Premature photopolymerization from ambient light exposure in a patient with an enhanced UV-protected light adjustable lens

Introduction: This report describes a case of irregular astigmatism induced by presumed premature photopolymerization of a light-adjustable lens (LAL) with ActivShield exposed to ambient light over a 2-year period without postoperative light treatments. Patient and Clinical Findings: A 74-year-old woman with blurry vision was referred for evaluation of distorted optics in an ActivShield LAL 2 years after cataract surgery complicated by a posterior capsule tear and vitreous prolapse requiring anterior vitrectomy and sulcus placement of the IOL. She had not received any postoperative light treatments to adjust or lock-in the IOL, which resulted in apparent premature photopolymerization of the optic material in the area of her pupil due to ambient light exposure. Diagnosis, Intervention, and Outcomes: The distorted LAL was exchanged for a conventional monofocal IOL with excellent visual results. After IOL exchange, the patient's visual distortion resolved. Her uncorrected distance visual acuity was 20/25, which improved to 20/20 with correction. Conclusions: ActivShield UV protector cannot indefinitely protect the LAL 2.0 from premature photopolymerization because of accidental exposure to ambient light. To achieve optimal visual outcomes, preoperative and postoperative counseling is critical to ensure compliance with UV protection until all light treatments have been completed.