Co-Management

The Secret Behind Our Cataract Practice’s Growth & Patient Happiness

Allen, Kim, OD (far left as you look at photo) with his practice team. Dr. Kim says RxSight Light Adjustable Lens is a game-changer for patients and practices.

How optometrists are shaping cataract surgery outcomes

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By Allen Kim, OD

Dec. 18, 2024

Cataract and refractive surgery have opened exciting possibilities for vision correction, changing the way patients see—and live. But what if patients could take the next step and fine-tune their vision to their liking after surgery?

With the RxSight Light Adjustable Lens® they can. This breakthrough lens allows for precise, personalized adjustments, offering patients more control and satisfaction with their vision. Here’s how this cutting-edge technology is making a difference in our practice.

What is the Light Adjustable Lens(LAL™/LAL+®)?

The Light Adjustable Lens is an intraocular lens that allows for the customization of a patient’s refractive error after the surgery has taken place, once they experience life through restored vision.

The lens is crafted from a silicone material that responds to a precise UV light pattern based on the patient’s current and target refractions. By applying UV light via the RxSight Light Delivery Device™ (LDD™), we can alter the lens’s curvature, correcting refractive errors and tailoring the visual outcome to meet each patient’s unique goals. Adjustments can be made in 0.25 diopter increments, for detailed customization of both spherical and cylindrical corrections.

Specifically, the Light Adjustable Lens offers a spherical adjustment range of -2.00 to +2.00 diopters and a cylindrical adjustment range of 2 diopers for each adjustment. The Light Adjustable Lens can treat astigmatism as low as 0.5 diopters.

Patients undergo one to three adjustments, each spaced at least three days apart, with final adjustments “locked in” once optimal vision is achieved. Since patients are partnering with us to in the decision-making, they have a high likelihood of achieving vision that fits their lifestyle.

Driving Referrals to Both Optometrists and Ophthalmologists

Since first offering the Light Adjustable Lens as a premium IOL option in the summer of 2022, our center has seen an over 4x increase in patients choosing the Light Adjustable Lens. Most of this volume is driven by referring optometrists who often get inquiries from patients’ friends, family and co-workers who watched the patient go through the process and want the same experience.

Light Adjustable Lens technology stands out to patients for the personalized care it offers. Patients collaborate closely with our eyecare team through several sessions, ensuring that adjustments are made based on their unique visual needs and lifestyle preferences. Patients value the chair time and their active role in the process, which leads to greater confidence and satisfaction in achieving a vision outcome that is truly customized for them. This approach enhances how they see as well as their overall experience, translating to word-of-mouth referrals.

This presents a unique opportunity for referring physicians to strengthen their practice, as patients typically rely on their eyecare providers for trusted advice when considering options for vision restoration.

Guiding Patients Through the Decision-Making Process

The team at our practice, NVISION, expertly guides patients through the Light Adjustable Lens journey by getting to know how they use their eyes on a daily basis, what their immediate and long-term visual goals are, and understanding how the patient values their eyesight. As part of my role as an optometrist, I deliver the UV light treatments to help patients progress toward their desired outcomes.

Our staff members are provided with continuous support from RxSight representatives to help understand the technology and value behind the lens.

An Industry Partner You Can Count On

RxSight offers an expansive team of trainers, liaisons and technicians to ensure that every practice has all the training, educational materials and support they need to provide the best care for patients.

In addition, resources such as handouts, videos and continuing education are readily available online or through RxSight representatives for educating patients about the lens.

The next steps for success include broader education and exposure about the capabilities of this lens. It is still relatively new and unknown, so we’re still working on increasing recognition and understanding the value proposition of the Light Adjustable Lens for providers and patients alike.

This would come in the form of continuing education series, outreach with referring providers and students at optometry schools and social media coverage.

The Power of Word-of-Mouth

The power of word-of-mouth can’t be overstated. Patients frequently tell me about all their friends and family asking about how they’re doing throughout the process, and we are now seeing these friends and family come in for the Light Adjustable Lens themselves.

The results speak for themselves, but it wouldn’t be possible without a strong support team from RxSight to help train our doctors and staff to provide patients with everything they need throughout the process.

The folks at RxSight make the process easy and seamless, which translates into a smooth experience for the patient as well. Our patients remember this outstanding experience, return to us for care and refer many others.

Allen Kim, ODAllen Kim, OD, is the clinical director for the Oregon offices of NVISION, an OD-MD practice with locations across the U.S. To contact him: allen.kim@nvisioncenters.com

 

 

INDICATIONS FOR USE AND IMPORTANT SAFETY INFORMATION

INDICATIONS: The Light Adjustable Lens (LAL) and Light Delivery Device (LDD) system is indicated for the reduction of residual astigmatism to improve uncorrected visual acuity after removal of the cataractous natural lens by phacoemulsification and implantation of the intraocular lens in the capsular bag in adult patients with preexisting corneal astigmatism of ≥ 0.75 diopters and without preexisting macular disease. The system also reduces the likelihood of clinically significant residual spherical refractive errors. CONTRAINDICATIONS: The Light Adjustable Lens is contraindicated in patients who are taking systemic medication that may increase sensitivity to ultraviolet (UV) light as the LDD treatment may lead to irreversible phototoxic damage to the eye; patients who are taking a systemic medication that is considered toxic to the retina (e.g., tamoxifen) as they may be at increased risk of retinal damage during LDD treatment; patients with a history of ocular herpes simplex virus due to the potential for reactivation from exposure to UV light; patients with nystagmus as they may not be able to maintain steady fixation during LDD treatment; and patients who are unwilling to comply with the postoperative regimen for adjustment and lock-in treatments and wearing of UV protective eyewear. WARNINGS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting an IOL in a patient with any of the conditions described in the Light Adjustable Lens and LDD Professional Use Information document. Caution should be used in patients with eyes unable to dilate to a pupil diameter of ≥ 7 mm to ensure that the edge of the Light Adjustable Lens can be visualized during LDD light treatments; patients who the doctor believes will be unable to maintain steady fixation that is necessary for centration of the LDD light treatment; patients with sufficiently dense cataracts that preclude examination of the macula as patients with preexisting macular disease may be at increased risk for macular disease progression; and patients at high risk for future vitreoretinal disease that may require silicone oil as part of therapy. The Light Adjustable Lens must be implanted in the correct orientation with the back layer facing posteriorly. PRECAUTIONS: The long-term effect on vision due to exposure to UV light that causes erythropsia (after LDD treatment) has not been determined. The implanted Light Adjustable Lens MUST undergo a minimum of 2 LDD treatments (1 adjustment procedure plus 1 lock-in treatment) beginning at least 17-21 days post-implantation. All clinical study outcomes were obtained using LDD power adjustments targeted to emmetropia post LDD treatments. The safety and performance of targeting to myopic or hyperopic outcomes have not been evaluated. The safety and effectiveness of the Light Adjustable Lens and LDD have not been substantiated in patients with preexisting ocular conditions and intraoperative complications. Patients must be instructed to wear the RxSight-specified UV protective eyewear during all waking hours after Light Adjustable Lens implantation until 24 hours post final lock-in treatment. Unprotected exposure to UV light during this period can result in unpredictable changes to the Light Adjustable Lens, causing aberrated optics and blurred vision, which might necessitate explantation of the Light Adjustable Lens. ADVERSE EVENTS: The most common adverse events (AEs) reported in the randomized pivotal trial included cystoid macular edema (3 eyes, 0.7%), hypopyon (1 eye, 0.2%), and endophthalmitis (1 eye, 0.2%). The rates of AEs did not exceed the rates in the ISO historical control except for the category of secondary surgical interventions (SSI); 1.7% of eyes (7/410) in the Light Adjustable Lens group had an SSI (p < .05). AEs related to the UV light from the LDD include phototoxic retinal damage causing temporary loss of best spectacle corrected visual acuity (1 eye, 0.2%), persistent induced tritan color vision anomaly (2 eyes, 0.5%), persistent induced erythropsia (1 eye, 0.3%), reactivation of ocular herpes simplex Infection (1 eye, 0.3%), and persistent unanticipated significant increase in manifest refraction error (≥ 1.0 D cylinder or MRSE) (5 eyes, 1.3%). CAUTION: Federal law restricts this device to sale by or on the order of a physician. Please see the Professional Use Information document for a complete list of contraindications, warnings, precautions, and adverse events.

INDICATIONS: The Light Adjustable Lens+ (LAL+®) and Light Delivery Device (LDD) system is indicated for the reduction of residual astigmatism to improve uncorrected visual acuity after removal of the cataractous natural lens by phacoemulsification and primary implantation of the intraocular lens in the capsular bag in adult patients with preexisting corneal astigmatism of ≥ 0.75 diopters and without preexisting macular disease. The system also reduces the likelihood of clinically significant residual spherical refractive errors. CONTRAINDICATIONS: The LAL+ is contraindicated in patients who are taking systemic medication that may increase sensitivity to ultraviolet (UV) light as the LDD treatment may lead to irreversible phototoxic damage to the eye; patients who are taking a systemic medication that is considered toxic to the retina (e.g., tamoxifen) as they may be at increased risk of retinal damage during LDD treatment; patients with a history of ocular herpes simplex virus due to the potential for reactivation from exposure to UV light; patients with nystagmus as they may not be able to maintain steady fixation during LDD treatment; and patients who are unwilling to comply with the postoperative regimen for adjustment and lock-in treatments and wearing of UV protective eyewear. WARNINGS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting an IOL in a patient with any of the conditions described in the LAL+ and LDD Professional Use Information document. Caution should be used in patients with eyes unable to dilate to a pupil diameter of ≥ 7 mm to ensure that the edge of the LAL+ can be visualized during LDD light treatments; patients who the doctor believes will be unable to maintain steady fixation that is necessary for centration of the LDD light treatment; patients with sufficiently dense cataracts that preclude examination of the macula as patients with preexisting macular disease may be at increased risk for macular disease progression; and patients at high risk for future vitreoretinal disease that may require silicone oil as part of therapy. The LAL+ must be implanted in the correct orientation with the back layer facing posteriorly. PRECAUTIONS: The safety and effectiveness of the LAL+ has not been substantiated in clinical trials. The effects of the LAL+ optical design on the quality of vision, contrast sensitivity, and subjective visual disturbances (glare, halo, etc.) have not been evaluated clinically. Surgeons must weigh the potential benefits of the modified optical design of the LAL+ against the potential for risks associated with degradation in vision quality and the lack of clinical data to characterize the impact of the LAL+ optical design on contrast sensitivity and subjective visual disturbance. These considerations may be especially relevant to patients with certain pre-existing ocular conditions (prior corneal refractive surgery, irregular corneal astigmatism, severe corneal dystrophy, macular disease, or optic nerve atrophy, etc.) or intraoperative conditions (posterior capsular rupture, complications in which the IOL stability could be compromised, inability to place IOL in capsular bag, etc.). The long-term effect on vision due to exposure to UV light that causes erythropsia (after LDD treatment) has not been determined. The implanted LAL+ MUST undergo a minimum of 2 LDD treatments (1 adjustment procedure plus 1 lock-in treatment) beginning at least 17-21 days post-implantation. All clinical study outcomes were obtained using LDD power adjustments targeted to emmetropia post-LDD treatments. The safety and performance of targeting to myopic or hyperopic outcomes have not been evaluated. The safety and effectiveness of the LAL+ and LDD have not been substantiated in patients with preexisting ocular conditions and intraoperative complications. Patients must be instructed to wear the RxSight-specified UV protective eyewear during all waking hours after LAL+ implantation until 24 hours post final lock-in treatment. Unprotected exposure to UV light during this period can result in unpredictable changes to the LAL+, causing aberrated optics and blurred vision, which might necessitate explantation of the LAL+. When performing refraction in patients implanted with the LAL+, confirmation of refraction with maximum plus manifest refraction technique is recommended. ADVERSE EVENTS: The most common adverse events (AEs) reported in the randomized pivotal trial of the parent LAL included cystoid macular edema (3 eyes, 0.7%), hypopyon (1 eye, 0.2%), and endophthalmitis (1 eye, 0.2%). The rates of AEs did not exceed the rates in the ISO historical control except for the category of secondary surgical interventions (SSI); 1.7% of eyes (7/410) in the LAL group had an SSI (p < .05). AEs related to the UV light from the LDD include phototoxic retinal damage causing temporary loss of best spectacle corrected visual acuity (1 eye, 0.2%), persistent induced tritan color vision anomaly (2 eyes, 0.5%), persistent induced erythropsia (1 eye, 0.3%), reactivation of ocular herpes simplex Infection (1 eye, 0.3%), and persistent unanticipated significant increase in manifest refraction error (≥ 1.0 D cylinder or MRSE) (5 eyes, 1.3%). CAUTION: Federal law restricts this device to sale by or on the order of a physician. Please see the Professional Use Information document for a complete list of contraindications, warnings, precautions, and adverse events.

©2024 RxSIGHT. All Rights Reserved. COM-1261 Rev. A

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