Reply: Optimized constants for an ultraviolet light-adjustable intraocular lens : Journal of Cataract & Refractive Surgery

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Reply: Optimized constants for an ultraviolet light-adjustable intraocular lens

Dick, Burkhard H. MD; Conrad-Hengerer, Ina MD; Hengerer, Fritz MD; Haigis, Wolfgang PhD

Journal of Cataract & Refractive Surgery 38(5):p 924, May 2012. | DOI: 10.1016/j.jcrs.2012.02.030
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We appreciate Dr. Lam's comments about the promise of the light-adjustable IOL. This IOL allows the surgeon to correct residual spherical refractive error and astigmatism after cataract surgery noninvasively by shining a spatially profiled beam of ultraviolet (365 nm) light on the IOL.

In his letter, Dr. Lam expressed concern that only 52% of eyes were within ±0.50 D of emmetropia after implantation but before adjustment, less than the benchmark of 77% proposed by Hahn et al.,1 which was published with an excellent and also critical editorial by Steinert.2 In our study, the comparatively low percentage of eyes with ± 0.50 D of emmetrophia short term after surgery but before the necessary light adjustment/lock-in procedure was intentional. The accuracy of the refractive error adjustment is slightly better for hyperopic errors than for myopic errors, so surgeons using the light-adjustable IOL are trained to target a refractive outcome of ±0.50 D after the cataract surgery. The accuracy of the light-adjustable IOL would be more appropriately judged as the percentage of eyes between plano and ±1.00 D, but that piece of data was not analyzed in the report.

Of course, the important refractive result in assessing any IOL is not the refractive outcome 1 month after surgery but the outcome at the point of stability. At the point of stability, 96% of eyes treated with the light-adjustable IOL achieved a refraction within ±0.50 D of the intended spherical equivalent and an uncorrected distance visual acuity of 0.8,3 an outcome superior to Dr. Lam's proposed benchmark.


1. Hahn U, Krummenauer F, Kölbl B, Neuhann T, Schayan-Araghi K, Schmickler S, von Wolff K, Weindler J, Will T, Neuhann I. Determination of valid benchmarks for outcome indicators in cataract surgery; a multicenter, prospective cohort trial. Ophthalmology. 2011;118:2105-2112.
2. Steinert RF., 2011. Cataract surgery quality, streetlamps, and car keys [editorial], Ophthalmology, 118, 2103-2104.
3. Hengerer FH, Hütz WW, Dick HB, Conrad-Hengerer I. Combined correction of sphere and astigmatism using the light-adjustable intraocular lens in eyes with axial myopia. J Cataract Refract Surg. 2011;37:317-323.
© 2012 by Lippincott Williams & Wilkins, Inc.