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Moderator
Naveen K. Rao, MD, ABO
Panelists
Anita Nevyas-Wallace, MD, ABO; Kavitha R. Sivaraman, 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
Benjamin Stern, MD
Co-Authors
Damien Gatinel (PhD, MD)
Purpose
To evaluate the optical performance of a wide range of intraocular lens (IOL) models across diverse corneal anatomies in vitro, and to explore how such data may guide surgeons beyond simple power prediction toward individualized IOL model selection.
Methods
Fifty IOL models were analyzed using an optical bench system. Modulation transfer function (MTF) through-focus curves were measured at 10, 30, 50, and 100 line pairs per millimeter, as well as the mean MTF from 0 to 100 lp/mm. Each IOL was tested across 29 keratometric values (35.0-49.0 D, 0.5 D steps) and 21 corneal asphericities (Q-values ?1.0 to +1.0, 0.1 steps), yielding 609 corneal-IOL combinations per lens. Maximal contrast and in vitro depth of focus were calculated and compared across models and corneal conditions.
Results
Distinct performance profiles emerged for each IOL model depending on corneal curvature and asphericity. Certain designs demonstrated superior contrast transfer and extended depth of focus under specific anatomical conditions, while others showed marked sensitivity to corneal parameters. The resulting database enables objective comparisons of IOL behavior in anatomically diverse scenarios, revealing substantial differences not captured by power calculations alone.
Conclusion
In vitro analysis shows that IOL performance varies with corneal anatomy. Using model-specific optical data can guide surgeons beyond power prediction toward more personalized IOL selection and improved visual outcomes.
Presenting Author
Nick Mamalis, MD
Co-Authors
Zoha Mian (MD, MSc), Max Liu (BSc), Andy Renschler (BSc), Liliana Werner (MD, PhD)
Purpose
To assess the complications that resulted in the explantation or secondary intervention with foldable intraocular lenses (IOLs)
Methods
For the 28th consecutive year, surgeons were surveyed regarding complications associated with foldable IOLs requiring explantation or secondary intervention over the 2024 calendar year. These forms were made available online using the American and European Societies of Cataract and Refractive Surgery websites and a fax-on-demand service. Surgeons completed one survey for each foldable IOL requiring explantation or secondary intervention. Further analysis determined complication trends related to specific IOL styles, materials, and types over the past 19 years (2007-2025)
Results
Completed surveys were returned in 2024. In the 2024 survey, dislocation/decentration continued to be the most common complication overall. Intolerance to refractive outcome was the second most common complication. Glare/optical aberrations was a common complication associated with multifocal IOLs continuing a 19-year trend. Additionally, Iritis/UGH Syndrome was seen infrequently. Hydrophilic acrylic IOLs as well as some silicone lenses in eyes with asteroid hyalosis demonstrated calcification.
Conclusion
Dislocation/decentration remains the leading cause of explantation in most IOL types. Intolerance to refractive outcome is a continuing problem. Glare/optical aberrations continue to be a complication of multifocal IOLs suggesting this ongoing issue has yet to be resolved with this type of IOL.
Presenting Author
Brian J Szabo, DO
Purpose
To evaluate refractive and visual acuity outcomes of cataract patients seeking spectacle independence that were bilaterally implanted with the light adjustable lens (LAL) and LAL+ (mix and match).
Methods
This was a retrospective study of 29 patients that underwent bilateral cataract surgery. Patients were implanted with LAL in the dominant eye targeted for distance vision and with LAL+ in the non-dominant eye targeted for near vision. Target refraction for the distance eye was +0.25D. Target refraction for the near eyes was patient-determined based on VA and tolerance to anisometropia.
Results
After light adjustment, 57 of the 58 eyes (98.3%) were within 0.5D of target MRSE. The mean prediction error was -0.097D ± 0.229. The range of non-dominant eye target MR was 0 to -1.5D. 100% of distance eyes achieved 20/20 or better, 86.2% of which still had functional near vision of J7 or better. 89.7% of near eyes achieved J2 or better, 82.8% still had functional distance vision of 20/40 or better. Binocularly, 93.1% of patients achieved simultaneous 20/20 or better distance and J1 or better near.
Conclusion
Mix and match technique with the 2 types of adjustable IOLs provides good binocular distance and near vision for patients seeking spectacle independence. The ability to adjust the refraction to blend the vision based on patient feedback is critical in finding balance between vision performance and tolerance to anisometropia.
Presenting Author
Jonathan M. Davidorf, MD
Co-Authors
Michelle Vartanian (OD), Oliver Davidorf (BSc)
Purpose
To evaluate refractive stability, best spectacle corrected visual acuity (BCVA), and refractive adjustability in patients implanted with the ActivShield Light Adjustable Lens (LAL) who failed to return for lock-in until several months or longer after surgery.
Methods
In this retrospective case series, eyes implanted with the LAL were included if the interval between surgery (or last adjustment) and subsequent follow-up was ?90 days. Data collected included pre-gap and post-gap manifest refraction, uncorrected and best spectacle corrected visual acuity, number of adjustments/lock-ins completed, and responsiveness to additional light adjustments at return.
Results
Ten eyes returned after a mean delay of 426±123 days (range 210-565) without lock-in. Mean pre-gap manifest refraction spherical equivalent (MRSE) was ?0.24±0.64 D with cylinder 0.31±0.30 D. At return, MRSE measured ?0.31±0.72 D and cylinder 0.22±0.26 D. Mean change in MRSE was ?0.07±0.14 D (?0.25 to +0.13, p=0.83) and cylinder was ?0.08±0.18 D (?0.50 to 0, p=0.54).
Conclusion
In this small series, refractive change was minimal despite lock-in delays exceeding one year. While these observations demonstrate excellent stability, larger studies are needed to determine the incidence of clinically meaningful refractive drift in eyes with absent or delayed lock-in.
Presenting Author
Anny MS Cheng, MD
Co-Authors
Anup Kubal (MD), Aarup Kubal (MD), Jenna Handal (MS), Elizabeth Yang (BSc), John LiVecchi (MD)
Purpose
Traditionally,monofocal intraocular lenses (IOLs) were implanted in endothelial keratoplasties, but premium IOLs have recently been used in Descemet's Membrane Endothelial Keratoplasty (DMEK) to improve vision.This case series aims to focus on predictability of toric IOLs in DMEK triple procedures to provide insights that may enhance surgical plan.
Methods
This retrospective case series included 10 eyes of 6 patients affected by Fuchs corneal dystrophy and visually significant cataracts with astigmatism >1 diopter (D), who underwent implantation of 2 different models of toric IOLs in DMEK triple surgery. The cylinder power of toric IOLs and expected residual astigmatism were determined by an online toric calculator with keratoscopy measurements obtained using swept source optical coherence tomography biometer. Changes of vision, astigmatism and residual spherical equivalent (SE) were recorded. Predictor errors were assessed as a difference between the anticipated minus postoperative residual astigmatism.
Results
Tens eyes were implanted with 2 different models of toric IOLs in DMEK triple procedure. The follow-up duration was 2.72±1.49 years. The overall residual SE (spherical equivalent) was -0.19±0.59 D when the IOLs had a spherical refractive goal of -0.44±0.18 D. The average corneal astigmatism improved significantly from 1.9±0.7 D preoperatively to residual astigmatism of 1±0.7 D (p=0.01) postoperatively. All eyes achieved uncorrected distance visual acuity of 20/40 or better, whereas 70% obtained 20/25 or better at the last follow-up. No differences were observed in either pre- or postoperative astigmatism or vision improvement between cases of two different IOL models.
Conclusion
Our findings suggested that toric IOLs is effective in managing astigmatism and enhancing visual outcomes for patients undergoing DMEK triple surgery.
Presenting Author
Ruti Sella, MD
Co-Authors
Olga Reitblat (MD, MHA), Irit Bahar (MD, MHA), Rita Zlatkin (MD)
Purpose
To describe the refractive results of cataract surgery in patients with high corneal astigmatism treated with implantation of custom made toric intraocular lenses (IOLs).
Methods
This retrospective cohort study included eyes implanted with high-cylinder (?6.75 D) custom toric IOLs. A control group of eyes implanted with standard-toric IOLs (1.5 - 3.75 D) was also collected. Postoperative IOL misalignment, uncorrected visual acuity (UDVA), residual refractive astigmatism (RA), and the prediction error (PE) of the toric IOL calculation using the Barrett Toric Calculator were assessed.
Results
Sixteen eyes of 16 patients were included in the study group. The mean?±?SD toric power was 9.80?±?3.93 D (range: 6.75-19.00 D). The mean postoperative logMAR UDVA was 0.26 ± 0.18 (Snellen: 20/36). Mean absolute astigmatism decreased from 8.06?±?3.54 D preoperatively (corneal) to 0.78?±?0.79 D postoperatively (refractive) (p<0.001). Compared with controls (41 eyes), the high-toric group showed a non-significant trend toward slightly lower UDVA (20/25, p=0.064) and higher RA (0.58?±?0.50 D, p=0.626), as well as a significantly higher RA-PE, both in precision (0.63?±?0.39 D vs. 1.44?±?1.35 D, p=0.049) and accuracy (0.63?±?0.41 D vs. 1.49?±?1.45 D, p=0.049).
Conclusion
Customized high toric IOLs significantly improve UDVA and reduce RA in eyes with extreme corneal astigmatism. While slightly inferior to standard toric IOLs, they provide an effective treatment option for astigmatic correction in complex corneal pathologies with a central and relatively regular astigmatic component.
Presenting Author
Anita B Chander, BSc
Co-Authors
Eric Tam (MD, FRCSC), Sohel Somani (MD, FRCSC)
Purpose
In lens-based surgery candidates who desire refractive accuracy, the light adjustable lens (LAL) can be a promising option. However, comprehensive, up-to-date summaries of the existing evidence associated with LAL are scarce. This review assesses the reported benefits and limitations of LAL and considerations regarding post-operative UV treatments.
Methods
A scoping review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist. A search of MEDLINE, EMBASE, and CENTRAL was completed using a pre-defined search strategy and identified articles were uploaded to Covidence for abstract, title, and full-text screening. Original studies of individuals implanted with LAL during any lens-based surgery were included. Data extraction was completed based on parameters of interest including patient characteristics, patient outcomes, post-operative complications, and number/timing of UV light treatments. Extracted data were analyzed using frequency counts.
Results
46 studies and 2069 participants were included. Non-comparative studies were the most common (n = 38; 83%). Follow-up periods were usually 21 days in 19 (61%) studies (standard: 17-21 days). Studies comparing visual outcomes of LAL to a control IOL (n = 5, 11%) found that LAL performed better.
Conclusion
LAL can provide optimal visual outcomes when compared to standard monofocal IOLs and in patients with prior history of refractive surgery and/or certain baseline ocular features. However, post-operative UV treatments may need to be delayed in some of these patients. More studies with long-term data comparing LAL to other premium IOLs are needed.
Presenting Author
Itay Lavy, MD
Co-Authors
Benjamin Stern (MD), David Smadja (MD), Edward Averbukh (MD)
Purpose
To evaluate the feasibility and early outcomes of a novel single continuous PTFE suture technique for 4-point scleral fixation in patients with dislocated intraocular lenses (IOLs). This technique aims to enhance lens stability, reduce surgical complexity, and improve postoperative visual outcomes compared to traditional multiple-suture methods.
Methods
25 patients (ages 42-82) with dislocated IOLs due to pseudoexfoliation syndrome and prior vitreoretinal procedures underwent IOL removal or exchange, followed by 4-point scleral fixation using a single continuous 6/0 PTFE suture. The technique involves a single uninterrupted suture to ensure even tension distribution across all four haptics, preventing IOL tilt or folding. The IOLs were centered along the axis between two pairs of sclerotomies placed 7 mm apart, promoting self-centration and long-term fixation stability.
Results
All intraocular lenses (IOLs) remained well-centered at one-month follow-up. Transient hypotony occurred in three patients and resolved spontaneously within days. One patient experienced a self-limited vitreous hemorrhage. Five patients developed postoperative intraocular pressure (IOP) elevation; four were successfully managed with topical therapy, while one required glaucoma surgery. Seven patients underwent simultaneous Descemet Membrane Endothelial Keratoplasty (DMEK). Of 25 patients, 23 demonstrated significant improvement in best-corrected visual acuity (BCVA), from a mean of 0.01 to 0.5 (decimal). 2 patients maintained stable vision.
Conclusion
The single continuous PTFE suture technique for 4-point scleral fixation provides a simplified, efficient, and effective alternative to conventional methods. By ensuring stable lens centration, reducing surgical complexity and complications. This approach has the potential to significantly improve outcomes in complex cases of IOL dislocation.
Presenting Author
David Rabinovitch, MD
Co-Authors
Kashif Baig (MD, MBA), Saama Sabeti (MD, MPH, FRCSC), Jobanpreet Dhillon (MD, MSc), Andrew Samuel (MD), Abbie Lai (MD)
Purpose
To systematically evaluate the refractive accuracy, visual outcomes, and safety profile of light-adjustable intraocular lenses (LALs) through a comprehensive meta-analysis of published clinical studies.
Methods
A systematic search of MEDLINE, Web of Science, and Scopus was conducted through Dec 2024, following PRISMA 2020. Eligible studies reported ?3-month LAL outcomes; RCTs, prospective, and retrospective series with ?10 eyes were included. Two reviewers independently screened and extracted data. Primary outcomes were proportions of eyes achieving UDVA ?20/20 and within ±0.50 D and ±1.00 D of target. Secondary outcomes included mean absolute error, spectacle independence, satisfaction, and complications. Random-effects meta-analysis with Freeman-Tukey transformation was applied. Subgroup and sensitivity analyses were performed, and evidence certainty was rated using GRADE.
Results
Twenty-two studies (1,113 eyes) were included. Pooled accuracy was 98.1% (95% CI 96.9-99.3; I�=18.7%) within ±1.00 D, 91.2% (88.6-93.8; I�=45.2%) within ±0.50 D, and 88.5% (85.2-91.8; I�=23.5%) achieved UDVA ?20/20. MAE was 0.31 D (0.28-0.34). Satisfaction was 94.5%. Second-generation LALs showed numerically higher accuracy than first-generation (92.6% vs 89.8% within ±0.50 D, p=0.14). Post-refractive eyes achieved 84.0% within ±0.50 D compared with typical monofocal rates of 55-70%. Safety was favorable: complications 2.8%, with no IOL opacification or explantation. GRADE certainty was high for ±1.00 D and moderate for other outcomes.
Conclusion
Light-adjustable intraocular lenses achieve excellent refractive accuracy and visual outcomes with favorable safety across diverse clinical settings. These results exceed benchmarks for conventional monofocal IOLs and support LALs as an effective technology for patients pursuing optimal refractive outcomes following cataract surgery.
Presenting Author
Inder P. Singh, MD
Purpose
This retrospective case series aimed to assess the visual acuity outcomes in cataract patients with mild to moderate glaucoma with an enhanced monofocal toric intraocular lens (IOL) with intermediate-optimized optics. The most common toric power utilized was also assessed.
Methods
This retrospective case series included patients diagnosed with mild to moderate glaucoma who underwent cataract surgery and implantation of an enhanced monofocal toric IOL (enVista Aspire Toric, ETA, Bausch & Lomb). ETA uses higher-order aspheric coefficients on the posterior surface to create a broad depth of focus. Clinical endpoints collected were uncorrected and corrected distance visual acuity (UDVA/CDVA), uncorrected intermediate visual acuity (UIVA), manifest refraction spherical equivalent (MRSE), residual refractive cylinder, and visual field 1-6 month follow-up. Adverse events were also collected.
Results
Final data will be available prior to the meeting. Preliminary VF data does reveal an improvement in the MD and PSD.
Conclusion
Final conclusions will be finalized prior to the meeting.
Presenting Author
Paul S Zhou, MD
Co-Authors
Jonathan Lam (BSc, MS), Christopher Yang (MD), Matthew Wade (MD)
Purpose
To compare visual outcomes of the Light Adjustable Lens (LAL) and LAL Plus (LAL+) in normal corneas and post-refractive surgery eyes (LASIK/PRK, RK).
Methods
At a quaternary referral academic eye hospital, patients who underwent cataract extraction with LAL or LAL+ implantation between January 2023 and May 2025 were analyzed. Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were compared across subgroups (normal, post-LASIK/PRK, post-RK) using Welch's t-test.
Results
A total of 102 eyes were included (19 LAL+, 83 LAL). The LAL+ group included 4 post-myopic LASIK eyes, and the LAL group included 40 post-myopic LASIK, 16 post-hyperopic LASIK, and 2 post-RK eyes. At first adjustment, mean UDVA logMAR did not differ significantly between LAL+ and LAL (p = 0.13). At first lock-in, no significant difference in mean UDVA logMAR was observed (p = 0.60).
Conclusion
In this preliminary cohort, LAL+ and LAL demonstrated comparable uncorrected distance acuity in both normal and post-refractive corneas. Larger studies with extended follow-up and subgroup analysis by refractive history are warranted to clarify differences in near vision and refractive stability.
