Light-Adjustable Lens (LAL)

Cataract Surgery with the Ability to Fine-Tune Your Vision After Surgery

For most of the history of cataract surgery, the power of the lens implant was calculated before the operation and locked in permanently once placed. If the eye healed differently than predicted — or if the patient’s visual preferences became clearer after experiencing life without a cataract — there was no way to adjust the result without additional procedures. The Light-Adjustable Lens changes that entirely.

The Light-Adjustable Lens (LAL), developed by RxSight and FDA-approved in 2017, is the first and only intraocular lens implant whose power can be customized after cataract surgery using a precise, non-invasive UV light treatment. At River City Eye Associates, Dr. Hager offers the LAL as a premium cataract surgery option for patients who want the highest possible chance of achieving their target vision — with the unique advantage of seeing their result before it is permanently set.

How the Light-Adjustable Lens Works

The LAL is implanted during standard cataract surgery in place of the natural clouded lens, just like a conventional lens implant. What makes it different is its composition: the lens contains specialized photosensitive molecules (macromers) embedded within the lens material. When exposed to a specific wavelength of UV light delivered by a device called the Light Delivery Device (LDD), these molecules respond by shifting within the lens and changing its curvature — effectively adjusting the power and prescription of the lens while it is already inside the eye.

After surgery, once the eye has stabilized (typically four weeks), Dr. Hager performs a series of light treatment sessions in the office. Each treatment takes only a few minutes and is painless. Patients can provide feedback on their vision between sessions, and the prescription can be adjusted accordingly. Once the patient and doctor are satisfied with the result, a final “lock-in” treatment permanently stabilizes the lens. After lock-in, the lens behaves exactly like a conventional implant — stable and lifelong.

Who Is a Good Candidate for the Light-Adjustable Lens?

The LAL is an excellent option for patients who:

Have astigmatism that needs to be addressed at the time of cataract surgery. The LAL allows astigmatism correction to be verified and refined based on actual post-surgical healing rather than pre-surgical predictions alone — a meaningful advantage since corneal shape can shift slightly after surgery.

Have had prior LASIK, PRK, or other corneal refractive surgery. These patients present a well-known challenge for pre-surgical lens calculations because previous corneal procedures alter the measurements used to predict lens power. The LAL’s post-surgical adjustability provides a powerful safety net, allowing the prescription to be corrected based on real-world visual outcomes rather than estimates.

Want to minimize dependence on glasses for distance vision and are willing to invest in the highest-precision option available. While no lens implant can guarantee spectacle independence, the LAL offers the best available opportunity to achieve a target prescription because it accounts for how an individual eye actually heals — not just how it was predicted to heal.

Have high visual demands — professionals, pilots, avid readers, outdoor enthusiasts, or anyone for whom precise vision is especially important in daily life.

What to Expect: The LAL Experience at River City Eye Associates

The surgical experience with the LAL is essentially identical to standard cataract surgery — same facility, same technique, same recovery. The distinction comes in the weeks that follow.

Between surgery and the lock-in treatment, patients must wear UV-protective glasses provided by the practice whenever they are awake — indoors and outdoors. This is a non-negotiable requirement because uncontrolled UV exposure from sunlight or certain indoor lighting can inadvertently affect the lens before it is locked. Patients who are diligent about UV protection during this window consistently achieve excellent outcomes. The protective glasses are provided at no additional cost and are worn only during the adjustment period.

After lock-in, the UV glasses are no longer needed and the lens is permanently stable. Most patients complete one to three adjustment visits before lock-in, though the number varies based on the degree of correction needed and individual healing.

The Light-Adjustable Lens and Astigmatism

Astigmatism — caused by an irregular corneal curvature — is one of the most common reasons cataract surgery patients continue to need glasses for distance vision even after successful surgery. Conventional toric lens implants address astigmatism based on pre-operative measurements, but the cornea can shift slightly in the weeks after surgery, potentially leaving residual astigmatism that glasses must correct.

The LAL addresses this limitation directly. Because the astigmatism correction can be evaluated and refined after the eye has fully healed, the final result reflects the eye’s actual post-surgical state rather than a pre-surgical estimate. For patients with meaningful astigmatism, this represents a significant advance in precision.

Frequently Asked Questions About the Light-Adjustable Lens

Is the adjustment procedure painful? No. The light treatment is performed at a slit lamp in the office, takes approximately 40-90 seconds per treatment, and is entirely painless. Most patients describe a mild sensation of brightness during the treatment.

How many adjustment visits will I need? Most patients require one to three adjustment sessions before lock-in, though this varies. Each visit is brief, and adjustments are made based on your visual feedback and Dr. Hager’s measurements.

What if I’m happy with my vision before the lock-in — do I still need it? Yes. Lock-in is a required step regardless of how pleased you are with your vision after adjustments. Without lock-in, the lens remains photosensitive and vulnerable to unintended changes from UV exposure.

Does insurance cover the Light-Adjustable Lens? Cataract surgery itself is covered by Medicare and most major medical insurances. The LAL is a premium lens upgrade, and the additional cost associated with this technology is an out-of-pocket patient expense, as it is with all premium lens implants. Our staff can provide transparent pricing and discuss payment options during your consultation.

Can the LAL correct both distance and near vision? The LAL is currently optimized for distance or extended-range vision correction and is not a multifocal lens. Patients who choose the LAL for distance will typically still need reading glasses for close tasks, though the precision of distance correction is unmatched among currently available implants.

Schedule a Light-Adjustable Lens Consultation in San Antonio

If you have been told you have cataracts and want to explore whether the Light-Adjustable Lens is right for your vision goals, Dr. Hager welcomes you for a comprehensive consultation at River City Eye Associates. Our San Antonio clinic is located at 3338 Oakwell Court, Suite 190, San Antonio, TX 78218, conveniently accessible from Terrell Hills, Alamo Heights, Northwood, and Cibolo.

Call us at 210-930-2015 to schedule your cataract evaluation.