Light Adjustable Lenses: Optometrists Key to Success
- Patient expectations for the LAL, like with any premium lens, can make or break a postoperative outcome.
- One of my favorite mottos is the equation: Happiness = Results – Expectations.
- To avoid surprises, I prepare them for the possibility of three adjustments.
Key takeaways:
Table of Contents
- Optometrists can play an important role by preparing the ocular surface for corneal collagen crosslinking (CXL).
- Proper epithelial debridement is crucial for optimal CXL outcomes.
- New technologies, such as femtosecond lasers and transepithelial CXL, offer potential advantages but require careful consideration.
- Ongoing research is exploring ways to enhance CXL efficacy and minimize complications.
the landscape of surgical comanagement. Optometrist-led postoperative care allows surgeons to spend more time in the operating room doing what they love while we focus on refractive management and patient education.
set expectations
Patient expectations for the LAL, like with any premium lens, can make or break a postoperative outcome. Those who pay out of pocket,especially if they experienced the benefits of refractive correction previously,tend to be engaged and invested in their vision.
One of my favorite mottos is the equation: Happiness = Results – Expectations. Rather than promising a timeline or result, I focus patients’ attention on why their eyes are unique, how long the LAL process may take and requirements to protect their results after surgery. Patients appreciate the transparency and become more engaged partners.
Moast require two light treatments and two lock-ins. To avoid surprises, I prepare them for the possibility of three adjustments. Some patients hit their refractive target immediately; others want to explore every ounce of customization. Our job is to guide them toward the right endpoint, not the most adjusted one.
A powerful tool
When a patient is on the fence about whether to adjust their vision further, I place the potential refraction in a trial frame and let them experience real-world vision. I ask them to move about the office and look at their phone and a computer. If they are not sure about another adjustment, I suggest they continue trialing their current vision for a few more days. This can prevent regret-based adjustments and reduce the risk of hearing the dreaded phrase: “I think I saw better last time.” I recommend they make a list of activities they are grateful to see and do, alongside visual tasks they find challenging.
We might potentially be tempted to chase a patient’s “perfect” refraction. Remember, even perfect numbers may not produce perfect results. Especially in irregular corneas, leaving +0.5 D to +0.75 D of astigmatism can produce an extended-depth-of-focus effect, helping patients enjoy greater range without sacrificing clarity.
Common procedural challenges
Irregular corneas. Patients who previously underwent RK require modified timelines. Their corneas often remain edematous for longer and can behave unpredictably after surgery. Rushing almost always leads to disappointment; we typically wait 5 weeks or longer before initiating the first light treatment.
Ocular surface disease. Surgical planning for lens-based refractive procedures is dependent on precise preoperative measurements. before I use the phoropter,I evaluate the cornea. An unstable tear film or superficial punctate keratitis prompts a pause to treat the surface with lid hygiene, a dose of steroids/cyclosporine or the placement of punctal plugs. Optimizing the ocular surface before LAL surgery provides the best opportunity for patients to achieve their desired outcomes.
Elevate your game
As more practices integrate the LAL, optometrists will be critical to patient satisfaction. Three competencies stand out:
No. 1: Have clinical confidence and technical precision. Be comfortable managing irregular corneal behavior, fluctuating refractions, interpretation of subtle visual feedback and the optical impact of every 0.25 D decision. LAL management extends beyond routine refraction accuracy, encompassing a clinical understanding of how each measurement translates into a real-world refractive change.
No.2: Connect with patients and champion personalized goal setting. The LAL is customizable only if we clearly understand the patient’s priorities. Remember, a successful LAL outcome is not about achieving our ideal goal, but the patient’s. Listen for goal-oriented cues, ask whether patients prioritize activities like night driving or computer work, and find out if they prefer distance, near or blended vision. Such factors matter more than sphere or cylinder.
no. 3: Explain neural adaptation with confidence. For many patients, especially those who prefer blended vision, neural adaptation is as critical as optical precision.Describe how their brain integrates distance and near vision and how long adaptation may take. Reassure them that temporary visual imbalance is expected and educate them on how to distinguish neural adaptation from pathology. This prevents unneeded adjustments and builds patient confidence and satisfaction.
The future is collaborative
The LAL gives patients control over their postoperative vision. The key to unlocking that potential involves optometrists guiding them through nuances, timing and decision-making.
As LAL procedure volume continues to grow, the OD-MD partnership will only deepen. For optometrists ready to embrace an expanded role,the LAL is an opportunity to elevate the standard of refractive comanagement and redefine our contribution to surgical outcomes.
For more facts:
Lily Arendt, OD, FAAO, of parkhurst NuVision LASIK Eye Surgery, can be reached at lilyarendt1@gmail.com.
Sources/Disclosures
Source:
Expert Submission
Disclosures:
Arendt reports consulting for RxSight.
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