ESCRS 2026: David Mingo Botín, MD, PhD, on post-LASIK EDOF IOL data

Patients who underwent laser vision correction (LVC) years earlier are increasingly returning for cataract surgery with high expectations for spectacle independence, yet the corneal irregularities left behind by that earlier surgery have long raised questions about how well presbyopia-correcting intraocular lenses (IOLs) perform in these eyes.

David Mingo Botín, MD, PhD, FEBO, of the Department of Cataract and Refractive Surgery at IMO Madrid–Grupo Miranza and Hospital Universitario Ramón y Cajal in Madrid, presented data at the 44th Congress of the ESCRS in London addressing this question, from a multicentre retrospective study comparing visual, refractive, and patient-reported outcomes of the Tecnis PureSee (Johnson & Johnson) extended depth of focus (EDOF) IOL in 117 eyes with and without a history of LASIK.

Botín's clinical and research focus on corneal, ocular surface, and cataract/refractive surgery, including doctoral work on astigmatism management during cataract surgery, informed the study's design. In the following Q&A, Botín discusses the clinical gap the study was designed to fill, how the post-LASIK and control cohorts were structured, the key visual acuity and patient-reported findings between groups, how these results should shape patient counselling, and where non-diffractive EDOF IOL technology is headed next.

This Q&A has been lightly edited for length and clarity.

Ophthalmology Times Europe: What was the clinical question or gap in the post-LASIK IOL literature that this study was designed to address?

David Mingo Botín, MD, PhD, FEBO: Since the introduction of non-diffractive and extended partial-depth-of-focus (DOF) IOLs, they have gained popularity due to their presumed higher tolerance for corneal irregularities compared with traditional diffractive multifocal IOLs. In fact, patients who have previously undergone LVC to eliminate their refractive error often request near-vision functionality when they need cataract surgery.

Although previous studies had demonstrated favourable visual results with other EDOF/extended-range lenses in post-LVC eyes, no study to date had evaluated the performance of the Tecnis PureSee IOL in eyes with prior corneal refractive surgery. We wanted to know whether this IOL could provide comparable visual performance, refractive predictability, spectacle independence, and visual quality in post-LVC eyes compared with unoperated control eyes.

OTE: Walk through how the comparison between post-LASIK eyes and non-LASIK controls was structured, and why that design was chosen to isolate the effect of prior corneal surgery.

Botín: The study was based on a multicentre retrospective review of clinical records of patients implanted with Tecnis PureSee, with and without previous corneal refractive surgery. Strict exclusion criteria (glaucoma, macular disease, amblyopia, prior non-laser surgeries, intraoperative/postoperative complications) were applied to ensure that corneal alteration was the primary variable influencing outcomes.

A total of 117 eyes from 117 patients were evaluated, divided into 2 balanced cohorts: 59 eyes without prior corneal surgery and 58 eyes with a history of excimer laser corneal myopic refractive surgery. Postoperative outcomes were evaluated between 1 and 3 months, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity at 40 cm (UNVA), residual manifest refraction, photic phenomena via the Quality of Vision (QoV) questionnaire, and spectacle independence via the Patient Reported Spectacle Independence Questionnaire (PRSIQ).

OTE: What were the key visual acuity, refractive predictability, and patient-reported outcome findings between the 2 groups, and were there any differences that reached statistical but not clinical significance, or vice versa?

Botín: Regarding visual acuity, statistically significant differences were found in postoperative UDVA (0.04 ± 0.07 logMAR vs 0.07 ± 0.08 logMAR) and CDVA (0.01 ± 0.03 vs 0.04 ± 0.06), favouring the non-previous LVC group. However, these differences lack clinical significance, as the mean difference was about 2 logMAR letters. In contrast, no statistically significant difference was found in UNVA (0.16 ± 0.13 vs 0.16 ± 0.10 logMAR; P = .770), demonstrating equivalent clinical performance for near vision.

Another important finding was lower refractive predictability in the post-LVC group, reflecting the added challenge of IOL power calculation after corneal refractive surgery. Spherical equivalent prediction error was within ±0.5 D in 93.2% of eyes in the control group compared with 77.6% in the previous-LVC group (P = .040). Nevertheless, the mean absolute prediction error remained low, and no statistically significant difference was observed (0.22 ± 0.16 D vs 0.30 ± 0.24 D; P = .206).

The PRSIQ showed that a high level of spectacle independence was reported by 91.7% vs 84.6% of patients, with no statistically significant difference (P = .743). The QoV questionnaire showed no differences in any photic phenomena except halos: 89.8% of patients in the non-previous LRS group reported never perceiving halos compared with 67.5% in the post-LRS group, a statistically significant difference (P = .012). This finding was likely due to higher baseline corneal spherical aberration, but intensity and bothersomeness remained low and did not affect overall visual satisfaction (P = .240).

OTE: How should these findings shape counselling and IOL selection conversations with patients who have a LASIK history and are now considering a presbyopia-correcting lens?

Botín: These findings allow us to tell patients that their prior corneal refractive surgery does not preclude functional visual performance or the good rates of spectacle independence achievable with this extended partial-DOF IOL. However, preoperative counselling must set realistic expectations, explicitly advising patients that prior corneal alterations entail a slightly higher risk of residual refractive error and an increased propensity for perceiving postoperative halos.

OTE: Non-diffractive EDOF and extended-range lenses have been gaining ground in premium IOL conversations. Where is the technology heading next, and what still needs to be solved for post-refractive surgery patients?

Botín: I think the technology is moving towards extending the depth of field into near vision, trying not to worsen visual quality or dysphotopsias, through new refractive designs. We are also looking forward to improvements in software systems based on diagnostic tests, either on their own or in combination with optical simulators, which could predict the specific outcome for each patient. This would be very helpful when selecting IOL technology, especially in altered corneas.

Although it is improving, there is still a fundamental need to improve refractive predictability in IOL power calculation in patients with prior corneal surgery. Also in day to day practice, from a practical clinical perspective, it would be very helpful to have protocols that allow us to match a patient's specific corneal aberration profile with the most appropriate IOL model, as well as to reduce the current uncertainty in the thresholds at which a safe recommendation for IOL selection can be made. Although understanding of the optical functioning of these lenses is improving thanks to optical bench and profilometry studies, fitting the right lens to the right patient remains challenging in many individual cases.

Reference
1. Mingo Botín D, Tejerina V, Rabadán P, Gonzalez-Lopez F, Delgado-Tirado S, Péláez C. Visual and refractive outcomes of an EDOF IOL in post-LASIK eyes vs non-LASIK controls: a real-world retrospective comparison. E-poster presented at: 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS); September 11-15, 2026; London, England.