Bascom Palmer Eye Institute Ophthalmologist Reaches 100-Case Cataract Surgery Milestone
Dr. Kendall Donaldson performed her 100th cataract surgery using innovative Light Adjustable Lens™ (LAL®) technology.
Kendall E. Donaldson, M.D., Rodgers Clark Endowed Chair in Ophthalmology and professor of clinical ophthalmology at Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, recently completed her 100th cataract surgery case using innovative Light Adjustable Lens™ (LAL®) technology.
Dr. Donaldson, who is medical director of Bascom Palmer Eye Institute in Plantation, was celebrated for the accomplishment at a recent luncheon sponsored by RxSight, the U.S.-based company behind the technology.
We spoke with Dr. Donaldson about LAL as an important step in cataract surgery’s evolution.
What would you want your clinician colleagues and patients to know about the LAL?
The FDA-approved Light Adjustable Lens is a promising technology. We’ve been using it at Bascom Palmer for about two years. There has been research in this field for over 25 years, so we’re excited to finally have this available for our patients.
Cataract surgery is becoming a highly customized approach, with patients gaining more freedom from either glasses or contact lenses, in addition to getting rid of their cataracts for better vision quality.
Fortunately, we get great results with routine cataract surgery performed with standard intraocular lenses. However, we often encounter more challenging patients who have had prior photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) or radial keratotomy (RK). Having a history of other eye procedures can make it more difficult to pinpoint the optimal lens and calculate the exact power that will give an individual the highest degree of freedom from glasses.
The Light Adjustable Lens has been great for these patient subgroups. It can also be used in the routine patient who desires the ability to fine-tune their final refractive target to increase their range of vision. The LAL allows us to adjust the prescription in the lens, whether it is for distance or near or anything in between.
How is cataract surgery with the LAL done?
We usually do the surgeries, one for each eye, about a week apart. We do our first light adjustment about three weeks after the surgery for the second eye, giving the vision a chance to stabilize. It also allows time for the patient to live with that vision for a few weeks and provide us with feedback on what they need for an adjustment.
I’ve been practicing ophthalmology for about 25 years and, all the while, it has been in constant evolution, getting better and better every year. We have better lenses and better optics in our lenses that can provide more for our patients.
Dr. Kendall Donaldson
We can do up to three light treatments to make adjustments and fine-tune distance vision. We can also use the light treatments to increase the range of vision, allowing them to get more intermediate and near vision.
It has been really nice to customize and fine-tune our cataract surgery results, and we’ve achieved better results than ever.
You were celebrated for your 100th LAL cataract procedure at a recent luncheon. How does this reflect on you and your team at Bascom Palmer?
The Light Adjustable Lens requires extra patient visits and time spent with our staff. Our staff puts a lot of extra effort into caring for our LAL patients and they tend to get attached to these patients.
This was a celebration not for me but for the whole office. It celebrated each staff member, from the technician who put in the extra time with the patients to my optometrist, Natasha Michelle Tetlow, O.D., who spent a lot of time fine-tuning our plan so I could do light treatments.
LAL still makes up a small (but growing) percentage of cataract surgeries, at about 4% to 5% nationwide. Only a small percentage of cataract surgeons implant the Light Adjustable Lens. I was the first at Bascom Palmer, but now there are about three of us offering the technology.
It’s nice to have this as a specialty area, where colleagues can confidently refer cataract patients who are candidates or have heard about LAL. My team has gotten great at managing these patients for the best possible outcomes.
What excites you most about the future of cataract surgery?
I’ve been practicing ophthalmology for about 25 years and, all the while, it has been in constant evolution, getting better and better every year. We have better lenses and better optics in our lenses that can provide more for our patients.
All the devices that we use are becoming more and more accurate. Now, we’re using artificial intelligence to be able to make better decisions for our patients and can better approximate the type of lens and the power of the lens that would best suite each patient.
As we move forward with LAL, I’m hoping we’ll have more adjustability in future lens iterations. Now, once we complete our adjustments with the LAL, we lock the patient in. Once they’re locked, we can’t change it. Although most patients are pretty stable in their prescriptions once cataract surgery is done, it would be nice to be able to unlock the lens in the rare situation in which the patient develops other ocular pathology that alters their prescription with age.
We have many other exciting lenses on the horizon. The ultimate goal is to approximate the human lens. We’re trying to get closer to achieving the most accurate approximation of the human lens and maintaining that throughout life.
Tags: Bascom Palmer Eye Institute, cataracts, Dr. Kendall Donaldson, eye diseases, ophthalmology