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Moderator
Sherleen H. Chen, MD, FACS
Panelists
Amy Lin, MD, ABO; Robin R. Vann, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Wassef Chanbour, MD
Purpose
To evaluate the safety and efficacy of subconjunctival limbal botulinum toxin injections as a novel treatment for chronic, refractory corneal neuropathic pain.
Methods
A single-patient prospective therapeutic trial was conducted in a 46-year-old male with unilateral corneal neuropathic pain secondary to three prior phototherapeutic keratectomy procedures for recurrent erosion syndrome. The patient had previously failed all conventional therapies. He received four subconjunctival botulinum toxin injections (10 units nasally and temporally), administered at 3-month intervals. Subjective pain scores, ocular surface examinations, and corneal esthesiometry were used to monitor outcomes.
Results
After each botulin toxin injection, pain improved by 10–20% (a reduction of 1–2 points on a 10-point scale). Esthesiometry improved from 5.5 cm to 3.5 cm. The ocular surface remained stable, with minimal corneal and conjunctival staining. No intraoperative or postoperative complications were observed. The patient did not develop ptosis or extraocular motility disturbances. Botulinum toxin is believed to reduce neuropathic pain by inhibiting the release of neuropeptides such as substance P and CGRP, which are involved in peripheral sensitization and neurogenic inflammation. It may also modulate nociceptive signaling by impairing TRPV1 channel trafficking and reducing central sensitization.
Conclusion
Subconjunctival limbal botulinum toxin may offer safe, localized pain relief in refractory corneal neuropathy and merits further study in controlled trials
Presenting Author
Samuel Masket, MD
Co-Authors
Stephen Kwong (BSc), Don Pham (DO), Nicole Fram (MD), Vanessa Reyes (BSc), Sophie Kantor (BSc)
Purpose
There appears to be a disconnect between clinical presentations and optical laboratory investigations of the etiology of Negative Dysphotopsia (ND). In an attempt to gain further insight regarding the etiology of ND, patients with scleral fixated IOLs (SF IOLs) were surveyed to determine the incidence of ND in that previously unstudied cohort.
Methods
A retrospective chart review of cases in a single practice with either scleral sutured or intrascleral haptic fixated posterior chamber IOLs was carried out. Subsequently, a live telephone interview of qualified patients who were supplied with a clinical example of ND was completed. Rigorous exclusion criteria were applied to avoid including false positive or false negative case examples.
Results
203 cases of SF IOLs were discovered on chart review; 118 were excluded with either optic neuropathy, history of retinal detachment, CVA, BCVA less than 20/50, iris/pupil abnormalities, etc. Of the remaining cases, 46 met the strict inclusion criteria and were available for telephone interview. None of the 46 had any symptoms of ND at any time following surgery. Assuming a 3% incidence of chronic ND after routine cataract surgery, 45 eyes were necessary to properly power the investigation.
Conclusion
Although SFIOLs sit in a similar anatomic location when compared with routine "in the bag" IOLs after cataract surgery, the incidence of ND appears to be markedly less or absent in the SFIOL group. This finding challenges the currently accepted ray tracing "Illumination Gap" theory of etiology and raises additional possibilities.
Presenting Author
Victoria M. Fernandes, MD
Co-Authors
George Waring (MD), Karolinne Rocha (MD, PhD)
Purpose
Evaluate Salzburg Reading Desk (SRD) reading performance in subjects bilaterally implanted with a violet light-filtering full visual range (FVR) IOL, the Tecnis Odyssey IOL.
Methods
In this observational, prospective study, patients who had successfully undergone bilateral implantation of the Tecnis Odyssey or Odyssey Toric IOLs with postoperative astigmatism ?0.75 D underwent SRD testing. Patients with a history of ocular trauma, prior ocular surgery, ocular comorbidities that limit the ability to achieve 20/20 acuity, or planned combined surgery were excluded. Distance-corrected reading acuity at subjectively preferred near and intermediate distances at 100% contrast/luminance was evaluated, along with the reading distance; reading time; and the percentage of subjects with reading speed of ?80 words per minute (wpm) and ?100 wpm at 20/20, 20/25, and 20/40 font sizes.
Results
Postoperatively, the mean binocular reading acuity at near (mean reading distance 40.2 ± 10.1 cm) and intermediate (mean reading distance 65.6 ± 1.5 cm) distances was 0.10 ± 0.08 and 0.15 ± 0.08 logRAD, respectively. The mean reading speed was 11.93 ± 37.96 wpm and 115.20 ± 18.03 wpm at near and intermediate distances, respectively. The proportions of subjects with a reading speed of ≥80 wpm at 20/30 font size were 93.3% and 86.7%, respectively, for near and intermediate distances. 100% of subjects said they could see “very well” or “perfectly well” overall; 100%, 70.6%, and 76.5% rated their distance, intermediate, and near vision, respectively, as “very good” or “excellent”.
Conclusion
In this study, patients who were bilaterally implanted with Tecnis Odyssey or Odyssey toric IOLs achieved excellent binocular reading acuity at patient-preferred near and intermediate distances and had high levels of satisfaction with their vision.
Presenting Author
Lavender c Micalo, BSc
Co-Authors
Nathan Vu Pham (BSc), Marina Zakhary Gad El Sayed (BSc), Ibrahim Abboud (BSc), Kimia Rezaei (BSc), Khanh Tran (None), Asad Loya (MD)
Purpose
To compare intraoperative and postoperative complication rates of cataract surgery at either academic or non-academic centers in a nationally representative cohort using robust statistical analysis.
Methods
Adults (?18 years) undergoing cataract surgery at academic and non-academic centers were identified from the 2016-2024 TriNetX database and 1:1 propensity score-matched (PSM) for age, sex, race, ethnicity, and ocular/systemic comorbidities using propensity scores. After PSM (n=138,784), associations between center academic status and perioperative outcomes at 14, 30, and 90 days, such as endophthalmitis, retinal detachment, and retained lens material, were evaluated using multivariable regression models within TriNetX's integrated analytics platform.
Results
Prior to PSM, 578,266 and 161,154 patients underwent cataract surgery at AC and non-AC, respectively. After PSM (n=138,000 per cohort), AC patients demonstrated higher risk of endophthalmitis relative to non-AC at 14 days (RR, 1.71; 95% CI, 1.19-2.45; p=0.003), 30 days (RR, 1.81; 95% CI, 1.35-2.44; p<0.001), and 90 days (RR, 1.92; 95% CI, 1.50-2.46; p<0.001). AC was also associated with greater risk of retained lens materials relative to non-AC at 14, 30, and 90 days (RR, 1.48-1.57; 95% CI, 1.34-1.79; all p<0.001). Most notably, retinal detachment risk at AC was only higher at 30 (RR, 1.19-1.42; 95% CI, 1.05-1.57; p<0.05) and 90 days (RR, 1.42; 95% CI, 1.28-1.57; p<0.001).
Conclusion
Patients undergoing cataract surgery at AC experienced more complications at 14, 30, and 90 days, which may be attributable to referral bias, higher prevalence of ocular and systemic comorbidities in AC patients, or increased complexity of cases inherent to academic centers.
Presenting Author
Emily S. Tamblin, BSc
Co-Authors
Kathleen Scruggs (None), Tara O'Rourke (OD), Kristin Goodling (OD), Seth Pantanelli (MD, MS)
Purpose
To assess the intraoperative and postoperative outcomes in eyes that underwent cataract surgery using a non-ultrasound lens extraction device (MICOR) versus traditional phacoemulsification (phaco). This research seeks to understand the benefits and adverse event rates of the novel device compared to the current standard.
Methods
This was a single-center retrospective consecutive case series including all eyes that underwent cataract extraction with implantation of an IOL by a single surgeon between 3/23/2023 and 4/30/2025. Eyes with a history of incisional surgery or co-existing ocular pathology known to limit refractive stability or vision potential were excluded. Patient demographics, such as age and nuclear density, and intraoperative data including nucleus removal time, irrigation and aspiration time, total operative time, and adverse events were assessed. Visual acuity, refraction, intraocular pressure (IOP), and inflammation were assessed at postoperative day 1, week 1, and month 1 visits.
Results
112 eyes of 86 patients in the MICOR arm and 136 eyes of 103 patients in the phaco arm were included. Demographics were similar between groups (p > 0.05). 28.6% of MICOR cases were complex cases compared to 28.7% in the phaco arm. UCVA was similar at day 1 for MICOR and phaco arms, [0.25 ± 0.026 (SE) vs. 0.23 ± 0.023 (SE); p = 1.000], respectively. BCVA at month 1 was 0.01 ± 0.008 (SE) vs. 0.02 ± 0.005 (SE), respectively (p = 0.03). The adverse event rate was similar [0 vs. 2]. MICOR and phaco arms were similar for nucleus removal time [168 vs. 178 seconds (p = 0.268)], irrigation and aspiration time [63 vs. 58 seconds (p = 0.290)], and total operative time [589 vs. 616 seconds (p = 0.260)].
Conclusion
MICOR is a comparable alternative to phacoemulsification by many metrics. Further enrollment is needed to confirm the findings and results.
Presenting Author
Naren Shetty, MS, PhD
Co-Authors
Habeeb Ahmad (MD, MS), Daniel Cheng (OD), Linda Tsai (MPH)
Purpose
To report multicentric real-world spectacle independence and visual outcomes of a purely refractive Extended Depth of Focus (EDOF) PCIOL.
Methods
This is an ambispective, multicenter, observational, single-arm, single-visit study in patients bilaterally implanted with the EDOF IOL. Interim spectacle independence and visual acuity (VA) outcomes from the single 3-month post-op prospective visit are reported from 17 sites in Europe and Asia Pacific. Binocular uncorrected distance VA (UCDVA), intermediate (66cm) VA (UCIVA), near (40cm) VA (UCNVA), and best-corrected distance VA (BCDVA), distance-corrected intermediate VA (DCIVA), and distance-corrected near VA (DCNVA) are reported in logMAR (Snellen equivalent). Post-operative manifest refraction spherical equivalent (MRSE) and patient-reported outcomes are also reported.
Results
Data from 293 subjects was available. Mean ± SD post-op binocular UCDVA was -0.02 ± 0.08 (20/19), UCIVA was 0.12 ± 0.11 (20/26), UCNVA was 0.25 ± 0.16 (20/36), BCDVA was -0.06 ± 0.07 (20/17), DCIVA was 0.11 ± 0.10 (20/26), and DCNVA was 0.23 ± 0.17 (20/34). Mean MRSE was -0.02 ± 0.40 D. Most patients reported wearing glasses “none” or “a little of the time” at distance (99%), intermediate (98%), near (81%) and overall (97%). Most patients were “completely” or “mostly” satisfied with their uncorrected distance (95%), intermediate (95%), near (73%) and overall vision (93%), and 94% would recommend the lens to their family and friends.
Conclusion
The real-world results show that patients implanted with the purely refractive EDOF IOL have excellent distance, intermediate and functional near vision with high levels of overall satisfaction. Most patients experienced little to no dependence on spectacles.
Presenting Author
Winnie W. Yu, MSc
Co-Authors
Milena Cioana (BSc), Peng Yan (MD, FRCSC), Sohel Somani (MD, FRCSC), Eric Tam (MD, FRCSC), Hannah Chiu (MD, FRCSC), Mindy Lu (None)
Purpose
To evaluate longitudinal optical coherence tomography angiography (OCTA) changes following cataract surgery in eyes without diabetes, with diabetes but no retinopathy (DNR), and with diabetic retinopathy (DR).
Methods
A prospective cohort study included 114 eyes undergoing cataract surgery: 47 controls, 39 DNR, and 28 DR. OCT and OCTA scans (macular cube thickness, vessel density, perfusion density, and foveal avascular zone [FAZ] parameters) were obtained at baseline, 1 week, 1 month, and 3 months postoperatively. Longitudinal changes within and between groups were analyzed using repeated measures ANOVA.
Results
Across all groups, retinal vessel density significantly increased after surgery compared with baseline (p<0.05). Macular cube thickness increased postoperatively in controls and DR eyes (p<0.05). FAZ circularity index was significantly lower in DR eyes compared with controls (p=0.012) and DNR eyes (p=0.0006), while no significant inter-group differences were detected for other OCTA parameters.
Conclusion
Cataract surgery induces measurable OCTA changes in vessel density and retinal thickness across patient groups. Reduced FAZ circularity specifically characterized DR eyes, suggesting a biomarker of microvascular vulnerability. OCTA may be a valuable adjunct for postoperative monitoring in diabetic patients.
Presenting Author
Almiqdad Saeed, MD
Co-Authors
Gui-shuang Ying (PhD), Karan Patil (MS), Rina Nagatani (BA), Fangming Jin (MS), Lama Al-Aswad (MD, MPH)
Purpose
Currently, the lack of standardized preoperative risk assessment protocols for cataract surgery contributes to intraoperative complications. This study aims to evaluate the visual outcome based on surgeon experience and case complexity. We hypothesize that more experienced surgeons have better visual outcomes with more complex cataract surgeries.
Methods
We conducted a 3-year single center retrospective analysis of 2272 standalone unilateral cataract surgeries. Based on preoperative EHR data, we formulated a 7-factor surgery complexity risk score (CRS) considering age, cataract type, high ametropia, AC depth, prior PPV, corneal guttae, and post-LASIK status. Surgeon experience was categorized into five levels: Level 1 (<5 years), Level 2 (5-10), Level 3 (10-20), Level 4 (20-30), and Level 5 (>30). 3-month postop VA (20/40 or better vs 20/40 and worse) determined the surgical outcome. Surgery duration (incision to closure time) was considered as complexity measures.
Results
A multivariable analysis with a CI of 95% was conducted using a model with predictors including total CRS (ref: score 0), surgeon experience level (ref: Level 3), and patient age. Worse VA was linked to higher CRS (p = 0.007, adj ORs 1.70, 1.90, and 2.58 for scores 1, 2-3, and 4-6 respectively). Level 4 surgeons demonstrated significantly worse VA outcomes (p=0.004, adj ORs 0.72, 1.17, 2.89, 1.28 for levels 1, 2, 4, and 5 respectively). Surgery duration increased with higher CRS (p<0.001, adj ORs 1.96, 3.14, 3.57). With the exception of Level 1, surgery duration shortened as surgeon experience increased (p<0.001, adj ORs -5.13, 0.74, -1.39, -5.36). Patient age was not a significant factor.
Conclusion
The data underscores a clear relationship between preoperative risk factors and surgical outcomes. The association between surgeon experience and outcomes needs further analysis utilizing a larger and more balanced dataset.
Presenting Author
Angelica Hanna, BSc
Co-Authors
Sonia Anchouche (None), Marko Popovic (MD), Matthew Schlenker (MD, FRCSC), Joshua Teichman (MD, MPH), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
The optimal timing and modality of postoperative follow-up after routine cataract surgery remains debated. International guidelines differ, and considerable variation exists across centers. This study evaluated the follow-up practices of cataract surgeons in the largest cataract centre in Toronto, Canada.
Methods
A cross-sectional survey of cataract surgeons at the Kensington Eye Institute was conducted through structured in-person interviews. Demographic data and follow-up practices were collected, including timing, modality, and components of postoperative assessments. Descriptive statistics summarized findings, and multivariable logistic regression evaluated associations between surgeon characteristics and practice patterns.
Results
42 surgeons participated (100% response rate). 36% performed an in-person assessment on POD0/1. 29% relied on virtual follow-up at POD0/1, while 31% deferred the first in-person review to POD2-6, and 5% delayed until postoperative week 1-2. Most surgeons (62%) scheduled two postoperative visits, with 36% scheduling three. In multivariable analysis, female surgeons were less likely to use virtual follow-up and more likely to dilate patients postoperatively. Mid-career surgeons were more likely than early-career surgeons to schedule only two visits, while medium-volume surgeons were less likely than low-volume surgeons to dilate. Subspecialty was not associated with practice patterns.
Conclusion
Postoperative assessments following cataract surgery are variable. Surgeon sex, career stage and subspecialty influence practice decisions. These findings highlight the need for guidelines to support safe, patient-centered, and efficient postoperative care.
Presenting Author
Sharmila Rajendrababu, MBBS, MD
Purpose
To compare the surgical outcomes of Femtolaser assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) in nanophthalmic eyes
Methods
We included twenty eyes of 20 nanophthalmic patients with visually significant cataracts and randomized them to undergo FLACS or CP. We included only one eye of each patient from each group choosing the eye with worse visual acuity
Results
The median Corrected Distance Visual Acuity (CDVA) improved significantly from baseline in both groups at all post-operative visits. FLACS group showed a significant reduction in Retinochoroidal scleral (RCS) thickness compared to the CP group at third month postoperative visit (p=0.002). The percentage of endothelial cell loss (ECL) was lower in FLACS (7.2) than CP (11.9) at 1month follow-up (p=0.247) and equal at 3 months (13.25 & 13.6 in FLACS & CP respectively, p =0.428). The median total surgical time in FLACS was significantly lower than the CP group (10 Vs 25.5, p=0.034) and the median cumulative dissipative energy (CDE) was also lower in FLACS (6.65) than CP (8.46)
Conclusion
Both FLACS & CP are equally safe surgeries causing significant improvement in post-operative visual acuity in nanophthalmic eyes. FLACS however had greater RCS reduction than CP and also required significantly lesser surgical time & lower CDE than CP. FLACS was also slightly more beneficial in protecting endothelium in short eyes
Presenting Author
Pooja Mehta, MBBS, MS
Co-Authors
Rohan Mehra (MBBS, MS), Himanshu Mehta (MBBS, MS)
Purpose
To correlate the Dysfunctional Lens Index with lens grading based on LOCS 3 and scheimpflug based lens density in patient having BCVA of 20/20 and post operatively comparing the outcome based on Dysfunctional Lens Index.
Methods
158 eyes having BCVA of 6/6 underwent slit lamp examination to assess the grade of cataract, itrace aberrometry for Dysfunctional Lens Index and pentacam for scheimpflug based Pentacam Nuclear staging. Clinical grading of cataract was done by single surgeon. DLI value was correlated with clinical grading, objective grading by LOCS 3 and with scheimpflug based Pentacam Nuclear Staging.
Results
62.5% patients had a DLI value of <7, their BCVA being 6/6 and primary complaint being blurred vision. Out of them 7 had clear lens and 7 had early lens changes clinically. Their average DLI was 6.06 and 7.5 respectively . Out of 7 clear lens patients 5 were PNS stage 1, 1 was PNS stage 0 and 1 was stage 2. All the ELC patients were PNS stage 1. Post Operatively patients symptoms were markedly reduced showing that using DLI as a marker to perform cataract surgery was beneficial and had a positive correlation.
Conclusion
Patients with BCVA of 20/20 and minimal cataract clinically,confirmed from PNS showed significant values of DLI. Hence though BCVA improves to 20/20 and clinically cataract was minimal, early intervention would benefit the patients with complaints of visual symptoms. DLI could serve as a biomarker for early cataract intervention in future.
Presenting Author
Sunayana Narasimha Murthy, MBBS, MS
Co-Authors
Rohit Shetty (FRCS), Vibha Singh (MBBS, MS), Apeksha Kataria (DNB)
Purpose
To evaluate how preoperative corneal epithelial mapping impacts postoperative visual quality and patient-reported quality of life (QoL) in cataract surgery patients, using Artificial Intelligence (AI) to identify predictive markers
Methods
Two hundred fifty patients underwent pre- and postoperative evaluation, including epithelial mapping (Placido-OCT and ray-tracing-based system) and tear biomarker analysis using the BioM Pathfinder kit. Based on epithelial status, Group 1 (n=169) had regular epithelium and Group 2 (n=81) had irregular epithelium. Postoperative assessments included UCVA, PROWL scores, OQAS, and epithelial/corneal HOAs. AI algorithms were applied to identify predictors of visual and QoL outcomes.
Results
UCVA gains were comparable across groups. However, Group 1 had significantly better visual quality and QoL scores (PROWL<80 in 162/169 patients), while Group 2 had poorer outcomes (PROWL>120 in 48/81). Corneal HOAs and inflammatory biomarkers were markedly elevated in Group 2 (p<0.05). AI identified epithelial irregularity as a key predictor of both reduced visual quality and lower QoL
Conclusion
Corneal epithelial mapping and tear biomarkers serve as effective surrogate markers for predicting both visual outcomes and postoperative quality of life following cataract surgery. Preoperative epithelial mapping helps predict and optimize visual quality after cataract surgery
Presenting Author
Jeffrey Olsen, BSc
Co-Authors
Traeson Brandenburg (BSc), Mina Sitto (MD), Majid Moshirfar (MD), Brooklyn Jones (BSc)
Purpose
To analyze if the postoperative change in manifest refraction (MR) after cataract or lens exchange surgery results in a hyperopic shift compared to postoperative baseline refractive stability, and determine preoperative characteristics that may influence refraction trajectory.
Methods
This is a retrospective chart review of 514 eyes from 306 patients who underwent cataract or lens replacement surgery at Hoopes Vision (Utah). Data was collected beginning in 2002 via the IOL Master or Lenstar and continued consecutively until more than 500 eyes were collected. Inclusion criteria consisted of having preoperative surgical data and MR between 21 and 90 days after surgery with corrected distance visual acuity of 20/40 or better. We then compared postoperative (PO) MR at the following year marks: 0.5, 1, 2, 4, 7, 10, 15, and 20. Not every eye had a documented MR at each follow up interval but were included where available.
Results
The mean PO spherical equivalence (SE) at refractive stability was -0.133 diopters (D). SE at the above year marks were -0.037, 0.114, 0.210, -0.140, -0.177, -0.190, -0.223, and 0.099 D, respectively. The SE at 0.5, 1, and 20 years was hyperopic compared to baseline (p < 0.05). This analysis showed a hyperopic shift up to 2 years PO, 4 to 15 years returned to a SE similar to baseline, and 20 year data showed an additional 0.232 D hyperopic shift. Subgroup analysis revealed a similar pattern when selected for near target, distance target, women, virgin corneas, less than and more than 70 years of age at the time of surgery. Male eyes uniquely showed a myopic shift (SE = -0.175) 2 years PO.
Conclusion
This study provides a reference point for cataract surgeons to estimate the long-term refractive stability expected after cataract extraction with intraocular lens placement. This 20 year study indicates a potentially fluctuating MR of +/- 0.217 D.
