Eyeworld

42 | EYEWORLD | WINTER 2026 ATARACT C TO THE MOON AND BACK more clout and get more attention than when just one person is pushing the ideas." Dr. Miller said the Task Force will assemble their best list of innovation priorities to meet unmet needs within anterior segment surgery, which will then be considered by the ASCRS Executive Board. In the spirit of starting to think about un- met needs in cataract surgery, EyeWorld asked Dr. Naseri and David F. Chang, MD, for their perspectives on this front. IOLs Dr. Chang said he finds the lack of lower power toric presbyopia-correcting IOLs in the U.S. "inexcusable." "In terms of uncorrected distance visual acuity, monofocal IOLs are reasonably forgiving of 0.5 D–0.75 D of residual astigmatism. How- ever, EDOF and multifocal IOLs are less tolerant because they distribute light across an extended range or multiple focal points along the defocus curve," Dr. Chang said. "Residual astigmatism lowers contrast at every point along the defo- cus curve and significantly reduces functional range. Outside the U.S., manufacturers offer low toric powers for presbyopia-correcting IOLs at no additional charge. FDA regulatory require- ments have effectively made the U.S. the only country in the world where patients cannot receive presbyopia-correcting IOLs with lower toric powers." Dr. Naseri acknowledged that the premium IOL channel has grown significantly in terms of astigmatism correction, postoperative power adjustability, extended depth of focus (EDOF), and multifocality, but he said an important gap remains: delivering a full range of vision with- out dysphotopsias. "Although 'light splitting' technologies have improved incrementally over the last two decades, they have not resolved this issue," Dr. Naseri said. "Dysphotopsias remain the most common reason for IOL explantation and, perhaps more importantly, the most challeng- ing preoperative concern for patients choosing among IOL options. Because of this compro- mise, the vast majority of patients still opt for monofocal and toric lenses over EDOF and multifocal lenses. Many start-ups are pursuing a I f you look at cataract surgery from a histor- ic perspective, many of its basic needs and innovations have been satisfied, but if you ask today's ophthalmologists, there are still a myriad of unmet needs. "Cataract surgery has evolved into a highly mature and efficient market. Where signifi- cant unmet needs have existed, market forces and inventor ingenuity have quickly stepped in to fill the gaps," said Ayman Naseri, MD. "In the 75 years since Ridley first implanted an IOL, advances in technology and technique have touched nearly every element of cataract surgery, including preoperative diagnostics, perioperative management, surgical technique, phacoemulsification, and, of course, the IOL itself. Together, these advances have produced a safe, efficient procedure that delivers significant value to patients and surgeons alike. So, what are the remaining unmet needs?" This is what the new ASCRS Innovation Priorities Task Force will put forth. Started un- der the direction of ASCRS President Kevin M. Miller, MD, with agreement from the Executive Board, and chaired by Kuldev Singh, MD, MPH, with John Vukich, MD, William Trattler, MD, Reay Brown, MD, Steven Sarkisian Jr., MD, and Clara Chan, MD, the Task Force will put togeth- er a document of what it thinks are the import- ant unmet needs that could improve patients' lives in the area of anterior segment surgery. "We hope to get broad input in this pro- cess. The goal is to create a document that can be shared as a roadmap that is helpful to all stakeholders with an interest in innovation to advance the diagnosis and treatment of eye disease," Dr. Singh said. Dr. Miller said he started giving presenta- tions at major ophthalmic meetings in 2018 that described "Ten Things Industry Partners Should Do for the Benefit of Cataract Surgeons and Their Patients." He received positive feedback on the ideas, but this was usually followed by comments about a lack of financial backing for these priorities at the time. Not a single idea that he presented was acted upon, he said. "The Innovation Priorities Task Force is an attempt to pursue this goal once again," Dr. Miller said. "If a list of priorities can be pub- lished and endorsed by ASCRS, it might carry Shoot for the stars: identifying and addressing unmet needs in cataract surgery About the physicians David F. Chang, MD Altos Eye Physicians Los Altos, California Kevin M. Miller, MD Kolokotrones Chair in Ophthalmology Chief of the Cataract and Refractive Surgery Division Department of Ophthalmology David Geffen School of Medicine at UCLA Los Angeles, California Ayman Naseri, MD Professor Department of Ophthalmology University of California, San Francisco San Francisco, California Kuldev Singh, MD, MPH Professor of Ophthalmology Chief of the Glaucoma Division Stanford University School of Medicine Stanford, California by Liz Hillman Editorial Co-Director

• Cover