetropia.
CASE REPORT
A 58-year-old patient presented with cataract and a
preoperative refraction of -5.00 -0.50 X 170° and
-5.25 -0.75 X 18° in the right and left eyes, respectively.
The LAL was implanted bilaterally; the right was targeted
for emmetropia and the left for -1.00 D. Two weeks after
surgery, his far UCVA was 1.0 in the right eye and 0.6 in
the left. Near visual acuity was J2. We discussed the possibility
of more or less myopia in his left eye; however, he
was satisfied with the far and near visual acuities.
Therefore, we locked in both eyes.
CONCLUSION
Monovision, with the use of this technology, provides a
good refractive and visual outcome. The LAL may be able
to provide a multifocal correction in the future; however,
this is not yet possible. In my opinion, use of this technology
will be important for the correction of presbyopia
because it provides a perfect distance refraction. ■
Christoph Winkler von Mohrenfels, MD, is a surgeon at
Technical University, Munich, Germany. Dr. Winkler von
Mohrenfels states that he has no financial interest in the
products or companies mentioned. He may be reached at
e-mail: christoph.wvm@web.de.