Eyeworld

56 | EYEWORLD | WINTER 2026 R EFRACTIVE uncorrected defocus curves and other binocular uncorrected measures should remain central when the objective is to understand patient-cen- tered performance rather than the intrinsic efficacy of the IOL." Dr. Koch cautioned physicians against looking at a defocus curve or looking at this classification and thinking that lens A and lens B are the same because they fall in the same category. There may be differences in contrast, dysphotopsias, and function at different pupil sizes. "It's a complex situation," Dr. Koch said, noting the functional classification is just the first, albeit critical, step as we study contrast, dysphotopsia, patient-reported outcomes, and tolerance to defocus. One of the main priorities of the group is to make the framework easier to apply for industry and clinicians. The group plans to develop guid- ance to allow IOLs to be classified more con- sistently, that helps accumulate evidence over time and clarifies what each functional category means in terms of expected clinical performance and patient outcomes, Dr. Fernández said. "… we also need better tools and method- ologies that help clinicians analyze their own outcomes because the scientific method should not be limited to formal research studies; it can also improve everyday clinical practice, bench- marking, decision-making, and communication with patients," he said. Dr. Koch said there is a lot of work yet to be done to better understand the functional perfor- mance of different IOLs. Takeaway for the practicing cataract surgeon What's the take-home message for the practic- ing surgeon? According to Dr. Fernández, it's that the category becomes clinically actionable, rather than simply descriptive. "Instead of using terms such as multifocal or EDOF as a proxy for what a lens is likely to deliver, the surgeon can start from a defined functional profile, how much depth of field the lens provides and how vision behaves as we move from distance toward intermediate and near. This gives us a more direct way to match the expected performance of the lens with the visual priorities of an individual patient," he said. Dr. Koch said that, despite the terminology in the paper, surgeons will likely continue using descriptions that they're already comfortable with in patient discussions. "I think a lot of physicians are going to continue to say things like, 'Do you want to be able to see at all three distances without glasses? Are you willing to compromise sharpness a bit and get some glare? Or do you want to have the highest sharpness of vision, which would be a single focus?' Our hope is that the functional classification gives clinicians insights to better select IOLs and counsel patients, with whatever terminology they prefer." Dr. Fernández said the classification should not be viewed as a fixed product label. "It rep- resents the functional performance supported by the available evidence, and the confidence in that assignment can evolve as more data become available. So, in clinical practice, the category becomes a starting point for decision- making, which must still be combined with the individual eye, the binocular strategy, the specif- ic lens, and the patient's expectations." Success for the Functional Vision Frame- work, to Dr. Fernández, would be that stake- holders have a clearer, realistic, more evi- dence-based understanding of what each IOL can deliver. He also said he'd like to see more clinicians participating in the generation and analysis of evidence. "If the framework helps improve both the quality of research and the way clinicians understand and communicate IOL performance, I think it will have achieved its main objective," Dr. Fernández said. continued from page 55 John Hovanesian, MD, EyeWorld Cornea Editorial Board member, commented on new tools, techniques, and challenges in anterior segment surgery: "The robots are coming, and they're likely to make us all better surgeons. Combining multimodal imaging, anatomical mapping, and safeguards against entering danger zones, surgeon-controlled robotics will im- prove precision and safety, making surgical excellence consistent across all levels of surgical proficiency and experience." to the MOON and BACK

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