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ASRS 2025: Racial and ethnic disparities in retinoblastoma treatment options

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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

ASRS 2025: Neighborhood-level characteristics associated with delay in surgery and loss to follow-up

Discover how dropless vitrectomy with suprachoroidal injection effectively controls inflammation, offering a promising alternative to traditional eye drop therapy.

ASRS 2025: Dropless vitrectomy with suprachoroidal triamcinolone-moxifloxacin

Ophthalmology Times connects eye care professionals with surgery, imaging, gene therapy, & diagnostic advances to enhance clinical and patient care.

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Ophthalmology Times – Clinical Insights for Eye Specialists

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Results from quality of life and vision surveys provide insight on patient-based subjective outcomes after bilateral implantation of presbyopia-correcting IOLs.

Presbyopia-correcting IOLs do well; not all alike

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

'® David Hutton on the highlights of her presentation "

Early Clinical Assessment of Aberration Neutral One-Piece Monofocal Toric IOL with Enhanced Optic Recovery and Alignment ORA

" during the 2020 ASCRS virtual meeting.


ASCRS

Dee Stephenson, MD, ABO, discusses the highlights of her presentation "Early Clinical Assessment of Aberration Neutral One-Piece Monofocal Toric IOL with Enhanced Optic Recovery and Alignment ORA" during the 2020 ASCRS virtual meeting.

ASCRS 2020: Assessing aberration of monofocal toric IOL with enhanced optic recovery, alignment

Alice Epitropoulos, MD, FACS, from The Cataract & Refractive Center of Ohio, speaks with 

 David Hutton on the key highlights from her presentation "Image quality or depth of field or both: Clinical outcomes from spherical aberration neutral monofocal toric IOL," during the 2020 ASCRS virtual meeting.
	
	

 Dr. Epitropoulos has no financial interest in the subject of this paper. She is a consultant for Bausch + Lomb.

ASCRS 2020: Image quality, depth of field, or both?

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

The acquisition focuses on LayerBio's OcuRing-K technology, with plans to initiate the next clinical trial.

PainReform acquires majority equity interest in LayerBio

The planned acquisition of STAAR includes the EVO family of lenses (EVO ICL) for vision correction for patients with moderate to high myopia with or without astigmatism.

Alcon agrees to acquire STAAR Surgical

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

Alcon's Clareon Panoptix Pro IOL enhances cataract surgery with advanced light utilization and low visual disturbance.

Alcon’s Clareon PanOptix Pro IOL approved in Canada for cataract patients

ASCRS 2025: Seth Pantanelli, MD, speaks about compromise and decision-making in IOLs 

At the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting, Seth Pantanelli, MD, shared findings from a comparative study on IOL performance in low-light conditions. Dr. Pantanelli is a professor of ophthalmology at Penn State College of Medicine in Hershey, Pennsylvania. In his ASCRS presentation, he shared findings from a trial of the TECNIS Eyhance IOL (J&J Vision) and the enVista IOL (Bausch + Lomb).

To hear complete results from the study, watch the full video. 

Dr. Pantanelli shared some background on the study, including the central question that investigators sought to answer. "This is a study that we've been doing for close to 2 years, and the rationale for the study is that both are monofocal IOLs. There's been some marketing behind the Eyhance which says that it gives you about a line better of intermediate vision. But we found some interesting results in previously-published literature that actually said, in some conditions, the enVista IOL can actually give you a line better than the Eyhance at intermediate, in dark light conditions. So that piqued my interest," he explained. “We thought, well, maybe we should test the visual performance of these two lenses in both bright and dark conditions and see how they perform relative to each other. And we wanted to do that in a really rigorous way."

Dr. Pantanelli explained that the study is a multicentre, randomized control trial, which is almost completely enrolled. "We have about over 70 patients enrolled, and 54 of them have completed their final follow up," he said.

Initially, Dr. Pantanelli and colleagues found that many of the patients who received the Eyhance IOL did see about a half a line better at intermediate compared to patients with the enVista, in bright-light conditions. "The surprise…and why we did the study, was that in dark light conditions, the enVista saw about a half a line better than the Eyhance…and that was especially evident at near [vision]," he said.

"I think the takeaway message is that everything is a balance. If you're going to get something in one way from a lens, you're probably going to have to give up something in another way," Dr. Pantanelli explained. "Right out of the gate, there's a lot of fanfare about about new lenses, but you always have to take a step back and say, 'Okay, there's no free lunch in optics.' There must be a compromise somewhere else. And I think the study shows that."

HCP Important Safety Information and Indications

Note: ISI headers and subheads must be 25% larger than ISI text

IMPORTANT SAFETY INFORMATION AND INDICATIONS

EYLEAis contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.

Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.

Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.

There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.

Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.

The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.

Patients may experience temporary visual disturbances after an intravitreal injection with EYLEA and the associated eye examinations. Advise patients not to drive or use machinery until visual function has recovered sufficiently.

EYLEAâ (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).

Please see accompanying full Prescribing Information.

Please click for full Prescribing Information.

Investigators were surprised by the outcome of a comparison between the Eyhance and enVista IOLs in low-light conditions.

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.

Part 3: Biggest innovations in ophthalmology in 50 years

In celebration of Ophthalmology Times 50th anniversary, we asked leading experts in the field what they see as the biggest innovation in ophthalmology in the last 5 decades.

Editor's note: The below transcript has been lightly edited for clarity.

So I was just asked a challenging question: in celebrating 50 years of Ophthalmology Times, what has changed in ophthalmology and in my field, which is coronary and external disease, [I] had to think for a few minutes. There's so many things, but I would say first is the development of phacoemulsification by Charles Kelman that totally transformed our approach to cataract extraction. The amazing new options for intraocular lenses, for multifocality and increased depth. I would say, femtosecond laser, being able to precisely do certain steps of cataract surgery. Doing LASIK, which I learned 30-something years ago. So those have been dramatic. I would say in the corneal transplantation space, endothelial transplantation has been an incredible improvement for our patients with endothelial disease. Or even selective keratoplasty, where we just transplant the part that is diseased. And I'm looking forward to the future where we're able to do endothelial transplantation in a very simple way for the patients. And the final thing is for patients with stem cell deficiency. The group from India have taught us that we can now do simple limbal epithelial transplantation, and that has dramatically improved the lives of patients with stem cell deficiency. And in my space, which is the treatment of ocular surface tumors, I think the evolution of interferon and then topical therapies to treat neoplasias has also greatly improved the lives of our patients with ocular surface cancers.

Gosh, that's a hard question. We just came up on the 75th-year anniversary of the IOL, the one billionth IOL being placed in. I mean [it] may be the most significant surgery for humanity in terms of restoring sight and getting people their vision back. I would say similarly on the cataract surgery front the invention of phacoemulsification, or the journey it took to get there. I think, to be able to safely perform cataract surgery in a very elegant manner with very little downtime and recovery afterwards, I would say that's also been an incredible innovation for our field.

Something that I think is very special about what's happened in the last 50 years with ophthalmology is the focus on the patient's well-being. There's so many aspects of our field that we really can't do a lot about, like some of the retinal conditions, but ophthalmology has found ways to improve patient vision, improve their quality of life, with procedures, with medications that we never really thought could exist. So prime example, is for the longest there was no treatment for dry macular degeneration. We had to just watch patients progress, and ultimately, sometimes progress to wet macular degeneration. So late last year, there was an FDA approved treatment for dry macular degeneration, which has made a huge, huge, huge impact on the patients in my practice.

So initially, all we could do for these would be surgery, but over the years, we've developed things that maybe have come and gone as far as fads, or who's taking care of these patients to repair them surgically. Sometimes you'll see a patient who has a laceration and now it's repaired with glue instead of traditional suturing. I don't love that. I still tend to fall into the camp of real surgery, but sometimes we'll see some of these trends. I think one of the biggest changes, though, is how we modulate our wounds long term. So now we have a lot of things we could do to inject maybe a scarred area, or to treat a keloid or a thickened scar. So we have a lot more wound modulating things, or even cosmetic treatment options for scars, lasers, silicone products. So I think that's been a really big change, and that can help us with the function of those tissues that were injured, but also the appearance of them.

Envision Summit: Getting Started with ICL Surgery in Your Practice

At the Envision Summit 2025 in San Juan, Puerto Rico, Arjan Hura, MD, talked about EVO ICL surgery, its benefits, and how every ophthalmologist has the ability and training to conduct the surgery even if they aren't aware. 

Good morning everyone. My name is Arjun Hura. I'm a refractive cataract and anterior segment surgeon at the Maloney-Shamie-Hura Vision Institute in Los Angeles, California. I'm here in sunny Puerto Rico, I just finished giving my talk at my first-ever in Envision 2025 meeting. I was so happy to be here, and it was great to be in a room full of cataract and refractive surgeons. Very interesting to see the mix between academics and private practice, those doing laser vision correction, those doing RLE refractive cataract surgery.

My talk this morning focused on the value proposition of EVO ICL technology. We looked at what are the sort of patients coming in for vision correction, what are their age groups, what are the demographics. And whether you're in private practice or academics, what is the capital cost of potentially acquiring a femtosecond or excimer laser in order to do something like PRK, LASIK or SMILE, relative to the lower, maybe, startup cost of doing EVO ICL surgery?

Every cataract surgeon is trained in ophthalmology residency on how to do cataract surgery. So if you know how to make a paracentesis, a main incision, put an OVD into the eye, take out the OVD, load an IOL and insert an IOL into the eye–for cataract surgery, you have the ability to perform EVO ICL surgery. It's a life-changing surgery that can correct anywhere from -3 to -16 diopters of myopia. It can correct up to 4 diopters of astigmatism. And it's a reversible procedure that can be performed in the same day, bilateral surgery-type manner, to give LASIK-like outcomes with near LASIK-like recovery. Once that dilation wears off, those patients are really seeing great.

So the point of my talk was to show everyone you have the skill set to do refractive surgery if you didn't learn how to do LASIK or PRK or SMILE in residency or fellowship. If you don't have access to lasers to do those surgeries, it doesn't matter, because there's an alternative form of refractive surgery called EVO ICL surgery that can give those same outcomes and give patients visual freedom.

Yeah, well, I would say when it comes to ICL surgery, one of the biggest changes that recently took place was EVO ICL. And so compared to the previous generation of ICL technology, the EVO ICL has a central port and then 2 peripheral ports on each side as well, so a total of 5 ports. And it may sound like a small change from the previous iteration, but this was a very big deal, because 2 of the big things we used to worry about with the old version of ICL technology was one, potential early ASC cataract formation, and two, long-term IOP issues, or glaucoma. Because of that central port, sizing has become much more forgiving. The incidence internationally and even in our FDA clinical trial here in the United States, of early cataract formation, long-term pressure issues was very, very low. And so the EVO ICL surgery has become the safest version of it in its near 3 decade, 3 decade-plus journey. And so it's easier now for people or surgeons who are maybe a little hesitant about adopting it because of some of the risks associated with it in the past, to take it on now and really give patients excellent, uncorrected vision.

Envision Summit 2025: Incorporating EVO ICL into your practice

Anthony Wallace B+L

Hi, I'm David Hutton of Ophthalmology Times Bausch + Lomb Corporation announced the FDA has granted approval to the enVista Envy full range of vision IOLs. Joining me to discuss this approval is Anthony Wallace, vice president and general manager of the US Surgical Business for Bausch + Lomb. First off, what distinguishes the enVista Envy full range of vision IOL from the other intraocular lenses on the market, and how does it enhance vision outcomes for cataract patients?

Yeah, thanks, David. Well, eVista Envy offers a continuous range of vision with excellent dysphotopia tolerance on the widely used enVista platform. In fact, more than 6 million eyes have implanted worldwide with the enVista technology. So surgeons are very comfortable with it. Also, enVista Envy enables surgeons to treat a wider range of astigmatic patients with more accuracy and precision with half diopter or less steps between the cylinder range.

Can you elaborate on the technology behind the enVista Envy IOL and how it provides a full range of vision, particularly for patients looking to reduce their dependence on glasses after surgery?

Sure. Well, enVista Envy uses diffractive technology to offer patients that distance, intermediate and near visual acuity. But in our research and development of this lens, we really wanted to rethink diffractive technology, to offer that spectacle independence in all lighting conditions, while reducing those bothersome dysfytopsias that are generally associated with diffractive Technology. The first piece is the use of active syncoptic In INVISTA envy. It's designed to enhance image contrast when patients need it most, evenly distributing light in photopic conditions and prioritizing distance in mesopic conditions. In phototopic conditions, where the pupil size is generally around three to four millimeters. Active syncoptic maintain excellent full range of vision for those patients and in pupils larger than four millimeters, active syncoptic is able to prioritize that light energy which facilitates the night vision. And then, in addition to the active, syncoptic, enVista Envy is enhanced with a proprietary clear path technology designed to reduce light scattering in those patients.

Tell me a little bit about the clinical trials and patient outcomes that played a key role in securing FDA approval for this IOL.

Yeah, well, we have 2 large-scale clinical trials. The first one was done in Canada and aligned with the approval of enVista Envy in Canada earlier this year. The US one, specifically, we had 23 investigational sites, more than 1000 eyes implanted with two thirds of those being in enVista Envy. Patients achieve mean visual acuity of 20/20, distance, 20/25, intermediate and j1 near. Most importantly, more than 9 out of 10 patients had little to no bothersome dysphotopsias.

How do you envision the enVista Envy IOL, impacting the US cataract surgery market, especially in terms of adoption by ophthalmologists and patient satisfaction?

Yeah, well, you know, starting off top of mind, enVista can treat a broader range of astigmatic patients, and that's something that's not just with Envy, but with our our platform. So, 9 diopters of CIL with half diopter increments or less really enables us to have that precision on patients that they maybe don't have today. There are definitely good options in the market, but we think we can add to that. While the premium IOL market does have good options, as mentioned, for patients today, we believe that it's still an unsatisfied market and and that is, in my opinion, that's defined by the Marketscope data that shows, you know, if you look at it, over the last 8 or 9 quarters, the market's really been flat. This presbyopia correcting, premium market has really been, has been flat to, in some cases, declining. And we feel that enVista Envy can offer spectacle independence with a positive patient experience. So, we believe that envy will give that confidence to surgeons and patients to return back to the premium market.

And when will these products be available?

Yeah, so we got approval last week ... last Thursday. We began shipping lenses on Friday and Saturday. So the lenses are available and they're being implanted as we speak.

What support or resources will Bausch + Lomb provide to surgeons to ensure successful integration of the enVista Envy IOL into their practice. And how does this fit with your broader US surgical strategy?

Yeah, well, our customer facing team is fully trained, right? They've been learning about this technology. They've been trained on it for the last 3 or 4 months. We also train them at the end of the week last week with approval. But as of this morning, they're out there face-to-face with surgeons supporting them. We also have a full suite of resources that are available online, including our instructions for use, a surgeon brochure, patient brochures. We also have a toric calculator that is that is fully online and ready to go. So, our sales team is out there in full, you know, in full force, and they're really supporting, supporting their surgeons. As far as the question fitting into our strategy, you know, we believe that patients should receive a premium outcome that they truly expect and deserve. In fact, earlier this summer, we acquired Trukera Medical and its ScoutPro point-of-care device for precisely measuring osmolarity. We know that dry eye disease is prevalent in cataract surgery candidates and can have a significant negative impact on outcome. So, being a leader in both in both cataract surgery as well as in dry eye management, we now have the ability to test, treat and offer technology to surgeons and patients to provide that premium outcome. And our goal, really again, is to help them see better, to live better, and we believe that this enables us to do that.

Bausch + Lomb's enVista Envy IOL has received FDA approval, offering a full range of vision with enhanced dysphotopia tolerance. Utilizing diffractive technology and proprietary features like active syncoptic and clear path technology, it aims to reduce dependence on glasses and improve night vision. Clinical trials demonstrated high patient satisfaction and minimal dysphotopias. The IOL targets the unsatisfied premium market, promising spectacle independence and positive patient experiences. Bausch + Lomb supports integration with comprehensive resources and aligns with their broader strategy, including recent acquisitions for enhanced cataract surgery outcomes.

The FDA granted approval to the enVista Envy full range of vision IOLs following Canadian approval in May 2024. 

Anthony Wallace of Bausch + Lomb talks about enVista Envy FDA approval

cataract surgery in karatoconus patients at IKA 2024

Elizabeth Yeu, MD, Executive Board Member of IKA, and a cataract and refractive surgeon at Virginia Eye Consultants, talked about perioperative considerations for cataract surgery in keratoconus patients.

My name is Elizabeth Yeu. I'm a cornea, cataract and refractive surgeon at Virginia Eye Consultants. And we have had a wonderful time here at the second annual International Keratoconus Academy annual meeting. With that we've had some excellent discussions surrounding the perioperative considerations for cataract surgery in our keratoconus patient. So as we know, the cornea naturally will crosslink over time with age, just as any part that has collagen, like our joints. But not all the corneas that we see are naturally cross-linking, especially if patients are eye rubbers. So that is something that we do take into consideration depending on if they are patients that are ours to begin with, or if it's a first-time referral. So when we do evaluate these patients, these are very important historical pieces of information that we need to gather. If their vision is correctable in spectacles versus contact lenses, and what type of contact lenses, and of course, their goals. If they're looking for uncorrected vision, etc.

Diagnostically, we know that these are some of the toughest patients in terms of reading and getting consistent values. And it is a great thing if we can get their manifest refraction to have at least meridian alignment with what we see from their different diagnostic values. For example, their advanced optical biometry and their topographic values with their tomography. So if their meridian at their manifest and in their spectacles is at 110 degrees, and we see that it is traveling, even if a little irregular, but at about 110 degrees. That also helps us know that at least there is alignment there versus totally irregular astigmatism.

And finally, it also is helpful to know if they were able to achieve some level of decent spectacle corrective vision in soft contact lenses and glasses, versus if they were completely dependent on using scleral lenses. That also tells a different story in terms of the diagnostic pathway of what we would do at the time of cataract surgery. And sometimes doing a contact lens over refraction can be also very helpful in determining what part is cornea and what part is a cataract. Particularly if this is a new patient to us. With that being said, we know that eyes that are steep have a lot of negative spherical aberration. And so it's helpful for us to either use a zero sphericity IOL. And if possible, if they were able to achieve good correctable vision at some point or decent correctable vision, we can use a zero sphericity toric IOL in order to help them achieve some level of uncorrected vision. Otherwise, using a monofocal with zero sphericity in it is probably going to be a great way to go. Or you can even use a positive aspheric IOL monofocal in order to help neutralize what is going on into the cornea. And obviously there's also the light adjustable lens as a monofocal that can be helpful. And then now in this whole new class of small aperture IOLs, if they have a normal macula, and they are good, otherwise they're not too dry. This is a great new off label indication where small aperture IOLs have helped us to actually open the possibility. I have had some of the happiest patients who start with poor uncorrected vision and are able to have this great extended depth of focus, even if they have more than one and a half diopters of astigmatism to start with because the small aperture still provides the ability to actually block out the peripheral irregular coma rays.

So with that being said, you know, it is so great that we do have more understanding that there are great IOL formulas like the Barrett True-K for keratoconus and the Kane for keratoconus and these different breadth of lenses and we are taking this into consideration for our keratoconus patients in cataract surgery.

IKA 2024: Keratoconus patients in cataract surgery

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. 

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