The Light Adjustable Lens for Cataract Surgery: How It Works, What the Evidence Shows, and When It Will Be Available in Australia

The Light Adjustable Lens (LAL), developed by RxSight Inc., is one of the most significant advances in cataract surgery IOL technology in the past decade. Unlike every other intraocular lens currently available, the LAL allows the refractive power of the implanted lens to be adjusted after surgery using a series of non-invasive ultraviolet light treatments. This means that if the initial surgical result is not precisely on target, the prescription built into the lens itself can be changed without additional surgery. The result is a level of refractive accuracy that no other monofocal lens can match. This post covers the technology behind the LAL, what the published evidence shows about outcomes, the complete postoperative experience including the UV treatment protocol and the UV-protective glasses requirement, costs in Australia, and the current state of availability. For context on how the LAL fits within the broader landscape of lens options, see the premium IOL guide covering all lenses available in Australia and the guide to cataract surgery in Melbourne.

The technology: how the Light Adjustable Lens works

The LAL is made from a photosensitive silicone material containing macromers, photosensitive molecules that can be polymerised by ultraviolet light at approximately 365 nanometres. When UV light is directed at the lens in a specific spatial pattern using the Light Delivery Device, the illuminated zones polymerise and change their curvature, altering the refractive power of the lens in a controlled and predictable way.

The spatial pattern of UV light delivery is controlled precisely by the LDD using a digital light processing system. By adjusting the pattern, intensity, and duration of UV exposure, the clinician can predictably change the spherical power of the lens, the cylindrical power, or create a modified power profile that extends the depth of focus. The change in lens power is proportional to the intensity and area of UV light applied.

After the desired refractive adjustment has been achieved through one to three light treatment sessions, the lens is locked in place using a final UV lock-in treatment that polymerises all remaining unpolymerised macromers. This permanently stabilises the lens at the adjusted power, after which no further adjustment is possible and no further UV protection is required beyond standard UV-blocking sunglasses for general eye protection.

The LAL 2.0 is the current generation lens, which incorporates ActivShield technology. ActivShield is a UV-absorbing filter built into the lens material that reduces the sensitivity of the lens to ambient UV light, providing passive protection from indoor UV exposure while allowing the controlled LDD UV delivery to still produce the intended adjustment. ActivShield significantly changed the UV glasses requirement compared with the original LAL, as described below.

Why the LAL is different from other premium IOLs

Every other premium IOL available for cataract surgery has a fixed power determined before surgery based on biometry and IOL power calculation. Even the best current formulas achieve a result within 0.50 dioptres of target in only 85 to 90 percent of cases. The LAL decouples the refractive outcome from biometry accuracy by allowing adjustment after surgery once the eye has healed and the final refraction is stable.

For the 10 to 15 percent of patients in whom the fixed-power lens misses the intended refraction, the options are glasses, contact lenses, or a further surgical procedure such as LASIK or IOL exchange. The LAL eliminates this uncertainty by measuring the actual postoperative refraction once all variability has resolved and adjusting the lens directly to achieve the intended target. The final refraction is not predicted before surgery; it is measured after surgery and corrected in the implanted lens.

For patients with complex eyes including those with previous LASIK, PRK, or radial keratotomy, prediction accuracy from standard IOL formulas is lower still. The LAL is particularly valuable in this population, where a fixed-power lens carries a higher baseline risk of refractive surprise. For a detailed clinical review of this patient group, see our guide to cataract surgery after refractive surgery.

The LAL does not provide the extended focal range of a trifocal or EDOF lens. It is a monofocal lens and will provide clear distance vision (or near vision if targeted for monovision) at one primary focal plane. Patients who want functional vision at both distance and near without glasses should be counselled about diffractive premium lenses and their trade-offs, including the halos and reduced contrast sensitivity that are characteristic of that lens category. For a detailed comparison of the full range of premium lens options, see the full range of vision IOL analysis.

What the evidence shows

The published evidence for the LAL is comprehensive and strongly positive. The FDA approval study demonstrated that 92 percent of LAL eyes achieved results within 0.50 dioptres of target refraction. A 2025 ASCRS systematic review of 18 studies found that 91.5 percent of patients achieved within 0.50 dioptres of target after lock-in, with outcomes maintained at seven years postoperatively.

The FDA approval study was a prospective controlled multicentre 12-month study of 600 patients randomised to receive the LAL (403 patients) or a commercially available monofocal IOL (197 patients). It demonstrated that 92 percent of LAL eyes achieved results within 0.50 dioptres of target manifest refraction spherical equivalent. Patients implanted with the LAL were approximately two times more likely to achieve 6/6 (20/20) uncorrected distance visual acuity or better at six months compared with the monofocal control group.

An ASCRS systematic review published in 2025, analysing 18 studies comprising 819 LAL implantations in 609 patients performed between 2009 and 2023, found that 91.5 percent of patients achieved within 0.50 dioptres of target refraction after lock-in treatments, with 85 percent achieving uncorrected distance visual acuity of 6/6 (20/20) or better. Long-term follow-up showed good visual acuity and refractive stability, with outcomes maintained at seven years postoperatively.

For astigmatism correction, a post-approval study comparing the LAL against two contemporary toric IOLs found that the mean absolute error of residual astigmatism was 0.26 dioptres for the LAL, compared with 0.36 dioptres and 0.38 dioptres for the two toric comparators. The percentage of cases with residual astigmatism of 0.50 dioptres or less was 92.5 percent for the LAL, compared with 76.6 percent and 76.2 percent for the toric controls. This represents a meaningful improvement in astigmatic correction accuracy over current fixed toric IOLs (PubMed 41664266).

The LAL has also been studied in patients with previous corneal refractive surgery, where standard IOL power calculation is least accurate. A 2024 study published in the Journal of Cataract and Refractive Surgery found excellent outcomes in this population, confirming the LAL's advantage where fixed-power lenses are most likely to miss the refractive target (Jones et al., JCRS 2024;50(9):936-941).

The surgical experience

Implantation of the LAL uses the same phacoemulsification technique as standard cataract surgery. From the patient's perspective the operative experience is identical to any other cataract procedure: the same small incision, the same instrument, the same operating time. The difference from other IOLs becomes apparent in the postoperative period when the light treatment sessions begin.

The LAL is inserted through the same small incision used for any other modern IOL. No additional surgical steps are required and the operative time is not meaningfully different from a standard phacoemulsification procedure. The postoperative care in the immediate days after surgery, including topical antibiotic and steroid drops, is the same as for any other cataract operation. For patients with dry eye disease that requires optimisation before surgery, the same pre-operative principles of ocular surface treatment apply as for any cataract patient. See the guide to optimising dry eye before cataract surgery for the full pre-operative dry eye management framework.

The postoperative UV glasses requirement: what the LAL 2.0 changes

The LAL 2.0 with integrated ActivShield technology significantly reduced the UV glasses burden compared with the original LAL. With the original lens, UV-protective glasses were required indoors and outdoors at all times until lock-in. With the LAL 2.0, UV-protective glasses are required only when outdoors or in direct sunlight, not during normal indoor activities.

With the original LAL, UV-protective glasses were required to be worn at all times during all waking hours, both indoors and outdoors, until the final lock-in treatment was completed. This was because the unprotected lens material was sensitive to ambient UV light from all sources including indoor fluorescent lighting and sunlight through windows.

The LAL 2.0 with ActivShield changed this substantially. ActivShield absorbs ambient UV light at the wavelengths that affect the photosensitive macromers, providing continuous passive protection from incidental UV exposure at indoor ambient light levels. The LDD treatment uses a controlled UV delivery that can still penetrate ActivShield to produce the intended adjustment.

The current UV glasses guidance for the LAL 2.0 is:

Outdoors in daylight: UV-protective glasses must be worn at all times, including on overcast days, as UV light penetrates cloud cover. This applies from the day of surgery until 24 hours after the final lock-in treatment.

Indoors: UV-protective glasses are generally not required during normal indoor activities due to ActivShield protection.

Sleeping: glasses are not required during sleep.

The total period of mandatory outdoor UV glasses wear is from the day of surgery until 24 hours after the final lock-in treatment, typically six to ten weeks depending on the number of adjustment sessions needed.

Note: individual surgeon protocols may vary as the LAL is introduced in Australia. Patients should follow the specific UV glasses instructions provided by their treating surgeon.

The light treatment protocol: what happens at each session

Light treatment sessions are performed in the clinic using the Light Delivery Device, a slit-lamp-mounted device that delivers precisely controlled UV light to the implanted lens. Each session takes approximately ten to fifteen minutes and is comfortable and painless, requiring no anaesthetic. Most patients require one to three adjustment sessions followed by two lock-in sessions.

The protocol typically involves:

Light treatment adjustment sessions: performed approximately two to three weeks after surgery once the initial healing is complete and the refraction has stabilised sufficiently for measurement. The final refraction is measured and the target adjustment is planned. A mydriatic drop is instilled to dilate the pupil. The LDD delivers a specific pattern of UV light to the lens surface through the dilated pupil. Patients see a bright light during treatment but experience no discomfort. One to three adjustment sessions are typically required. A period of one to two weeks between sessions allows each adjustment to take full effect before the outcome is re-assessed.

Lock-in treatment: once the intended refraction is achieved and stable, the lock-in treatment is performed. This polymerises all remaining macromers throughout the lens, locking the power permanently. A second lock-in session is performed one to two weeks after the first to ensure complete polymerisation.

The average total treatment period from the first adjustment to completion of lock-in is approximately 28 days in published studies. A retrospective study found that targeting emmetropia required three adjustment sessions in approximately 5 percent of cases, while targeting mild myopia required three sessions in 21 percent of cases.

Costs in Australia: what to expect

No specific Australian pricing for the LAL has been published as the lens is not yet in clinical use. In the United States the all-inclusive cost ranges from approximately USD 4,000 to 6,000 per eye. Premium IOL upgrades in Australia currently add AUD 3,500 to 6,500 per eye, and the LAL is expected to be priced in a similar range once available.

In Australia, premium IOL upgrades for trifocal and EDOF lenses currently add approximately AUD 3,500 to 6,500 per eye above the base cataract surgery cost even with private health insurance. The LAL is likely to be priced in a similar range as a premium upgrade once it becomes available, though the exact figure will depend on the Prostheses List benefit set and the surgeon's and facility's fee structure.

The postoperative light treatment sessions (LDD adjustment and lock-in appointments) represent additional clinical consultations not required with standard cataract surgery. In Australia these will likely attract a Medicare rebate as standard ophthalmology consultations, with any gap fee depending on the individual surgeon's billing arrangements. The out-of-pocket cost per treatment session is not yet established for the Australian market.

The key financial consideration for Australian patients is that until the LAL is listed on the Prostheses List, private health insurers are not required to contribute toward the lens cost, meaning the full lens upgrade cost is borne by the patient as an out-of-pocket expense above the standard Medicare and health fund contributions toward surgical and hospital fees. Once Prostheses List listing is achieved, the lens benefit will be set by negotiation between RxSight and the Department of Health, and any patient upgrade above that benefit would be the out-of-pocket component.

Patients interested in the LAL should request an itemised written quote covering the lens upgrade fee, the surgical and hospital fees, and the expected cost of postoperative light treatment sessions before committing to this lens.

Australian availability: TGA approval and the Prescribed List

The LAL has received TGA approval in Australia, meeting the Therapeutic Goods Administration's requirements for safety and efficacy. However TGA approval alone does not determine health insurance coverage. An IOL must also be listed on the Prostheses List before private health insurers are required to contribute toward the lens cost. As of July 2026, the LAL awaits this listing.

In Australia, IOLs used in private cataract surgery are funded through the Prostheses List (also called the Prescribed List), which sets the minimum benefit private health insurers must pay for approved prostheses. For a lens to be covered by private health insurance it must be listed on the Prostheses List with an approved benefit level.

As of the date of publication of this post, the LAL has TGA approval but is currently awaiting Prostheses List reimbursement approval. Until listed on the Prostheses List, private health insurers are not required to contribute toward the lens cost.

RxSight is currently engaging with Australian surgeons and presenting at meetings including RANZCO to introduce the technology and help practices understand how to integrate the postoperative workflow. Surgeons will be required to undergo dedicated training and accreditation before offering the system clinically.

The content on this page reflects the availability status as of July 2026. Patients interested in the LAL should discuss current availability and costs with their surgeon at consultation.

Who is most likely to benefit from the LAL?

The LAL is a monofocal lens providing distance vision without the halos of diffractive premium lenses. Its principal advantage is refractive accuracy after surgery. Patients most likely to benefit are those with previous corneal refractive surgery, those with high accuracy expectations unsuitable for diffractive lenses, and those who experienced a refractive surprise after cataract surgery in the fellow eye.

Patients most likely to benefit significantly include:

Patients with previous corneal refractive surgery (LASIK, PRK, radial keratotomy) where standard IOL power calculation is least accurate and the risk of refractive surprise is highest. This population benefits most clearly from the LAL's ability to adjust the lens power to the actual postoperative refraction. For a detailed review of the specific challenges in this group, see the guide to cataract surgery after refractive surgery.

Patients with high expectations for spectacle independence who are not suitable candidates for diffractive premium lenses due to macular disease, glaucoma, or contrast sensitivity concerns. Patients with age-related macular degeneration are particularly relevant here: a monofocal lens is standard in this group, and the LAL can achieve the most accurate monofocal outcome possible. See the guide to cataract surgery with macular degeneration for how lens choice is made in this population. Patients with glaucoma requiring a monofocal lens due to contrast sensitivity concerns would similarly benefit from the LAL's accuracy. See the guide to cataract surgery with glaucoma for how lens choice is made in this group.

Patients who have previously experienced a refractive surprise after cataract surgery in the fellow eye and want maximum precision for the second eye.

Patients with significant irregular astigmatism or corneal disease where standard toric IOL alignment is uncertain.

The LAL is not appropriate for patients who cannot reliably wear UV-protective glasses outdoors as instructed, or patients who cannot cooperate with the clinic-based LDD treatment sessions.

Arranging an assessment

If you are considering cataract surgery and want to discuss your IOL options including the Light Adjustable Lens, a referral from your GP or optometrist is required. I consult at Northern Eye Consultants, Northpark Private Hospital, Bundoora, and at Bass Coast Eye Centre, Wonthaggi. Appointments can be arranged through Northern Eye Consultants.

Contact Northern Eye Consultants to arrange an appointment. For referral information for GPs and optometrists, visit the Northern Eye Consultants for-referrers page. Further information on cataract surgery Melbourne including a published five-year surgical outcomes audit is available at drmacintyre.com. For referral information for optometrists including guidance on complex cases, visit the dedicated referrers page at corneaeyedoctor.com.

References

1. Light Adjustable Lens Results of Spherical Equivalent and Astigmatism Correction from the FDA Post-Approval Study. PubMed 41664266. https://pubmed.ncbi.nlm.nih.gov/41664266/
2. Jones M, et al. Clinical outcomes of the light-adjustable lens in eyes with a history of prior corneal refractive surgery. J Cataract Refract Surg. 2024;50(9):936-941. https://pubmed.ncbi.nlm.nih.gov/38736178/
3. ASCRS 2025 Systematic Review: Visual Outcomes of the Light Adjustable Lens. https://www.ascrs.org/clinical-education/presentations-on-demand/meetings/2025-ascrs-annual-meeting/papers/2025-sps-114
4. Wong JR, et al. Visual Outcomes of an Enhanced UV Protected Light Adjustable Lens Using a Novel Co-Managed, Open-Access Methodology. Clin Ophthalmol. 2022. https://pubmed.ncbi.nlm.nih.gov/35957659/
5. RxSight UV-Protective Glasses: Best Practices and FAQs. RxSight Inc. https://rxsight.com/blog/uv-protective-glasses-faqs/
6. RxSight Light Adjustable Lens: Practice Integration. Review of Ophthalmology. https://www.reviewofophthalmology.com/article/light-adjustable-lens-practice-integration
7. RxSight's test drive approach could reshape cataract surgery. Insight News. 2026. https://www.insightnews.com.au/rxsights-test-drive-approach-could-reshape-cataract-surgery