Midyear cataract check-in: What 2026 has brought to the OR and beyond

June marks Cataract Awareness Month—a reminder that cataracts remain the leading cause of preventable blindness worldwide, and that the clinical and surgical landscape is far from static. In the first half of 2026, Ophthalmology Times has covered everything from a safety alert in the OR to new postoperative therapies and emerging noninvasive treatment options. Here is where things stand at the midyear mark.

"This is the largest treatable disability burden in all of medicine, and the gap is getting wider, not narrower. That should bother us more than it does,”—John Berdahl, MD

The Global Cataract Gap and a Brain Connection

In a Q&A timed to Cataract Awareness Month, John Berdahl, MD, of Vance Thompson Vision laid out the math: of roughly 43 million blind people worldwide, an estimated 17 million are blind from cataract, nearly 40% of all blindness, and the number keeps climbing despite falling age-standardized prevalence. Domestically, Berdahl argued the problem is not capacity but access, and he pointed to EyeCare America as a structural intervention worth scaling.¹

Berdahl also addressed the emerging data linking cataract extraction to reduced dementia incidence. Multiple large cohort studies, including work from the Adult Changes in Thought cohort and the UK Biobank, have reported associations between cataract surgery and lower all-cause dementia risk.² Berdahl was measured in his interpretation: the signal is real and consistent, but confounding by indication and reverse causation mean a causal claim cannot yet be responsibly made. Still, the hypothesis is biologically plausible across sensory-deprivation, circadian-rhythm, and post-surgery engagement mechanisms.

Safety Alert: Contaminated Trypan Blue Linked to Fungal Endophthalmitis Outbreak

A case series published in JAMA Ophthalmology in May 2026 described six patients who developed postoperative fungal endophthalmitis following cataract surgery at two outpatient clinics in Japan. The causative organism, Sarocladium kiliense, was recovered from patient ocular samples and from the trypan blue supply—including an unopened manufacturer vial—pointing toward manufacturer-level contamination rather than in-clinic handling errors.³

The clinical presentation diverged from typical acute bacterial endophthalmitis, with limited hypopyon and anteriorly localized vitreous opacities. Management required vitrectomy, intravitreal antifungals, and systemic therapy; some cases needed reoperation or IOL removal. All six cases ultimately resolved with a mean postoperative BCVA of 20/30. The findings reinforce that off-label use of trypan blue prepared from laboratory-grade reagents carries supply-chain contamination risks that may not be detectable at the point of care.³

Noninvasive LED Therapy: Early Safety Data for Early-Stage Cataracts

Edinburgh Biosciences reported encouraging long-term safety and performance follow-up from its clinical program for Revisyon, a non-invasive LED light-based therapy designed to address cataract-related vision changes without surgery. Participants were monitored for an average of 20 months post-treatment (longest follow-up: 36 months), with no adverse events reported and stable visual function throughout. Alok Machchhar, Chief Commercial Officer at Edinburgh Biosciences, described the follow-up as 'an important milestone in Revisyon's development,' while cautioning that any availability remains subject to regulatory approval. The company positioned the therapy as a complement to existing cataract care, intended to expand access in primary care settings before vision loss progresses to the surgical threshold. As of mid-2026, the company has not yet completed peer review submission or secured regulatory approval, with final timelines dependent on certification processes still underway.

Post-Op Inflammation Management: New Options Move Forward

Two developments on the anti-inflammatory front are worth tracking.

TRIESENCE phase 3 trial receives FDA IND clearance. In March, Harrow received FDA IND clearance for a planned phase 3 trial evaluating preservative-free TRIESENCE (triamcinolone acetonide injectable suspension, 40 mg/mL) for ocular inflammation and pain following cataract surgery. The randomized, placebo-controlled, double-masked study will enroll approximately 250 patients at a 2:1 ratio, with primary endpoints targeting absence of anterior chamber cells at day 14 and absence of pain at day 8. Harrow's rationale centers on reducing reliance on complex multi-week at-home drop regimens—a well-recognized compliance challenge in older post-cataract patients.⁵ Amir Shojaei, chief scientific officer of Harrow, described the approach as enabling physicians to "maintain greater control over both the procedure and the recovery process."⁵

CLOBIVIS approved in Canada. In late March, Health Canada approved clobetasol propionate ophthalmic suspension 0.05% (CLOBIVIS; Apotex Inc.) for postoperative inflammation and pain following cataract surgery. Formulated using nanoparticle technology to improve dispersion and ocular surface residence time, CLOBIVIS introduces a superpotent corticosteroid into the Canadian post-cataract care landscape. As with all topical ophthalmic corticosteroids, class-related risks—IOP elevation, delayed epithelial healing—apply, and head-to-head comparative data with existing agents such as prednisolone acetate or difluprednate were not disclosed in the approval announcement.

Ocular Surface Optimization Before Surgery: Demodex in Focus

A June case-based roundtable moderated by Alice Epitropoulos, MD, director of the Dry Eye Center of Excellence at The Eye Center of Columbus, reinforced a critical preoperative message: Demodex blepharitis is far more prevalent in cataract surgery candidates than historically recognized. The Titan Study reported that 56% of patients scheduled for cataract surgery have Demodex blepharitis, as identified by collarettes.⁶

Two cases discussed at the roundtable illustrated the clinical stakes. In one, a 78-year-old patient with a visually significant nuclear sclerotic cataract also presented with 2+ collarettes. Treatment with lotilaner (Xdemvy; Tarsus Pharmaceuticals) resolved the collarettes prior to surgery. In the second, a 54-year-old with a 20-year history of ocular rosacea, Demodex blepharitis, and meibomian gland disease—refractory to more than a dozen prior treatments—showed rapid improvement with lotilaner, with collarettes, lid swelling, burning, and redness resolving after treatment.

Epitropoulos described the discussions as reflecting "a shift in thinking" about preoperative workups. “Many attendees seemed to leave the discussion with the idea that optimizing the ocular surface is really no longer an optional approach for surgical patients, especially those with high expectations for implantation of premium intraocular lenses,” she said. Epitropoulos added that the roundtable highlighted how frequently Demodex is overlooked in surgical patients and "the potential consequences of not treating this condition."

Market Disruption: Alcon-LENSAR Merger Collapses Under FTC Pressure

Alcon and LENSAR mutually agreed to terminate their proposed $365 million merger after the FTC signaled its intent to seek an injunction. The FTC argued the transaction would have combined the two most significant players in the femtosecond laser-assisted cataract surgery (FLACS) market, threatening to raise prices and reduce the competitive innovation that had already benefited surgeons and patients. LENSAR retained a $10 million deposit; its share price fell approximately 30% in after-hours trading following the announcement.⁷

The collapse marks Alcon's second failed acquisition attempt in early 2026, following the STAAR Surgical deal's failure to receive stockholder approval in January. The regulatory outcome leaves LENSAR independent and the FLACS competitive landscape intact, at least for now.

Looking Ahead

The second half of 2026 promises continued momentum on several fronts. Harrow's TRIESENCE phase 3 trial is expected to begin enrolling, with results that could reshape how post-cataract inflammation is managed at the time of surgery rather than delegated to patient drop regimens. Edinburgh Biosciences' peer-reviewed Revisyon dataset, if favorable, could open a regulatory conversation around earlier, nonsurgical intervention in primary care settings, a meaningful step toward closing the access gap that Berdahl described. Internationally, the cataract surgery-dementia association continues to attract investigator interest, with Berdahl noting that the signal warrants attention even as causal claims remain premature. The story of cataract in 2026 is still being written—but so far, it is a busy one.

References
1. GBD Vision Loss Expert Group. "Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020." *Eye (London)*, 2024;38(11):2156-2172. (2020 blindness/MSVI figures; rising absolute burden despite falling age-standardized prevalence) https://www.nature.com/articles/s41433-024-02961-1
2. Ma LZ, Zhang YR, Li YZ, et al. Cataract, cataract surgery, and risk of incident dementia: a prospective cohort study of 300,823 participants. Biol Psychiatry. 2023;93(9):810-819. doi:10.1016/j.biopsych.2022.06.005
3. Torikai T, Shimasaki T, Keino H, et al. Trypan blue use during cataract surgery and postoperative fungal endophthalmitis. JAMA Ophthalmol. Published online May 21, 2026. doi:10.1001/jamaophthalmol.2026.1471
5. Harrow to Initiate Phase 3 Clinical Trial Seeking to Expand TRIESENCE® Label to Include Ocular Inflammation and Pain Following Cataract Surgery Indication. Published March 3, 2026. Accessed March 6, 2026 https://www.harrow.com/news-releases/news-release-details/harrow-initiate-phase-3-clinical-trial-seeking-expand-triesencer
6. Trattler W, Karpecki P, Rapoport Y, et al. The prevalence of Demodex blepharitis in US eye care clinic patients as determined by collarettes: A pathognomonic sign. Clin Ophthalmol. 2022;16:1153-1164. doi:10.2147/OPTH.S354692
7. Alcon and LENSAR, Inc. Agree to Terminate Merger Agreement. Published March 16, 2026. Accessed March 20, 2026. https://www.alcon.com/media-release/alcon-and-lensar-inc-agree-terminate-merger-agreement/