IOL Selection and Expectation Management in a Hyperopic Patient With Astigmatism Considering Advanced Lenses

This final case discussed a 58-year-old hyperopic male with significant astigmatism and visually limiting cataracts who initially presented seeking LASIK but was determined to be a poor refractive surgery candidate. The panel reviewed corneal topography demonstrating oblique astigmatism and low higher-order aberrations, reinforcing the importance of careful preoperative assessment. Emphasis was placed on confirming macular health with fundus photography or OCT prior to considering advanced IOLs, particularly to rule out conditions such as age-related macular degeneration or glaucoma that may limit multifocal suitability. Lens options included monofocal enVista lens, Toric enVista Lens, and advanced multifocal designs, with discussion ultimately favoring an enVista Envy lens, given the patient’s postoperative J1 near vision and functional outcomes. Broader discussion focused on balancing distance and near vision priorities across different multifocal platforms, as well as the critical role of expectation setting. Faculty emphasized that proactively counseling patients about potential glare, halos, and adaptation time is essential to minimizing dissatisfaction, reducing postoperative chair time, and avoiding more invasive interventions such as lens exchange.