AAO 2026: Setting realistic expectations with refractive IOLs

Setting realistic expectations is essential for patient satisfaction after refractive intraocular lens (IOL) implantation, according to David F. Chang, MD, a clinical professor of ophthalmology at the University of California, San Francisco, who practices in Los Altos, California. Chang co-chairs the symposium “Spotlight on Cataract: Phaco/IOL Challenges, My Top 5 Pearls.” At the American Academy of Ophthalmology (AAO) 2026 Annual Meeting in New Orleans, Louisiana, he spoke with Ophthalmology Times about patient counseling and the symposium’s 25-year history.

How can surgeons set realistic expectations with refractive IOL patients?

“You may do a perfect job with surgery with an outstanding lens, and they’ll be dissatisfied if they enter with unrealistic expectations,” Chang said. Because patients often think in yes-or-no terms, he explains that there are 3 categories of lenses (single focus, extended depth of focus [EDOF], and multifocal), with a toric option for astigmatism. He compares the eye to a camera with 4 focal zones, from distance to reading. An EDOF lens covers 3 of the 4 zones, and a trifocal extends partially into the fourth. Using a school grading analogy, he tells patients that a trifocal gives most people a B for near vision, so they may still want glasses at times.

To save time, Chang has patients watch videos of himself explaining these concepts, so the visit can focus on what is unique to each patient. He also asks patients to record the conversation with the voice memo app on their phone. “It really cuts down on the questions and the misunderstanding,” he said. Patients can review the recording at home and share it with family members who were not at the visit.

Virtual reality tools and online visual simulators from companies also help patients who struggle to understand trade-offs. One example is losing uncorrected near vision after distance correction.

What has the Spotlight on Cataract meant over 25 years?

Chang plans the symposium around topics and speakers he wants to hear, and it has featured hundreds of faculty members. He said he enjoys it as much as an attendee as he does as a planner and is grateful to the Academy for the opportunity to lead it for 25 years.

Chang discusses his “surf and turf” approach to refractive IOL selection in part 1 of this interview.

For more from the meeting, visit Ophthalmology Times’ AAO 2026 coverage.