Novel use of Light Adjustable Lenses to improve visual acuity in patients with corneal abnormalities: a case report.




Worley, Josh
Capps, Zachary


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Background: Keratoconus is characterized by thinning and protrusion of the cornea that produces an irregular astigmatism and decreased visual acuity. Individuals with these corneal abnormalities commonly experience undesirable visual acuity outcomes due to lack of effective traditional treatment options. We postulate Light Adjustable Lens (LAL) may be a safe and effective treatment where neither multifocality nor Laser-Assisted In Situ Keratomileusis (LASIK) are a viable method to achieve decreased spectacle dependence following surgery. This report presents a single patient diagnosed with forme fruste keratoconus undergoing LAL intraocular lens (IOL) replacement surgery. The patient was selected based on their history of corneal abnormalities and ability to benefit from IOL replacement. Potential benefit from IOL replacement was determined based on the patient’s ocular complaints and visual test results in clinic. Lens selection parameters were made based on keratotomy and biometry data obtain from the Lenstar LS900. Visual acuities after LAL implantation and postoperative light treatments were recorded and compared with preoperative visual acuities. The patient received LAL, made of foldable silicone, implanted through phacoemulsification and standard IOL implantation techniques in both eyes (OU), and after completion of 1-month postsurgical healing received postoperative light treatments for lens adjustment. Case Presentation: A 69-year-old man presented in clinic with complaints of decreased central vision. His brightness acuity test (BAT) was 20/40 OU and slit lamp examination (SLE) and oxidative stability index (OSI) revealed nuclear sclerotic (NS) cataracts of 2+ grade OU. Scheimpflug imaging (Figure 1.1) showed corneal abnormalities consistent with FFK OU. Imaging measured a topographic irregularly irregular astigmatism of 0.50 D at 115 degrees with a total corneal power (TCP) of 0.44 D at 127 degrees in the right eye (OD) and 0.33 D at 80 degrees with a TCP of 0.32 D at 88 degrees in the left eye (OS). Keratotomy measurements can be found in Table 1. The patient’s primary goal was to achieve reduced spectacle dependency. Preoperative serial refraction established refractive stability OU. RxSight LAL of +20.5 D and +20.0 D were selected for the OD and OS respectively. 1-month UDVA was 20/20 in the OS and UNVA was Jager 5 (20/50) OD. Following 2 postoperative UV light treatments spaced 4 days apart and 1 lock-in UV light treatment after 3 days, the patient maintained UDVA of 20/20 in the OS and achieved UNVA of Jager 1 (20/25) OD. Conclusions: This case shows the potential of LAL to be a reliable and reproducible treatment method that can result in positive visual acuity outcomes in patients with corneal abnormalities. It also demonstrates that in patients with FFK and mild keratoconus, LAL has potential to utilize spherical aberration to successfully achieve extend depth of the focus (EDOF) vision.