The Annual ACES/SEE Caribbean Eye Meeting presents hot topics for anterior segment surgeons and healthcare professionals.

Mark your calendar for the 2026 Caribbean Eye meeting, taking place February 6–9 at the luxurious Kempinski Hotel in Cancún, Mexico. Join Program Chairs William Wiley, MD, and Robert Weinstock, MD, alongside esteemed ophthalmology experts, for an inspiring event focused on advancing eye care. Earn CME/COE credits while gaining insights, building connections, and boosting your clinical skills in a breathtaking tropical setting. Below, you’ll find a summary of one of the standout presentations from the 2025 meeting—a preview of the rich content Caribbean Eye has to offer. Scan the QR code to watch this and other key sessions from the meeting.

The Light Adjustable Lens in Extreme Eye Lengths

Piggybacking the LAL in challenging eyes.

By John F. Doane, MD

Here, I highlight two piggyback IOL cases in which I implanted the Light Adjustable Lens (LAL; RxSight) in the capsular bag after first implanting a posterior-chamber IOL.

Case 1

A 70-year-old White female presented in 2024 with a cataract. Her refraction was -9.00 +2.50 x 111 OD and -19.00 +2.50 x 082 OS. The left cornea had a steep anisometropic cone (55.84/58.67 x 171). The axial lengths were similar: 25.48 OD and 26.12 OS. I targeted plano for the right eye and likely -1.00 D for the left. The right eye’s surgery was straightforward: a single +7.00-D LAL. For the left eye, I knew that implanting a -10.00-D AR40M Sensar lens in the posterior chamber capsular bag would result in roughly +0.44 D of residual refractive error that would require inducing some myopia to ensure a myopic result if I were off with my calculations. At the time, the lowest-powered LAL available was +4.00 D. I predicted +4.00 would result in -2.64 D if placed in the capsular bag piggy-back, and if the AR40 predicted + 0.44 the result sum guestimate would be equal to -2.20 D (using the Kane Keratoconus formula for the AR40 Sensar lens).

Before the LAL adjustment, the right eye (with a single lens) was 20/70 UCDVA and J10 UCNVA. The left eye with piggybacked lenses was 20/30 UCDVA and J8 UCNVA (slightly above target). After the first adjustment, the patient achieved 20/30 OD and J2 UCNVA. The left eye achieved 20/60 and J1. We did a second adjustment. Prior to the second lock-in, she saw 20/25 and J3 in the right eye, and 20/40 and J1 in the left eye. With both eyes together, her vision was 20/20 and J1. I don’t think I could have achieved this outcome by placing a single lens with any other technology.

Case 2

A 75-year-old male with significant retinal history presented with cataracts. He’d worn rigid gas permeable lenses for quite a while. His refractions were -11.25 +3 x 125 OD and -14.5 +4.5 x 070.The axial length in both eyes was almost 26 mm. He had an ocular history of retinal tears OU and a scleral buckle OS. After 6 months out of the RGP lenses, his cylinder measured 51.5/59.0 x114 (7.47D) OD and 52.4/58.6 x 076 (6.18D) OS. With such long eyes and steep corneas, the lowest available spherical power of toric IOLs would have left him with an SE of -2.63 OD and -4.58 OS. I proceeded with piggybacked IOLs. For the right eye, a -8.00-D AR40 lens (Sensar) was placed posteriorly, predicting +2.96 D of refractive error, and a + 4.00-D LAL was implanted anterior to the Sensar, predicting -1.96 D of refractive error for a sum of +1.00 D prior to adjustment. For the left eye, a -10.0-D AR40M was placed posteriorly, predicting +2.23 D of refractive error, and a +4.00-D LAL was placed anterior to the Sensar, predicting -2.24 D of refractive error, for a sum of +0.06 D prior to adjustment. At 6 months postoperatively, after 4 adjustments and 2 lock-ins, he achieved 20/40 distance and J5 near vision OU.

Click here to watch the full presentation, including Case #3.

Panel Discussion

Following my case presentations, fellow panel members and I held an interactive discussion with audience participation to discuss our clinical use of the LAL (Figure).

Figure. From left to right: Zarmeena Vendal, MD; Cathleen McCabe, MD; James Katz, MD; Arjan Hura, MD; and John Doane, MD.