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Opioids like fentanyl effectively prevent sneezing during propofol sedation for periocular injections, enhancing patient safety in ophthalmic procedures.

Using opioids to prevent sneezing and potential ocular tissue damage during sedation and periocular injections

assistant professor of ophthalmology at the Atrium Health Wake Forest Baptist School of Medicine

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The EnVision Summit, co-founded by Bonnie An Henderson, MD, is a unique family-friendly, multispecialty CME ophthalmology conference, along with a newly introduced optometry track. Henderson sits down with 

' Sheryl Stevenson, group editorial director - eye care, to talk about the 2025 conference that will take place February 14 to 17 at the Caribe Hilton San Juan, in Puerto Rico.

Henderson describes the meeting as “a place where not only are physicians and optometrists learning, but their families are part of the experience too,” emphasizing the opportunity for personal and professional growth in a supportive, community-oriented environment.

The 2025 agenda will include symposia, surgical videos, panel discussions, and leadership seminars that highlight rapid advancements across ophthalmology specialties, including cataract, refractive, retina, glaucoma, pediatrics, and oculoplastics. “It’s incredible how quickly things change in ophthalmology—if you miss a year or two, you’ll be amazed by the innovations that have emerged,” Henderson shared. Updates on new intraocular lenses, surgical tools, and diagnostic techniques will showcase the field’s forward momentum. Additionally, a leadership seminar led by Malvina Eydelman, MD, Director of the Office of Ophthalmic, Anesthesia, Respiratory, ENT, and Dental Devices at FDA, Silver Spring, Maryland, will feature discussions on career pathways and diversity, empowering attendees with insights from industry leaders.

The optometry track, introduced last year, continues to expand, emphasizing collaboration between ophthalmologists and optometrists in critical areas like preoperative and postoperative care, medications, and diagnostic tools. As Henderson explained, “It's important for both fields to come together and discuss how we can work together to improve patient care.” This cross-disciplinary dialogue reflects the summit's dedication to advancing care through shared expertise.

The youth program offers age-appropriate activities that allow children to engage in fun learning while also witnessing their parents' professional contributions. "It’s amazing to watch these kids grow up at EnVision Summit and form lasting friendships,” said Henderson. The trainee program, which offers free registration for residents, fellows, and medical students, has also seen growth. Henderson highlighted the program’s value, noting that it “gives young professionals the chance to network with leaders in the field and gain invaluable mentorship.”



To learn more about or to register for EnVision Summit 2025,

EnVision Summit

The EnVision Summit, co-founded by Bonnie An Henderson, MD, is a unique family-oriented, multispecialty ophthalmology CME conference, along with a newly introduced optometry track. Henderson sits down with Ophthalmology Times to talk about the 2025 conference that will take place February 14 to 17 at the Caribe Hilton San Juan, in Puerto Rico.

Connect, learn, and innovate in a family-friendly atmosphere:  What to expect at EnVision Summit 2025

Marguerite B. McDonald, MD, FACS, shares a front-row view of ophthalmology’s “revolution with a capital R."

From firsts to the future: A pioneer's perspective on ophthalmology

Q&A: Natalie Afshari, MD, FACS, championing on-label pediatric IOLs: turning advocacy into access

Enhanced monofocal IOLs provide a slight depth-of-focus boost without compromising contrast, making them a versatile choice for patients seeking improved distance and intermediate vision while still needing glasses for near tasks.

What increased depth of focus can mean to your monofocal IOL patients

According to the company, enVista Envy IOLs will be commercially available in the U.S. on a limited basis in the coming weeks and more broadly in 2025. Bausch + Lomb is also in the process of seeking regulatory approvals for the lens in additional markets.

FDA approves Bausch + Lomb’s enVista Envy range of IOLs 

According to the company, the center, which officially opens on Thursday, September 26, will serve as a hub for hands-on training and education in lens-based vision correction.

STAAR Surgical expands its Experience Center to meet surgeon demand

Dr Robert Maloney gives keynote lecture on IOLs at the 2025 Controversies in Modern Eye Care meeting

Robert Maloney, MD, MA, revisits the legacy of Harold Ridley at CIME 2025

 (CIME) meeting in Los Angeles, one of the most compelling sessions, given by Robert Maloney, MD, MA, wasn’t about the newest device or drug—it was about history. Specifically, the moment 75 years ago when Harold Ridley implanted the first intraocular lens (IOL) in a human eye. This landmark event reshaped ophthalmology forever. Yet, as emphasized during the talk, Ridley’s innovation was not immediately embraced—it was denounced, criticized, and feared. And for good reason.

The early IOLs were fraught with problems. They caused inflammation, had not been properly vetted in preclinical trials, and violated emerging ethical norms—particularly those outlined in the Nuremberg Code, which was only beginning to influence medical research in the post-WWII era. Ridley’s decision to proceed was audacious, some might say reckless. But it also marked the beginning of one of the most impactful advances in ophthalmic surgery.

Maloney invited ophthalmologists to reconsider this tension between innovation and regulation. “The process of invention is really a conversation between the radical who wants to push boundaries and the establishment who must protect patients,” Maloney said. This balance remains crucial today. Whether evaluating new gene therapies, surgical techniques, or AI-driven diagnostics, ophthalmologists must weigh potential against harm—often in real-time and with incomplete data.

History, as the talk suggested, doesn't repeat itself exactly—but it does spiral. Understanding the Ridley story isn’t just about honoring the past. It’s a framework for making better decisions today. The progress of ophthalmology has always depended on risk-takers, but it has also relied on rigorous standards, peer critique, and course corrections after early missteps.

The CIME meeting’s approach reflects that philosophy. Rather than offer textbook-style lectures, CIME explores ambiguity, debate, and clinical judgment. “Too many conferences deliver resident-level lists and bullet points,” Maloney noted. “Here, we focus on the places where the field is still uncertain—where practice is evolving.”

For practicing ophthalmologists, CIME offers something uniquely valuable: a space to reflect critically, engage with controversial ideas, and return to clinic with sharper insight.

Jennifer Loh, MD, discusses her presentation at EyeCon 2024.

EyeCon Jennnifer Loh OT

During a presentation at EyeCon 2024, in Fort Lauderdale, Florida, Jennifer Loh, MD, of Loh Ophthalmology Associates in Miami, Florida, discussed the latest advances in anterior segment technology, focusing on dry eye treatments and new surgical technologies for intraocular lenses.

Loh emphasized the importance of understanding dry eye etiologies, such as evaporative and aqueous deficiency, and inflammatory components. She also highlighted new medications, like varenicline nasal spray, cyclosporine, and lifitegrast, and new eye drops for evaporation.

Loh noted the second part of the discussion focused on different surgical technologies in the cataract space. She noted a shift in refractive targeting for IOL calculations, moving from myopic to slightly hyperopic targets, based on data from more than 18,000 patients. Advances in biometry devices and improved intraocular lens implants were also mentioned as significant developments.

During a presentation at EyeCon 2024, Jennifer Loh, MD, of Loh Ophthalmology Associates in Miami, Florida, discussed advances in anterior segment technology, focusing on dry eye treatments and new surgical technologies for intraocular lenses. 



EyeCon 2024: Advances in anterior segment technology

William F. Wiley, MD, shares some key takeaways from his ASCRS presentation on binocularity and aperture optics.

ASCRS 2024: Binocularity and stereoacuity in modern monovision with a small-aperture IOL

William F. Wiley, MD, shares some key takeaways from his presentation on binocularity and aperture optics during ASCRS 2024 with 

- This transcript has been edited for clarity.

Hi, Dr. William Wiley here at ASCRS in Boston. I'm the medical director of Cleveland Eye Clinic, and here I'm giving a presentation on binocularity and aperture optics.

As we know, when looking at monovision, we treat a lot of patients with traditional monovision—one eye set for distance and one eye set for a little bit better up-close vision. Typically, to get a good near effect you might have to target -150 to get that monovision near effect. However, what we notice—yes, you do get near vision but you often lose stereoacuity when you target too near.

What we found, though, is with aperture optics, that aperture allows you to target less near, so you can target about -75 with an aperture optic. It's going to deliver the near vision, intermediate, and maintain some of the distance vision. So, you're going to have maintenance of distance vision, but picking up intermediate and near vision. And, also, you don't lose that stereoacuity effect like you see with traditional monovision.

So, with the aperture monovision, more or less, you're getting distance, intermediate, and near without sacrificing stereoacuity.

Sydney Tyson concludes this series discussing common challenges following IOLs implantation, such as visual halos, and the means to reduce these artifacts. 

Managing Postoperative Challenges Following IOLs Implantation

Sydney Tyson, MD, MPH concludes the series by highlighting the evolution of aspheric lenses, emphasizing the significant advancements made over the years. He reflects on the transformation from lenses that potentially worsened vision to the current era of aspheric lenses that greatly improve visual quality. He underscores the pivotal ability to choose specific aspheric lenses, tailoring them to individual patient needs. He expresses optimism about the bright future of aspheric lenses, emphasizing the ultimate beneficiaries: the patients.

Sydney Tyson, MD, MPH concludes this series discussing common challenges that patients may face following IOLs implantation, such as visual halos, glare, or low contrast, and the means available to reduce these artifacts. 

Sydney Tyson discusses types of aspheric IOLs that cater to a patient’s lifestyle, highlighting recent developments in the therapeutic landscape. 

Types of Aspheric IOLs: Monofocal and Multifocal Lenses

Sydney Tyson, MD, MPH delves into the various types of aspheric lenses available for patients, emphasizing the importance of tailoring lens selection to the patient's preferences, lifestyle, and visual demands. The decision involves balancing visual quality, range of vision, and minimizing visual disturbances like glare, halo, and starbursts. Tyson discusses offsetting positive spherical aberration found in most corneas using lenses with negative spherical aberration. He explains the choices available, including lenses with 0 aberration, -0.2, and -0.27 aberration, aiming to achieve a balanced or 0 spherical aberration for optimal image quality. Different scenarios, such as maximizing image quality, minimizing tilt or decentration sensitivity, maximizing depth of focus, and addressing previous refractive surgeries, influence the choice of lens and the modulation of spherical aberration.

In specific clinical situations, Dr. Tyson recommends the CT Lucia 621p lens, known for its unique design with negative spherical aberration in the center and gradual transition to neutrality in the periphery. This design proves beneficial in cases of potential lens movement, such as in patients with exfoliation or trauma, and for large corneal angles where the pupil is not centered on the visual axis.

Sydney Tyson, MD, MPH discusses various types of aspheric IOLs that cater to a patient’s lifestyle, highlighting recent developments in the therapeutic landscape like the CT Lucia 621P IOL. 

Ophthalmology Times© spoke with Robert Lin, MD at the 2023 ASCRS meeting in San Diego, where he shared the value of using the Insight 100 by Arcscan in his practice and why it provides a safer outcome for patients.

Hi, this is Dr. Robert Lin, founder of IQ Laser Vision [and] also assistant clinical professor at the David Geffen School of Medicine at UCLA. Today I want to talk about a great technology that's really helped our practice. It's the Insight 100 from ArcScan. I've had this unit for over 5 years now and we've done thousands of scans for our patients.


The primary reason I purchased this unit is because of the very precise epithelial mapping that we're able to achieve with this unit. There are other units that have this function as well but I found that this one has the most reproducibility and precision and measures up to 1 micron of accuracy. The reason we have this technology is because when we look at topographies, a lot of patients...we're kind of puzzled. Over up to 20% of our patients that come in for a laser vision correction on consultation, we're wondering, is there a little bit of impure steepening. Is there some forme fruste keratoconus, is there some thinning that we're concerned about.


So this technology has a very low incidence of false positives and false negatives. Based on many studies, we're able to use this as an extra data point in order to collaborate with the topography, of course , the patient history of whether they're rubbing their eyeballs or not or if they're having thinner corneas to have a history of keratoconus. What we're looking for is an area of thinning over an area of steepening. If we're seeing both in epithelial thinning, usually in the inferior central or inferior area, and we correlate that with some inferior steepening or some posterior elevation on one of the Pentacams or Ziemer technologies then were very concerned that this person does have forme fruste or actually keratoconus. If we don't see that, and everything else looks pretty normal even though that the bad scan on the Pentacam or some other parameters look a little bit if it was giving us a little of a yellow flag, then we still feel more confident that this person still could be a candidate for laser vision correction.


Of course, there's other technologies which is like the ICL, and this is the second indication that we've been using for the ArcScan for the Insight 100. What we're able to do is have reproducible images of the anterior chamber and also behind the iris. Therefore, instead of using the white to white measurement as mandated by the FDA, we're able to actually measure the sulcus and actually see where we're actually supposed to put the lens in. Using that measurement developed by Dan Reinstein, we're able to very precisely calculate which of the four sizes of ICL is best suited for this patient. So we don't have the issues of overvault, which can cause a higher chance of angle closure glaucoma, or some other problems especially early postoperatively, or undersizing, which can cause a higher incidence of cataracts or rotation of toric lenses.


So the ArcScan using this function is amazing. I've compared other UBMs to try to reproduce this, but it's very technician dependent, so that even with the same technician on the same patient, we're unable to get reproducible results that are very precise. The machine here with the ArcScan actually has a little robot inside that whirls around really really quickly and lines up the picture so that it's reproducible and then the technician merely just puts a ruler on it and measures those different areas. So it has been a game changer for us as well, especially when we're operating on eyes that are smaller eyes where it's very precise. We need a very precise lens to put into this eye so that we get the safety that we need for the patient.

ASCRS Live: IOL placement and increasing patient safety with precision and accuracy

“In my experience and my opinion, it is possible that the extended haptic contact surface area with the capsular bag for the toric enVista platform may contribute to its superior rotation stability.”

Edward Hu, MD, PhD, gave a presentation during the 2022 ASCRS annual meeting on his four year retrospective analysis of comparative evaluation of clinically significant IOL rotations in his personal experience.

Looking at the use of over 812 Toric IOLs of various platforms, he concluded that the total Toric rotation rate in his experience was low at 2.1%

Edward Hu, MD, PhD, looked at  812 toric IOLs utilized of various platforms, concluding a low total toric rotation rate at 2.1%.


Retrospective study shows toric IOL rotation rate to be low at 2.1%


Ed Hu, MD, PhD, a cataract surgeon at the Wolfe Eye Clinic (Cedar Rapids/Iowa City, IA), shares highlights from his paper analyzing three years' worth of his own postoperative data on comparative lens rotations in toric IOL platforms.

Ed Hu, MD, PhD, shares highlights from his paper analyzing three years' worth of his own postop data on comparative lens rotations in toric IOL platforms. 

Analyzing comparative lens rotations in toric IOL platforms

Karolinne Rocha, MD, PhD, director, Cornea & Refractive Surgery, Storm Eye Institute (Medical University of South Carolina), discusses addressing presbyopia-correcting IOLs and matching today's advanced technology to patients, as well as what to recommend for patients when cataract surgery isn't an option. 

In recognition of Cataract Awareness Month. 

Looking at technological advancements in cataract surgery

Fasika Woreta, MD, MPH, of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, discusses the determining factors and indicators to consider when treating cataract patients with IOLs.

In recognition of Cataract Awareness Month, Fasika Woreta, MD, MPH, discusses IOL options for cataract patients. 

Assessing IOL options for cataract patients

3.	Nicole Fram, MD concludes this series on the potential of decentration, highlighting zero and negative spherical aberration lens options.

IOL Selection for Eyes With Unique Anatomy

Nicole Fram, MD discusses the significance of optical center and pupillary center misalignment in certain patients, emphasizing the importance of selecting intraocular lenses (IOLs) with flexibility in de-centration. In cases where the optical center does not align with the pupillary center, Fram recommends IOLs with zero spherical aberration, such as the enVista or the LI61AO. Additionally, lenses like the CT Lucia 621, with a small amount of negative spherical aberration, are noted for their tolerance to de-centration.

Fram specifically considers patients with conditions like zonulopathy, pseudo-exfoliation, abnormal corneas, or de-centered obliques post-LASIK or radial keratotomy (RK). The choice of IOL is tailored to mitigate the impact of de-centration, acknowledging the importance of spherical aberration in these cases. Highlighting recent advancements, Fram speaks of the CT Lucia 621 as an exciting addition to the market. This unique design with an index of refraction of 1.49, minimizing hyperreflectivity on the surface and ensuring it is glistening-free. The CT Lucia 621 is particularly beneficial for eyes susceptible to zonulopathy or de-centration.

Nicole Fram, MD concludes this series on the potential of decentration and subsequent IOLs misalignment, highlighting zero and negative spherical aberration lens options for these unique cases. 

Nicole Fram, MD discusses the methods for assessing a patients’ ocular anatomy for IOLs, such as corneal topography, ray tracing, and optical biometers. 

Preoperative Assessment and Imaging

Nicole Fram, MD outlines a comprehensive approach to evaluating patients eligible for cataract surgery, emphasizing the importance of various diagnostic tests in refining intraocular lens (IOL) calculations. First, Fram focuses on corneal and tear film anatomy, involving corneal topography to assess astigmatism and irregularities. Placido imaging is employed to identify ocular surface abnormalities and scarring, which is particularly crucial in cases with epithelial basement membrane dystrophy that may impact IOL calculations.

Fram highlights the significance of ray tracing wavefront aberrometry, using the Eye Trace system to analyze the entire optical pathway from cornea to lens to vitreous. This technology proves critical in distinguishing aberrations originating from the cornea versus internal factors, aiding in determining the optimal timing for cataract surgery. The complex nature of certain eyes, such as those with a history of radial keratotomy (RK), requires a nuanced assessment. Additionally, the incorporation of macular optical coherence tomography (OCT) for all patients becomes integral in understanding eligibility for presbyopia correction and guiding strategies, whether presbyopia correction or a mini mono-vision approach with a monofocal lens.

Seth Pantanelli, MD discusses the landscape of monofocal aspheric intraocular lenses (IOLs) and how he caters treatment options to each patient. 

Key Features of Some of the Latest Monofocal Aspheric IOLs

Seth Pantanelli, MD discusses several monofocal intraocular lenses (IOLs) he favors in his practice, emphasizing their unique features and advantages. He mentions the enVista, a neutral aspheric lens known for being glistening-free and versatile in a wide power range. Pantanelli values the stability of the enVista, especially in cases of de-centered or irregular astigmatism. Another lens he highlights is the CT Lucia 621, which features a distinctive aspheric profile with negative spherical aberration in the center, transitioning to neutral and then positive in the periphery. This design aims to optimize vision quality in various lighting conditions and lens positions. The CT Lucia 621 also stands out for its exceptional clarity inside the eye and absence of glistening.

Pantanelli emphasizes that the choice of monofocal IOL depends on various factors, such as the patient's corneal condition, refractive history, and personal preferences. For patients with irregular astigmatism, he leans towards neutral aspheric lenses, while those with a history of hyperopic LASIK may benefit from older spherical IOLs with negative spherical aberration.

Seth Pantanelli, MD discusses the landscape of monofocal aspheric intraocular lenses (IOLs) and how he caters treatment options to each patient.

Nicole Fram, MD discusses unique ocular anatomies, such as keratoconus, that require IOLs selection, highlighting the risks associated with IOLs calculation. 

IOL Calculations for Unique Eye Anatomy

Nicole Fram, MD specializes in cataract, refractive, and corneal transplantation surgeries. In this series, she addresses challenges in intraocular lens (IOL) selection for complex cases. Fram identifies several challenging ocular conditions, including post-corneal refractive surgeries, long and short eyes (high myopes and hyperopes), and conditions like keratoconus. These cases pose difficulties in achieving precise IOL calculations. For post-corneal refractive surgery patients, Fram notes the challenge of transitioning from a high success rate with LASIK to potentially lower rates in cataract surgery.

The discussion also covers challenges in long-eye patients (high myopes) where surgery can lead to hyperopic outcomes. Short eyes, particularly those with unpredictable anterior chamber depth, present their own set of challenges. Fram delves into the unique challenges posed by keratoconus, ectatic corneas, and radial keratotomy patients. Lastly, Fram emphasizes the importance of considering epiretinal membrane and macular degeneration in IOL selection.

Nicole Fram, MD discusses unique ocular anatomies, such as keratoconus or high myopia, that require specialized intraocular lens (IOLs) selection, highlighting the risks associated with IOLs calculation. 

1.	Seth Pantanelli, MD discusses the differences between traditional monofocal intraocular lenses (IOLs) and aspheric options.

Benefits of Monofocal Aspheric intraocular Lenses

Seth Pantanelli, MD, a professor of ophthalmology at Penn State University, discusses monofocal aspheric intraocular lenses (IOLs), highlighting their advancements and differences in function compared to traditional monofocal IOLs. He delves into the significance of spherical aberration in optical systems before the advent of aspheric IOLs, emphasizing the potential issues arising from positive aberration in both corneas and spherical lenses.

Pantanelli discusses the potential benefits of using monofocal aspheric IOLs, emphasizing their goal of delivering high-quality vision. Patients can expect excellent distance vision without glasses but may still require them for tasks like reading or computer use. Pantanelli notes that patient satisfaction is high across these options, and the choice often depends on how frequently patients are willing to use glasses for specific tasks. He identifies specific patient groups well-suited for monofocal aspheric IOLs, including those desiring high-quality vision at a single distance, individuals with conditions predisposing them to contrast problems, post-LASIK or post-RK patients, and those with irregular astigmatism.

Seth Pantanelli, MD discusses the differences between traditional monofocal intraocular lenses (IOLs) and aspheric options.

IOL Advances

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