Eyeworld

HIGHLIGHTS FROM THE 2026 ASCRS CLINICAL SURVEY Presbyopia correction It's always interesting to consider the percentage of cataract procedures that involve presbyopia-correct- ing (depth of field or DOFi) IOLs. This year, around a quarter (26%) of respondents were in the 6–15% range, and another quarter (23%) were in the 16–35% range. Overall, the average of total cataract procedures involving DOFi IOLs was 18%. Compared to other industry estimates, this might seem a bit optimistic. As far as primary reasons for not performing any/ additional DOFi IOL procedures, there are a number of different reasons. I structure all of my thoughts regarding challenges in presbyopia correction around the framework of the Visual Quality RST Triad: visual quality and its relation to visual range, visual symp- toms, and visual tolerance. For example, "lack of accessibility to laser vision correction" ties into concern for visual quality and visual tolerance (to refractive er- ror). Concerns about comorbidities are really concerns about achievable visual quality and induction of visual symptoms (dysphotopsias) with respect to expecta- tions. Surprisingly, there's no mention of dysphotopsias in the survey, but they likely fall under the 60% who responded "other." Finances are always a concern. Although some patients simply cannot afford the investment, adoption rates of DOFi IOLs in healthcare systems that actually pay for them are surprisingly no higher than else- where. It's not about cost; it's about patients and sur- geons recognizing the value of correcting presbyopia. I think presbyopia correction should at least be considered for every patient undergoing cataract sur- gery. The value is not only a financial one for surgeons but also a safety one for patients because there's no better way of treating presbyopia than surgically. Multifocal glasses have a high association with falls in the elderly. That leads to the final question here: "Of the presbyopia-correcting lenses that you have implanted within the last 2 years, in what percentage have you had to manage issues related to patient dissatisfaction with their outcomes?" Looking at the percentage of those needing postop management including dry eyes, refractive care, and surgical intervention, it's about 5% average. That's also surprisingly low, but just one unhappy patient is enough to bring pause to any sur- geon. It would be nice to break this down further into the exact type of postop management needed because some issues are independent of presbyopia correction, and not all issues are of equal complexity. Overall, there is continued strong interest in presbyopia correction. It will be interesting to see if the recent introduction of a new fully refractive partial DOFi IOL impacts these results in next year's survey. —Daniel Chang, MD ASCRS Refractive Surgery Clinical Committee Chair Note: Other represents 60% Based on those who are not currently performing presbyopia-correcting IOLs (20%); n=164 What are your primary reasons for not performing any/additional presbyopia-correcting IOL procedures? (Select all that apply) 6% Prevalence of ocular co-morbidities 3% Concern over inadequate unaided near vision 2% Concern over inadequate unaided distance vision 2% Concern over inadequate unaided intermediate vision Lack of accessibility to laser vision correction to correct residual error 15% 13% I'd like to present the option, but my patients cannot afford the additional cost 9% I do not always present the option because I do not think patients will want to pay out-of-pocket 12% Concern over quality vision pq Statistically significant difference between segments n=817 What percentage of your current cataract procedures involve presbyopia-correcting IOLs? AVERAGE PROCEDURES BY SEGMENT 2026 Practice location U.S. 17% International 20% Years in practice Early stage (0–5 years) 16% Mid-stage (6–10 years) 17% Late stage (11+ years) 20% Perform majority of surgeries in Hospital outpatient department (HOPD) 16% Office 23% p Gender Male 18% Female 18% 1–5% 19% 14% None, and I have no plans to integrate 26% 6–15% 6% None, but plan to integrate in the next 12 months 23% 16–35% 12% >35% 18% Average cataract procedures involving presbyopia- correcting IOLs Based on those currently performing presbyopia-correcting IOLs (80%) n=653 Of the presbyopia-correcting lenses that you have implanted within the last 2 years, in what percentage have you had to manage issues related to patient dissatisfaction with their outcomes (including the need for optical correction, refractive enhancement, visual disturbances from ocular surface disease, need for explantation, etc.)? (Select one) 2% >20% 0–1% 28% 43% 2–5% 7% 11–20% 20% 6–10% The average for all segments is 5%. 5% Average presbyopia-correcting lenses implanted needing postop management

• Cover