Eyeworld

58 | EYEWORLD | FALL 2026 R EFRACTIVE Relevant disclosures Mathews: Alcon, Johnson & Johnson Vision, RxSight Waring: BVI Medical, Johnson & Johnson Vision Weinstock: Alcon, Bausch + Lomb, BVI Medical, Johnson & Johnson Vision overload." What's more, he said patients come in with a range of knowledge, from knowing nothing about advanced-technology IOLs to those who come in asking for a specific lens. "For refractive cataract surgeons, probably one of the most challenging aspects has become the preoperative consult, diagnostic testing, and the ocular and medical history that could affect can- didacy for IOL choices," he said. With the nuances for successful presby- opia-correcting IOL selection not well covered in residency, Dr. Weinstock said there are more practices offering fellowships in refractive cataract surgery. He said that modern cataract surgeons need to be open to trying new things because "if you don't, you fall behind." "You just have to do it thoughtfully and be trained in an environment that has that philosophy," he said. When it comes to refractive lens exchange, Dr. Mathews thinks these patients desire greater spectacle independence than most cataract patients. Therefore, she's reaching most often for full range of vision IOLs. "My two favorites are the Odyssey [Johnson & Johnson Vision] and the FineVision," she said. Over time, she has seen her conversations evolve with these IOLs when it comes to dysphotopsias; she still discusses these visual side effects but finds fewer of them compared to earlier IOLs. "We're not having to handhold as much. … The neuro- adaptation process is quicker with these newer lenses," Dr. Mathews said. Dr. Weinstock also said he has become so comfortable with how some of the full depth of field IOLs work that he's implanting in clear lens exchange patients at a rate that he would not have 10 years ago with earlier generation multifocal IOLs. He's also more confident performing clear lens ex- change on patients with lesser degrees of refrac- tive error thanks to advances in IOL options. Dr. Weinstock said that even with more options in the presbyopia-correcting IOL sub- categories, there is no one-size-fits-all option, though he's finding that more patients are having success with these lenses, requiring fewer enhancements or IOL exchanges. He's ex- changing (his preferred method for addressing an unhappy patient) at a rate of 1–2 lenses out of 100. "It's no longer taboo or considered high risk to do an exchange. In today's world, it's part of the arena and not considered a failure or complication. It's part of the process in a small percentage of patients who need it," he said. the range of field while maintaining contrast sensitivity and distance on par with a monofocal IOL." Dr. Weinstock explained that the optic of PureSee, being non-diffractive, features a blend- ed change of power/curvature from the center to periphery of the lens on the posterior surface. Dr. Waring also said that by optimizing and redistributing contrast sensitivity across the visual range, patients with this lens appear to have a greater tolerance to refractive error. "Early data suggests PureSee might be one of the most effective lenses to mitigate refractive error," he said. PureSee has been a great addition to the category for patients who historically would not have been a good candidate for a diffractive IOL, Dr. Waring said. "It's quickly becoming the lens of choice for post-myopic LASIK patients, and that's due to tolerance of refractive error." One of the things that puts PureSee on a different level, according to Dr. Mathews, who has been implanting this lens since April 2026, is the established TECNIS platform, which she said has good contrast sensitivity. "If I'm going to use an EDOF lens, it's going to be the PureSee lens," she said. She said this lens also appears to be a better fit for patients who are concerned about glare and halos, if they're willing to wear readers for small print after surgery. However, Dr. Mathews said she has had success achieving more near vision for her patients by offsetting the non-dominant eye by –0.5 D. Evolution of IOL subcategories "We have more choices than ever, and it's an amazing time to be a refractive cataract sur- geon," Dr. Waring said, noting that it's natural in the innovation evolution cycle for new technolo- gy to join the category while at times, leading to retirement of older technology. Overall, Dr. Waring said he thinks these "new kids on the block" may appeal to ophthal- mologists who were not offering presbyopia-cor- recting IOLs in general or who were being very conservative in offering them to select candi- dates due to being burned or hearing about less than ideal outcomes from colleagues using older technology. "If they are looking for something new but less likely to cause issues, these new lenses could bring them off the fence." Dr. Weinstock acknowledged that all of these options in the presbyopia-correcting IOL subcategories can carry some level of "sensory continued from page 57 Contact Mathews: priya.m.mathews@gmail.com Waring: gwaring@waringvision.com Weinstock: rjweinstock@yahoo.com

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