Feature|Articles|October 12, 2026

Raising the bar on patient satisfaction: Rethinking the premium IOL conversation

Fact checked by: Tracy Ann Politowicz, Lucia Gambuzza

A successful premium outcome depends not only on the lens, but also on how well the patient understands what to expect before surgery.

When people ask how I define a successful premium IOL outcome, they usually expect a number. The honest answer is that a premium lens experience has to include a premium education. This is not a car dealership. There is no Ferrari on the lot. Every option carries subtle pros and cons, and the consumer instinct to ask for the best one runs into the reality that there is no best one, only the right one for a particular set of eyes and priorities.

That is why 20/20 is an incomplete measure. In the full-range-of-vision category, a patient knowingly trades some quality for convenience, and many of the happiest patients I see walk out a line or 2 short of perfect because they expected exactly that. The unhappy ones are rarely unhappy about a letter on the chart. Something arrived that nobody warned them about, a pattern the published series on multifocal dissatisfaction has described for years.^1,2

The lens that is no longer manufactured

Patient expectations for night vision have risen, and the technology deserves the credit: Newer platforms such as nondiffractive spiral optics hold a broad range of vision while limiting halo and glare far better than early generations did, and patients expect the improved version. Patients are also far better informed, driven by organic search and, increasingly, by artificial intelligence tools that will happily produce a ranked list. The trouble is that this field moves faster than the literature can keep up with it. Designs change faster than trials can compare them, and I have had patients cite a study favoring a lens that is no longer manufactured. Educated patients are a gift, but they still need a translator.

There is no magic question

I do not rely on questionnaires to quantify a patient’s priority for range of vision vs quality. Instead, I have found much greater success in aligning patient expectations with IOL options by laying the trade-off out plainly and letting the patient ask it of themselves. I tell them I can offer a broad range of vision at some cost to quality. For people who value convenience and are flexible by temperament, that trade makes a world of sense, and these implants deliver on it. For the person who expects everything to be just so, I say the technology is not quite there yet. I will often bring a spouse into that conversation, because a spouse is often more candid about how particular a patient is than the patient is. When a surgeon imposes a read on someone's personality onto a lens choice, frustrated patients follow. When patients take an active role in the decision-making process, they are less likely to be surprised by the outcome.

What the low myope's brain expects

Two preoperative findings deserve a pause. The first, dry eye and surface disease, has been drilled into the industry for good reason and remains a real driver of dissatisfaction.^1,2 The second finding is followed far less consistently: the patient's visual history, and in particular the low myope. These are people who have spent their lives with effortless, tack-sharp vision at arm's length, and their brains demand it. Of the referred patients I see seeking an IOL exchange after a full range of vision lens, well over half lived in that low myopic range. A surgeon who respects that one rule will stay out of trouble most of the time.

Promise adaptation, not disappearance

How you say something shapes a patient's opinion of a product in seconds. Before anything else, I separate toric correction from this discussion entirely; a toric lens is such a clear win that lumping it under "premium" only muddies the conversation.

For the full range of vision options, I lead with the positives, and I mean them. For example, I may say, “It is convenient, it is luxurious, and it lets you look at the mountains and check your email in the same breath. In bright, natural light, these lenses are phenomenally successful.” Then I say that nothing is perfect. At night, when a patient is looking at a focal light source through a diffractive optic, I anticipate they will see halos, most noticeably early on. With time, the brain neuroadapts. Functional imaging has shown this at the cortical level, with glare-related signal changes present at 3 weeks largely resolved by 6 months.³

Then comes the question every patient asks: Will it go away? No. The optic is static. But you will adapt, and it will stop occupying your attention. When you first board an airplane, it is loud, and by the midpoint of the flight, half the cabin is asleep. What I never say is that the halos will disappear, because the unhappy patient at 6 months is the one who was told they would. And in the end, I want the patient to choose. I almost never tell someone they are a slam dunk for a full range lens. I remain wary with anyone who drives for a living, because every diffractive lens will produce some halo at night, and it is far easier to adapt facing it twice a week than 5 hours a day. Newer spiral designs have narrowed that gap.

Continuous power instead of split light

The newest designs are addressing light scatter and how light is apportioned across the defocus curve, marrying the smoothness of extended depth of focus with the broad landing zones of a full range lens so that vision feels continuous rather than disjointed. The latest diffractive designs are minimizing the valleys between peaks and doing a good job of it.

The most distinct expression of that goal is to abandon diffraction altogether. Nondiffractive designs, including a spiral optic that varies power continuously across the surface rather than splitting light into discrete foci, aim to deliver a continuous range without the ring structure that gives a diffractive halo its shape. The early published evidence on this approach, from the first such lens, the RayOne Galaxy (Rayner), showed significantly smaller halo and glare than a diffractive trifocal in preclinical simulation, with a comparable range of focus, and predominantly minor photic symptoms in a multicenter clinical series.⁴

The patient my technician flagged

I am not going to change my practice style; I will keep letting the patient choose. What has changed is my confidence in the outcome. Technicians have flagged patients to me as too particular for a multifocal, and after a thorough discussion, those same patients have chosen a full-range lens and done very well. Less light scatter and better dysphotopsia profiles are real, not marketing, and I am now far more willing to offer these lenses to a patient who has done the homework and says, "This is the lens I want." To colleagues who soured on the whole enterprise after the first 2 or 3 generations: The engineering has improved.

The lenses have never been better. The conversation is what makes the difference. Set the table honestly, keep the toric discussion separate, respect the low myope, promise adaptation rather than disappearance, and let the patient make the call. That is the bar.

Zachary J. Zavodni, MD, is a cornea, cataract, and refractive surgeon and medical director at The Eye Institute of Utah in Salt Lake City. Zavodni is a consultant to Rayner.