If you are researching the Light Adjustable Lens™ (LAL®) and you have landed on the word “problems,” here is the direct answer. The real drawbacks are not surgical complications. They are the demands the lens makes on your time and your discipline: UV-protective glasses every waking hour until lock-in, three to five additional office visits, and a care period that runs weeks longer than a conventional lens. In exchange, the power of your lens is set after your eye has healed, based on what you actually see, rather than predicted before surgery. I think that is a good trade for most of my patients. It is not a good trade for all of them.
I am Dr. Gregg Feinerman. I have implanted premium intraocular lenses since 2003, and I want to walk through the honest cost of adjustability before you decide.
What Light Adjustable Lens problems should you actually expect?
Every intraocular lens used in cataract surgery involves a prediction. Your surgeon measures your eye, runs formulas, and picks a lens power before making a single incision. If the prediction is slightly off, you live with the result or you wear glasses.
The Light Adjustable Lens is the only FDA-approved lens implant that can be adjusted after surgery. I implant it, your eye heals, you drive and read and work with the vision you have, and then brief, painless in-office light treatments, typically one to three, fine-tune the prescription based on your actual measured vision rather than a preoperative estimate. Once you are happy with your vision, two quick lock-in treatments make it permanent.
That design solves the prediction problem. It also creates the four demands below, which are what patients mean when they search for Light Adjustable Lens problems.
Light Adjustable Lens problems that are not actually problems
Two things patients worry about that the data does not support. The light treatments themselves are not painful, and in one published series of 34 eyes there were no adverse events attributable to them (Ichikawa et al., J Refract Surg, 2024). And a YAG capsulotomy later on, the routine laser polish many patients need months or years after cataract surgery, does not undo your adjustment. In a review of 485 Light Adjustable Lens eyes, YAG was safe and did not significantly change lens power or adjustment results, whether it was performed before or after lock-in (Abing et al., J Cataract Refract Surg, 2025).
UV glasses and lock-in: the Light Adjustable Lens problems patients notice first
This is the one nobody enjoys. The lens material responds to ultraviolet light, which is exactly what makes it adjustable, and it cannot tell the difference between my light delivery device and the sun. Until the day after your final lock-in treatment, the manufacturer’s instructions call for UV-protective glasses during all waking hours, indoors and outdoors, and the lens is shipped with clear pairs for indoors and tinted pairs for outside. Ultraviolet light includes sunlight through a window. I will go through exactly what this means for your daily routine at your visits.
What is not negotiable is protecting the lens from sunlight. Ultraviolet light reaching an unlocked lens can change your result in a way I cannot reverse.
If you cannot commit to wearing them consistently, tell me at your consultation. That is a reason to choose a different lens, and I would rather hear it before surgery than after.
Who performs your light treatments
RxSight has recognized me for completing more than 500 Light Adjustable Lens procedures, and Dr. Sally Corvacho, OD, for performing more than 500 light adjustment treatments here at Feinerman Vision. Your adjustments are done in our office by the same two people, every visit. There are no hand-offs to outside providers.
How many extra visits does the Light Adjustable Lens really take?
Plan on three to five additional office visits, on top of your normal post-operative schedule. That range comes from our own 2025 series: 46% of eyes needed a single light treatment, 30% needed two, and 25% needed three, and every eye then has two brief lock-in treatments. Our patients averaged about 1.8 light treatments, so with the two lock-ins the typical patient made about four extra trips to our office, and nearly half made three. In a published comparison, Light Adjustable Lens patients averaged 9 postoperative visits against 6 for monofocal patients (Merikansky et al., J Refract Surg, 2026).
The calendar stretches as well. With a conventional lens, your care typically wraps up within about a month. With the Light Adjustable Lens, the light treatments and lock-in run several weeks beyond that, because we wait for your eye to settle before each adjustment. You are buying customization with your calendar.
If you travel constantly, live several hours away, or cannot reliably attend appointments for two months, this lens fights your life. Say so, and we will look at other options.
Are Light Adjustable Lens problems more likely after LASIK, PRK, or RK?
This is the question I get most often, and the answer runs the other way. Prior corneal refractive surgery is the situation where this lens earns its keep.
LASIK, PRK, and radial keratotomy all reshape the cornea, which is precisely what makes standard lens power calculations less reliable in these eyes. The Light Adjustable Lens sidesteps that problem, because the final power is set after healing from your actual refraction rather than estimated from an altered cornea. It is my lens of choice for patients with prior LASIK, PRK, or most prior RK.
These are the eyes where we watch our numbers most closely. In our 2025 series, 48 eyes had prior LASIK, PRK, or RK. 96% landed within 0.50 diopters of the target prescription, 90% within 0.50 diopters of the target astigmatism correction, and 86% of the distance-targeted eyes saw 20/20 or better uncorrected. The 15 post-RK eyes in that group, the hardest of the hard, were 100% within 0.50 diopters of target. Individual results vary.
The published results in these eyes point the same way. In 76 eyes with prior laser corneal refractive surgery targeted for distance, 86% landed within 0.50 diopters of target and 74% saw 20/20 or better uncorrected (Jones et al., J Cataract Refract Surg, 2024). In 94 post-RK eyes, ranging from 4-cut to 16-cut procedures, 88% were within 0.50 diopters and 98% within 1.00 diopter (Webster et al., J Cataract Refract Surg, 2025).
One genuine caveat for RK patients: the Webster authors recommend delaying adjustments to let the refraction stabilize, which is exactly what I do. Your care period will run longer than average. That is a feature, not a delay.
Who is not a candidate for the Light Adjustable Lens?
Candidacy is decided at an examination, not on a web page, but these are the factors I evaluate:
- Pupil size. The adjustment is delivered through your pupil. A pupil that will not dilate adequately limits my ability to treat the lens.
- Certain medications. Some drugs increase light sensitivity or affect dilation and require review before we proceed.
- Retinal conditions. Some retinal disease changes both the risk calculation and the visual benefit you can expect.
- Ability to sit for treatments. Each light treatment requires you to hold steady at the device. Tremor, severe neck or back limitation, or difficulty with fixation can make this impractical.
- Willingness to wear the glasses. Discussed above, and the most common reason I steer a patient elsewhere.
None of these are disqualifying on their own. All of them are reasons to be examined before you commit to a lens.
How often does the lens actually land on target?
This is the number the tradeoffs are buying.
What the published studies report
In the FDA post-approval study of 332 eyes with corneal astigmatism, 93.1% of Light Adjustable Lens eyes were within 0.50 diopters of target spherical equivalent, and residual astigmatism of 0.50 diopters or less was achieved in 92.5%, against roughly 76% in two contemporary toric monofocal datasets (Holladay and Haller, 2026). A multicenter registry reported 91.1% of eyes within 0.50 diopters with the Light Adjustable Lens and 93.5% with the LAL+ (Doane et al., 2025).
Our own 2025 results
Across our 2025 series of 137 eyes, 98% were within 0.50 diopters of the target prescription, and 91% of eyes targeted for distance saw 20/20 or better uncorrected. Among the 48 eyes with prior LASIK, PRK, or RK, 96% were within 0.50 diopters. These are different cohorts from the published studies above, measured at a single practice, so this is not a head-to-head comparison. Individual results vary. The full series is published on our outcomes page.
What I tell my patients
When someone asks me whether the Light Adjustable Lens is worth the trouble, I ask them a question back: how much does it bother you to be close but not exact?
For a patient who would be content wearing glasses, a conventional monofocal is a fine lens. However, for someone who has spent thirty years in glasses and wants to know their result was verified rather than estimated, the extra visits stop feeling like a cost.
The patients who regret this lens are the ones who were not told what it would ask of them. That is why this page exists. If you had LASIK years ago, the calculation is different: the Light Adjustable Lens is my go-to lens for eyes with prior LASIK, because it is the one lens that lets me set your final power after healing instead of predicting it from a cornea that laser surgery has reshaped. I have written about that specifically in our guide to the Light Adjustable Lens after LASIK and to cataract surgery after LASIK.
Lens choice is personalized to your anatomy, your lifestyle, and your visual goals, informed by iTrace, Pentacam, Zeiss IOLMaster, OCT, and my own examination. No single lens is right for everyone, and I will tell you when a different one fits you better. You can read the full overview on our Light Adjustable Lens page, or, if you are weighing lens replacement before cataracts have developed, our refractive lens exchange page.
Book your evaluation with Dr. Feinerman at FeinermanVision.com or (949) 631-4780, and we will go through your measurements together and decide whether you may be a candidate.
FAQs About Light Adjustable Lens Problems
How long do I have to wear the UV glasses after a Light Adjustable Lens?
The manufacturer’s instructions call for them from the day of surgery until the day after your final lock-in treatment, during all waking hours, indoors and outdoors, with clear pairs supplied for indoor use. For most patients that period runs several weeks, and I go through the specifics of your routine at your visits.
Are the light treatments painful?
No. You sit at the light delivery device and look at a target while the treatment is delivered. In a published series of 34 eyes, there were no adverse events attributable to the light treatments (Ichikawa et al., 2024).
Can the adjustment wear off or change later?
Once the lens is locked in, the power is permanent. A YAG capsulotomy performed afterward does not significantly change lens power or the adjustment result (Abing et al., 2025).
What happens if I miss a light treatment appointment?
Tell us and we will reschedule. The lens stays adjustable until it is locked, so the main consequence is a longer period in UV-protective glasses. Continuing to wear them is essential while you wait.
Is the Light Adjustable Lens more expensive than a standard lens?
Cost depends on which lens you choose and, in the case of cataract surgery, on what your insurance covers. Per-eye figures for every situation are on our Light Adjustable Lens cost page, and we go through the specifics at your consultation so you see the whole picture before deciding.
Can I get the Light Adjustable Lens if I had radial keratotomy?
Often, yes, and it is usually my preferred lens for RK eyes. Adjustments are deliberately delayed in these eyes to allow the refraction to stabilize, so plan on a longer care period.
Related Reading
- Light Adjustable Lens (Pillar)
- What Happens at a Light Adjustable Lens Treatment Visit
- The Light Adjustable Lens After LASIK
- The Light Adjustable Lens After RK
- Our Light Adjustable Lens Results
- Cataract Surgery After LASIK
- Light Adjustable Lens Cost in Orange County
References
- Abing AA, Lee JK, Tran DB. J Cataract Refract Surg. 2025. doi: 10.1097/j.jcrs.0000000000001621
- Doane J, Newsom TH, Slade S, et al. J Cataract Refract Surg. 2025. doi: 10.1097/j.jcrs.0000000000001721
- Holladay JT, Haller M. J Cataract Refract Surg. 2026;52(7):666-669. doi: 10.1097/j.jcrs.0000000000001906
- Ichikawa K, et al. J Refract Surg. 2024. doi: 10.3928/1081597X-20241002-03
- Jones M, Terveen DC, Berdahl JP, et al. J Cataract Refract Surg. 2024. doi: 10.1097/j.jcrs.0000000000001481
- Merikansky S, et al. J Refract Surg. 2026. doi: 10.3928/1081597X-20260408-02
- Webster M, Baartman B, Jones M, et al. J Cataract Refract Surg. 2025. doi: 10.1097/j.jcrs.0000000000001596