At the 2026 ASCRS Annual Meeting, Aazim A. Siddiqui, MD, ABO, Ahmed F. Omar, MD, PhD, Kamran M. Riaz, MD, ABO, and Yassine Daoud, MD, FACS, presented a structured approach to understanding advanced-technology IOLs (ATIOLs). They started their presentation by pointing out that knowledge of ATIOLs, as well as their advantages and disadvantages, is crucial to providing their patients with the best possible outcomes.
“Study of these IOLs, and gaining a better understanding of them, becomes imperative for the modern cataract surgeon,” said Dr. Siddiqui. “In some ways, the surgery itself has become more straightforward. Determining which ATIOL to use — whether presbyopia-correcting, trifocal, extended depth of focus, hybrid designs, or aperture-based — in a given situation has become the hard part.”
The presenters explained that although the surgeon does not need to know every last parameter of every ATIOL, it is important to understand the pros and cons of each, as well as who is a good candidate and for which options. They also noted that, prior to surgery, it is important to rule out vision-limiting ocular pathology, such as corneal disease and retinal disease, as well as to have a thorough discussion of patient and surgeon expectations and limitations. It is also important, they said, to apply aggressive treatment of ocular surface disease both preoperatively and postoperatively. The presenters also stressed the significance of obtaining patient history, best-corrected visual acuity, and manifest refraction.
“Careful evaluation of corneal measurements, including potential mismatches between keratometric and refractive astigmatism, remains important when selecting advanced-technology IOLs, as it can influence both lens choice and postoperative visual quality,” said Dr. Siddiqui.
For postoperative management, the presenters emphasized the importance of personally evaluating these patients at follow-up visits, including assessment of uncorrected visual acuity at distance, intermediate, and near, as well as binocular vision and refraction. They also emphasized patient education, including reassurance regarding neuroadaptation and setting appropriate expectations for visual recovery.
The presenters looked at the core optical principles that underlie the ATIOLs discussed, such as defocus curves, modulation transfer function, and how these lenses distribute light across multiple focal points.
“These are all clinically relevant concepts to understand as a surgeon when we implant these lenses in our patients’ eyes, because that's what ultimately determines visual performance for our patients at distance, intermediate, and near vision,” Dr. Siddiqui explained. He also stressed the importance of additional factors like angle alpha, ocular surface, and patient lifestyle in determining a patient's overall candidacy.
Dr. Siddiqui pointed out that there is no perfect lens. “Although we would like there to be one there isn't. Every design involves some tradeoffs—whether it's between range of vision, contrast sensitivity, dysphotopsias, and many other variables. You have to match the right lens to the right patient,” he explained.
Dr. Siddiqui concluded that “while the technology behind these lenses is highly advanced, their success ultimately depends on matching the right lens to the right patient, and aligning that with their expectations and personality.”
