Comment on: Anchor-assisted capsular bag IOL implantation to correct subluxated lenses in children with Marfan syndrome: long-term follow-up

Reply: Clinical data registry comparing outcomes of two light adjustable lenses.We appreciate the thoughtful comments by Drs.Kocamis and Kesimal on our paper.This paper reports on real-world data collected from U.S. doctors who have used light-adjustable lens (LAL) and LAL + in a commercial setting. 1 We acknowledge that it was not a prospective randomized controlled trial with strict inclusion/exclusion criteria and manual of procedures.Baseline characteristics were also not collected, making it impossible to determine whether the 2 cohorts are comparable.As such, the comments that there are confounding factors that limit inferences that can be drawn are valid.There are a few points that need to be clarified.The LAL + optical profile has a broader depth of focus (DoF) compared with the LAL.Although clinical DoF was not used as the primary differentiating measure between the 2 IOLs, distance-corrected intermediate and near showed slightly better results with the LAL + , providing clinical evidence that supports the optical design.A 1-sided t test was used for the visual acuity comparisons where we had a directional hypothesis based on optical modeling.A 2-sided t test was used for the refractive accuracy comparisons.This distinction was not made clear in the article.Patient-reported outcomes were not used in these patients who underwent the procedure in a commercial setting.Quality of vision was measured using low-contrast acuity.We agree with the comment that the development of adjustable optics is important in addressing postoperative refractive surprises but would also like to stress that this technology addresses the problem that patients and doctors do not know what the patients want for their refractive target.It is nearly impossible for patients with cataracts to decide on their target refraction.This is evidenced by the 55.3% of patients modifying their refractive target during the adjustment period based on their visual function demand and tolerance to anisometropia.Although this can be seen as a confounding factor for a clinical trial, we, and our patients, find this positive feature a differentiator of the technology.