EnVision Summit 2026: One size doesn't fit all for challenging refractive cases

Rahul Tonk, MD, MBA, a cornea, cataract, and refractive surgeon at The Princeton Eye Group and Wills Eye Hospital, presents key insights from his talks at EnVision Summit 2026, a conference he describes as both educational and enjoyable. His focus centers on refractive surgery, dry eye, and ocular surface disease.

In his session on refractive surgery, Rahul discussed a series of unique and challenging refractive cases that he presented to a panel of expert refractive surgeons. These cases included:

• A high myope
• A myopic presbyopic patient
• An older latent high hyperope

He characterizes these as some of the most difficult refractive evaluations surgeons encounter in practice. By presenting them to a panel, the goal was to explore how different experts might approach the same complex scenarios, highlighting the nuances of clinical decision-making in refractive surgery.

Rahul emphasizes that refractive surgeons now have more technology than ever to address such challenges. He cites a range of modern options, including custom lens replacement with advanced presbyopia-correcting intraocular lenses, implantable collamer lenses (ICL), and procedures such as SMILE, LASIK, PRK, and what he refers to as Calex. According to him, these procedures are “better than ever,” reflecting major improvements in precision, safety, and visual outcomes.

A central conclusion of his presentation is that no single refractive procedure is ideal for every patient. Instead, he stresses the importance of customization: as refractive surgeons continue to evolve, they must increasingly tailor their approach to the individual visual needs, anatomy, and lifestyle of each patient. The overarching message is that the future of refractive surgery lies in personalized vision correction, using the expanding toolkit of technologies to achieve optimal, patient-specific outcomes.