Central Optic Distortion and Internal Higher Order Aberrations From Ultraviolet-Mediated Polymer Migration in Light Adjustable Lenses

To describe a spectrum of central optic changes and internal higher order aberrations (HOAs) associated with ultraviolet-mediated polymer migration in the Light Adjustable Lens (LAL; RxSight).

This was a retrospective case series of 7 eyes of 5 patients who developed visual symptoms following LAL implantation after cataract surgery. Clinical evaluation included slit-lamp biomicroscopy, manifest refraction, and ray-tracing aberrometry (iTrace; Tracey Technologies) with consistent photopic aperture analysis to differentiate corneal and internal optical contributions.

Central optic changes were associated with incomplete lock-in, delayed lock-in, or inconsistent ultraviolet protection and occurred in both first-generation LALs (without ultraviolet shield) and second-generation LALs (Active Shield). Patients presented with decreased corrected distance visual acuity (CDVA), progressive refractive drift, glare, and reduced quality of vision. Slit-lamp biomicroscopy demonstrated a focal central optic thickening of approximately 2 to 3 mm in 5 of 7 eyes, whereas 2 eyes had no visible structural abnormality. Ray-tracing aberrometry revealed elevated internal HOAs in all eyes, predominantly coma and spherical aberration, with dissociation between corneal and internal optical quality. One explanted lens demonstrated central thickening consistent with premature polymerization. Intraocular lens exchange was performed in 6 eyes and resulted in marked improvement in subjective visual quality and CDVA.

Ultraviolet-mediated polymer migration in the setting of incomplete or delayed lock-in or inadequate ultraviolet protection can produce a spectrum of LAL optic changes, ranging from overt central thickening to occult internal optical distortion detectable only by aberrometry. Recognition of corneal-internal optical dissociation is critical for diagnosis. Intraocular lens exchange is an effective treatment when visual quality is compromised. This represents a rare but clinically important complication requiring timely recognition and management.