In today’s healthcare landscape of heightened patient expectations, individuals undergoing cataract surgery are no longer satisfied with simple vision restoration. These patients expect a premium experience and optimized outcomes tailored to their lifestyle and visual demands. Integrating advanced technologies such as state-of-the-art diagnostics and intraocular lens (IOL) designs empower us to personalize cataract surgery and refine outcomes with greater precision than ever before. The key is to combine innovation with a collaborative approach to patient care, enhancing our opportunity to meet their goals and improve their overall quality of life. If we can consistently achieve precision outcomes, then we not only increase patient confidence and satisfaction but also elevate the standard of care in cataract surgery.
The need for customizable vision
Patients come to us with unique visual needs. Customizable vision solutions have become essential to meet these needs while considering each patient’s lifestyle, ocular health, and visual goals. Premium IOLs such as enhanced monofocal, multifocal, trifocal, and extended depth of focus lens designs provide a degree of customization that works for many patients. While these lenses offer the promise of spectacle independence, they may also introduce a compromise in contrast sensitivity and require a level of neural adaptation that isn’t suitable for every patient. Alternatively, I have found that an adjustable lens technology – such as the Light Adjustable Lens (LAL; RxSight) – offers the ability to customize vision postoperatively, addressing patients’ individual refractive targets while maintaining contrast sensitivity and minimizing unwanted visual side effects.
I have always been cautious about compromising contrast sensitivity, especially in cases with comorbidities such as dry eye disease or early retinal changes. In these and other patients, the LAL eliminates much of the uncertainty in cataract surgery outcomes. Traditionally, despite our best efforts with biometry, topography, and intraoperative aberrometry, we could only estimate the postoperative refractive outcome. With the LAL the patient can fine-tune their vision postoperatively through a series of light adjustment and lock-in procedures.
Collaboration with Patients
Historically, our discussion with patients about premium IOLs revolved around whether they wanted to be free of glasses. This strategy works for many patients, but it may not always improve conversion rates – especially when spectacle independence is not the main goal. Instead, my practice focuses the patient conversation on working together to achieve their personal vision goals. We focus on quality of vision now and tell patients there is a technology that helps fit the lens to their eye after surgery based on their unique real-world experience.
The concept of test-driving their vision before committing to a final prescription resonates with patients. It reframes cataract surgery as a customizable experience, giving them a sense of control and reassurance that we will get their vision exactly right (see sidebar). I think reframing the patient conversation from spectacle independence to quality of vision opened the door to a new patient population who normally would have opted for a standard monofocal IOL.
Growth in Premium IOL Volume, Changes to Workflow
When my practice first introduced the LAL, I was concerned that it might cannibalize our existing premium IOL offerings. Fortunately, we have experienced the opposite. Adding the LAL to our armamentarium has expanded our premium IOL volume, attracting patients who in the past might have opted for a standard monofocal lens. We have found that many of these patients are willing to invest in LAL technology because they value the promise of customized vision.
Offering the LAL technology required us to adjust our practice workflow. Initially, I performed all light adjustments myself and gained confidence in the postoperative process. This allowed me to understand the technology and refine our practice’s approach to treatments. As demand for the procedure and overall premium IOL volume grew, however, I saw an opportunity to expand the role of our optometrists. Their expertise in postoperative care made them ideal partners in managing the LAL process, from patient education to adjustments and lock-in treatments.
Delegating light adjustments to our optometrists was a game-changer. Not only did it free up my time for more surgery, but it also strengthened the collaborative care model within our practice. Patients developed deeper relationships with our optometrists, and our team became more cohesive in delivering personalized care. Additionally, having dedicated LAL clinic time and ensuring that our entire staff, including technicians and front-desk personnel, are educated on the technology helps to streamline the process. Our practice’s average now is about two adjustments before lock-in treatments.
Leveraging the LAL
My father, the late Kanwar A. Singh, MD, instilled in me a philosophy of never becoming complacent. His mindset shapes my practice every day, from the emphasis I place on refining my surgical technique to my passion for integrating the latest advancements and providing patients with superior outcomes and long-term satisfaction.
For me, the LAL represents more than just an innovative IOL. It’s a practice builder and a game-changer in modern cataract surgery. It allows us to move beyond the limitations of traditional surgery and provide a level of precision and personalization that was previously unattainable. As more surgeons integrate this technology into their practices, I believe we will continue to redefine what’s possible in cataract surgery and premium vision correction.
A Transformative Experience for Patients and Providers
One of my earliest LAL patients perfectly encapsulated the power of this technology. On Day 1 postoperative, his visual acuity was 20/10. When he realized he could fine-tune his vision even further, his excitement was palpable. The emotional impact of delivering truly life-changing vision cannot be overstated.
