Eyeworld

WINTER 2026 | EYEWORLD | 53 R TO THE MOON AND BACK by Liz Hillman Editorial Co-Director About the physicians Joaquín Fernández, MD, PhD CEO Qvisión Medical Director Andalusian Ophthalmology Institute at Vithas Hospitals Almeria, Spain Douglas Koch, MD Department of Ophthalmology Cullen Eye Institute Baylor College of Medicine Houston, Texas E DOF. Trifocal. Multifocal. Enhanced monofocal. There are a large number of IOLs beyond the traditional, single focus monofocal IOL, each working in differ- ent ways to achieve varying degrees of spectacle independence. Ophthalmologists using these lenses have increasingly found that describing these IOLs based on their optical design doesn't always correlate with what patients experience in terms of their vision. "Terms such as multifocal, trifocal, or EDOF describe aspects of optical design, but two lenses with the same optical label may provide different functional vision, while lenses with different designs may perform very similarly," said Joaquín Fernández, MD. With this, several societies—ESCRS, ASCRS, APACRS, LATAMSCRS—formed the Functional Vision Working Group to create, as Dr. Fernán- dez put it, "an evidence-based way of describ- ing lenses according to their measured clinical performance across distance, intermediate, and near vision, rather than relying mainly on prod- uct names or optical labels." This Functional Vision Framework—"Glob- al consensus on the evidence-based functional classification of simultaneous vision IOLs"—was published in the Journal of Cataract & Refractive Surgery in February 2026. 1 "A global consensus is particularly import- ant now because this debate was growing at the same time as the number of IOL technologies was expanding, and international standards were also evolving," Dr. Fernández, first author on the paper, explained in an email to EyeWorld. "But the Functional Classification goes beyond simply creating a common language. Its most important contribution is that this language is linked to scientific evidence and to measurable clinical outcomes, so that the functional clas- sification terms we use actually represent the visual performance patients can expect. In other words, the goal is not just to agree on what we call a lens but to ensure that each cat- egory has a clear and evidence-based functional meaning that can be translated into real patient outcomes." Douglas Koch, MD, who was the second author on the paper, said this framework will be especially relevant to surgeons outside the U.S. who are "bombarded" by companies making strong claims about their lenses' capabilities. In the U.S. where labeling is stricter from a regu- latory standpoint, Dr. Koch said, the goal of the paper is not to supplant the regulatory process or criteria of the FDA. Rather it is to deepen physicians' understanding of these how IOLs function beyond the FDA criteria. "This arose at a time when there is a pro- liferation of new IOL designs that are targeting various amounts of increased depth for our patients," Dr. Koch said. "Each IOL seems to come along with a certain amount of marketing terminology that may or may not accurately characterize the performance of the lens, which is understandable as the industry tries to max- imize its sales. Some greater scrutiny or more rigorous classification should help clinicians understand how these lenses perform in the real world—that's the goal of this framework." The Global Functional Vision Working Group was established after the 2025 Congress of the ESCRS when the involved societies recog- nized overlap in objectives toward which they were working and the need to work together. According to the paper, topics of discussion at the Congress included adopting: 1) the 6 categories with mild modification of the ESCRS proposal for a Functional Classification, 2) the ASCRS recommendations to use the term "depth of field" with the abbreviation DOFi in lieu of "range of the depth of field" with the abbreviation ROF, and 3) the Assessment of IntraOcular Lens Implant Symptoms (AIOLIS) questionnaire, a tool developed by AAO to enhance consistency in postoperative symptom assessment. The group recognized APACRS' and LATAMSCRS' emphasis on the role of optical bench data during early stages of evaluation. The societies established a goal to "set a global standard for evidence-based knowledge genera- tion in IOL research and clinical practice." Breaking down the categories The Working Group established use of the terminology depth of field (DOFi) to describe simultaneous vision IOLs "because it promotes clearer and more consistent communication When the stars align: a global consensus on classifying IOLs by depth of field continued on page 54

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