Comparative Visual Outcomes and Complications of Light Adjustable Intraocular Lens Technology: A Scoping Review

A scoping review was completed to evaluate visual outcomes of the light adjustable lens (LAL) relative to alternative intraocular lenses (IOLs) and post-operative adverse events associated with the LAL.

A structured search of MEDLINE, EMBASE, and CENTRAL was completed to identify primary studies of cataract surgery with LAL implantation.

Twenty studies (1743 eyes) were included. Six studies (30%) compared the visual performance of LAL to another IOL, reporting sphere (n = 2 studies), spherical equivalent (SE; n = 5), and residual cylinder (n = 6). Residual cylinder was lower with the LAL across all 6 studies, whereas comparative SE outcomes were variable. Uncorrected visual acuity (UCVA) was reported in 4 studies, with all 4 studies demonstrating improved UCVA with the LAL. Adverse events were reported in 18 studies (90%). Posterior capsular opacification or YAG capsulotomy was reported in the largest number of studies (n = 8 studies), with study-level proportions ranging from 0.7% to 28.6% of eyes. Macular edema was reported in 6 studies (0.6% to 10.9% of eyes) and secondary surgical interventions in 5 studies (1.0% to 12.5% of eyes). The first light delivery device (LDD) treatment was performed 17 to 24 days after surgery in 7 studies (35%).

LAL technology is associated with reduced residual refractive cylinder and improved UCVA compared to monofocal IOLs. The small number of comparative studies and heterogeneity across sources limit the strength of this evidence. The potential for UV light contamination with first generation models and LDD treatment delays warrant consideration.