Cataract Surgery after Radial Keratotomy | Light Adjustable Lens or IC8 Apthera?
In this video, I share my approach to Cataract Surgery and Refractive Lens Exchange (RLE) for patients with previous RK. As you know, there are many lens options for patients. Currently, my favorite lenses for RK patients are the Light Adjustable Lens (LAL) and IC8 Apthera. Given the higher possibility of a refractive surprises, these lenses are most forgiving. With the Light Adjustable Lens, you can adjust the prescription of the lens implant after the eye has finished healing and the prescription has settled. With the IC8 Apthera, large depth of focus is provided, and aberrant light is filtered out, helping improve vision quality. Neither of theses lenses are perfect and expectations need to be appropriately managed with the patient prior to surgery. These patients may have irregular astigmatism that cause unwanted symptoms, regardless of which lens the patient chooses. If the astigmatism is fairly regular and consistent preoperatively, you could consider a toric lens as well. Of course basic monofocals are always an option, but if it were for me and I had RK, I’d rather have an LAL or Apthera put in my eye.
How do I decide when to recommend the LAL vs IC8 Apthera? Let’s assume a patient is a candidate for both. If a patient has light sensitivity from their cornea (and not their cataract), and a lot of fluctuating vision, irregular astigmatism, I would lean towards the IC8 Apthera. Although the LAL would likely provide less residual refractive error and help with potential refractive surprises, it’s not going to address fluctuating vision or light sensitivity from the cornea. On the other hand, if the patient has fairly stable vision with minimal glare and light sensitivity, the light adjustable lens can knock out residual refractive error.
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