The Light Adjustable Lens (LAL):
An Honest Look Before You Choose
The Light Adjustable Lens is heavily marketed as the lens you can fine-tune after surgery. That part is true. What patients hear less about is the burden of the adjustment process, reports of the lens clouding after it is locked in, and the fact that after all those visits you end up with what is essentially an enhanced monofocal lens. As cataract surgeons in Upland, we believe you deserve the complete picture before choosing any lens implant.
What the Light Adjustable Lens Is
The Light Adjustable Lens (LAL), made by RxSight, is a silicone lens implant containing light-sensitive material. After cataract surgery or refractive lens exchange, the lens power is adjusted inside the eye with a series of ultraviolet (UV) light treatments using an office device called the Light Delivery Device. Once you and your surgeon are satisfied with the result, two final "lock-in" treatments make the power permanent.
The appeal is obvious: the prescription can be refined after the eye has healed. For a small group of patients, especially those with prior LASIK or RK whose lens-power calculations are genuinely unpredictable, that adjustability has real value. But adjustability is not the whole story.
What the Marketing Leaves Out
1. It is a demanding process, not a single surgery
The LAL requires multiple office visits after the operation: typically two to four light-adjustment sessions plus two lock-in sessions, each with dilation. Between surgery and the final lock-in, you must wear special UV-protective glasses during all waking hours, indoors and out, sometimes for months. If UV light reaches the lens before lock-in, it can change the lens power in an uncontrolled way. Patients who travel, live far from the office, or simply want to be done with surgery often find this schedule burdensome.
2. Reports of the lens clouding after lock-in
Surgeons around the country have reported cases in which the LAL develops cloudiness or opacification after the lock-in period. This is clouding of the lens material itself, which is different from the common and easily treated clouding of the capsule behind any lens implant. When the lens itself opacifies, no laser or medication can clear it. The only remedy is to surgically remove and exchange the lens.
3. Removing an LAL is harder than removing many other lenses
Every lens implant can be exchanged if necessary, but they are not all equally easy to remove. The LAL is a three-piece silicone lens whose haptics (the arms that hold it in place) can scar into the capsule over time, and an eye that has already had a YAG capsulotomy makes any exchange more delicate. Surgeons experienced in lens exchange report that removing an LAL is more problematic and carries more potential for complications than exchanging many other lens types. Dr. Shannon Wong, a high-volume lens-exchange surgeon in Austin who has performed hundreds of intraocular lens exchanges, has documented these situations candidly on his channel, including LAL patients unhappy with their quality of vision and an LAL exchange performed after YAG capsulotomy. His videos are linked below because we think patients considering this lens should watch them.
4. After all that work, it is essentially an enhanced monofocal lens
This is the point most patients miss. The LAL does not create the multiple focal points of a multifocal lens or the elongated focus of a true extended depth of focus (EDOF) design. Once the adjustments are finished, the optic behaves essentially like an enhanced monofocal. Extended depth of focus lenses provide a meaningfully greater range of vision than the LAL, and multifocal lenses provide more depth of field still, with the highest rate of freedom from glasses of any lens category. Most LAL patients still need reading glasses for near work.
Watch: A Lens-Exchange Surgeon's Experience with the LAL
These videos are by Shannon Wong, MD (Austin Eye), an ophthalmologist who performs a high volume of lens implant exchanges and shares his outcomes publicly. They are independent of our practice; we link them because they show real cases of the problems described above.
LAL in 2026: How Well Does It Work? (Shannon Wong, MD)
LAL Exchange After YAG Capsulotomy: Unhappy LAL Patient (Shannon Wong, MD)
LAL: Truth vs. Hype (Shannon Wong, MD)
How the LAL Compares to Other Premium Lenses
- Monofocal: one sharp focal distance, excellent optical quality, glasses for the other distances. The LAL ends up in this family, with an adjustable prescription.
- Toric: corrects astigmatism at the time of surgery, without months of UV glasses and light treatments.
- Extended depth of focus (EDOF): a genuinely elongated range of clear vision, distance through intermediate, considerably more depth of field than the LAL provides.
- Multifocal / trifocal: the greatest depth of field and the highest rate of complete freedom from glasses, including reading, in appropriately selected eyes.
Every lens involves trade-offs, and no single lens is right for every eye. Our objection is not that the LAL exists; it is that patients are often sold months of visits, UV glasses, and real removal risks without being told that simpler paths to better depth of field exist for most eyes.
Get an Honest Lens Consultation in Upland
Dr. Marc Shomer, MD, PhD and Dr. Robert Gunzenhauser, MD are board-certified ophthalmologists trained at the Jules Stein Eye Institute at UCLA. Dr. Shomer teaches cataract surgery as an Adjunct Associate Professor of Ophthalmology at the Keck School of Medicine of USC. We offer the full range of monofocal, toric, EDOF, and multifocal lens implants, we tell you plainly which one fits your eyes and your life, and we welcome second opinions, including from patients who have been quoted the Light Adjustable Lens elsewhere.
Answers from our surgeons.
Does the Light Adjustable Lens eliminate reading glasses?
Usually not. After the adjustments are complete the LAL behaves essentially like an enhanced monofocal lens, and most patients still use glasses for reading. Extended depth of focus lenses provide a greater range of vision than the LAL, and multifocal lenses provide the greatest depth of field and the highest rate of freedom from glasses.
What happens if a Light Adjustable Lens becomes cloudy after lock-in?
Clouding of the lens material itself cannot be cleared with a laser or medication. The only remedy is surgical removal and exchange of the lens, and exchanging an LAL is generally more difficult and carries more potential complications than exchanging many other lens types.
How many visits does the LAL process require?
Plan on the surgery itself plus typically two to four light-adjustment visits and two lock-in visits, each with dilation. Until the final lock-in you must wear UV-protective glasses during all waking hours, sometimes for months.
Is the Light Adjustable Lens ever a good choice?
For select eyes, particularly patients with prior LASIK or RK whose lens-power calculations are genuinely unpredictable, the adjustability can be valuable. For most eyes, simpler paths such as toric, EDOF, or multifocal lenses reach better depth of field without the added burden and risks. We review your specific measurements and goals before recommending any lens.
Talk Through Your Lens Options
Call 909-981-9800 or request an appointment online. Our office is at 1298 W 7th Street, Upland, CA 91786, with free parking behind the building.