AAO 2026: A surf and turf approach to refractive IOL counseling

Giving patients the option of 2 complementary refractive intraocular lenses (IOLs), rather than asking them to choose 1 type for both eyes in advance, can reduce anxiety and indecision, according to David F. Chang, MD, a clinical professor of ophthalmology at the University of California, San Francisco, who practices in Los Altos, California. At the American Academy of Ophthalmology (AAO) 2026 Annual Meeting in New Orleans, Louisiana, Chang spoke with Ophthalmology Times about his talk, “Efficient/Effective IOL Counseling.” The talk is part of the symposium “Spotlight on Cataract: Phaco/IOL Challenges, My Top 5 Pearls.”

Chang, a co-chair of the symposium, described the Spotlight on Cataract as “a little bit like a mini subspecialty day for cataract surgery.” The 25th edition features international experts sharing their top 5 pearls in 7 minutes each, enforced by a shot clock timer. Sections cover refractive IOLs and comorbidities in complex phacoemulsification cases. A final section covers sustainability, ergonomics, talking with patients after complications, and risk management for premium IOLs.

How can surgeons make refractive IOL counseling more effective?

The biggest challenge, Chang said, is the number of choices. More options make decisions harder and can lead patients to put off cataract surgery. He used to ask patients to choose in advance between 2 options: a refractive IOL with fewer halos but limited near vision, or a lens offering full range of vision with some compromise in contrast or halos.

He now offers most good candidates an extended depth of focus (EDOF) IOL in the dominant eye and a trifocal diffractive IOL in the nondominant eye, starting with the lens he considers the better fit. Patients who like the first lens can choose it for the second eye. His office calls the approach “surf and turf.” According to Chang, 3 of 4 patients choose the complementary lens, and the approach reduces indecision and fear of missing out.

“I have to say that surf and turf has just changed the experience for the patient going through this,” he said. Rather than reducing contrast in both eyes with bilateral multifocal lenses, he said, surgeons can provide a full range of vision in one eye and use the other to maximize contrast and quality of vision.

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