ASCRS 2026 data show smarter EDOF and toric choices after LASIK/PRK, plus reverse optic capture to relieve negative dysphotopsia.
At the 2026 ASCRS Annual Meeting in Washington, DC, several presentations converged on a set of questions that define the
What links these presentations is a shared clinical population: the patient who has had corneal refractive surgery and now presents for cataract surgery with high expectations and a shared direction in the evidence. Whether the question is managing a complication of premium IOL surgery, tolerating refractive miss with a new EDOF platform, selecting a lens for a post-LASIK eye, or correcting astigmatism with a toric after LVC, the data from ASCRS 2026 consistently point toward expanded confidence. The tools—better IOL designs, better planning software, and better surgical salvage techniques—are maturing. The remaining work is in deploying them systematically and counseling patients with the precision the evidence now supports.
Collectively, the data offer cataract and refractive surgeons a more nuanced and more optimistic picture of what premium technology can deliver in challenging clinical scenarios.
Negative dysphotopsia remains one of the most frustrating complications of modern cataract surgery—a temporal dark shadow or arc that patients describe vividly and that surgeons often struggle to address. Its management in eyes implanted with premium IOLs is even less well characterized, making a retrospective case series from Irene S. Zhou, BSc a welcome addition to the literature.1
Zhou and colleagues evaluated reverse optic capture (ROC), a technique in which the IOL optic is posteriorly captured behind the anterior capsule, as a treatment for symptomatic temporal negative dysphotopsia in 19 eyes of 14 patients previously implanted with either the
The outcomes were reassuring. ROC was technically successful in 17 of 19 eyes; the 2 aborted cases involved anterior capsular tears from preexisting pathology unrelated to the procedure itself, and 1 of those patients ultimately underwent bag-to-sulcus IOL exchange. Among the 17 successful cases, 82% reported complete symptom resolution and 18% reported improvement, signaling that every patient who underwent successful ROC experienced at least some benefit. Post-ROC mean manifest refraction spherical equivalent was –0.25 ±0.43 D, with a modest myopic shift of –0.44 ±0.02 D, and no loss of best-corrected or uncorrected near visual acuity. No adverse events were recorded.
The laterality pattern is worth noting. ROC was performed in 79% of left eyes that had OS surgery, 90% of right eyes that had OD surgery, and 60% of bilaterally operated eyes—broadly consistent with the known laterality asymmetry of negative dysphotopsia. For surgeons managing patients with premium lenses who are struggling with temporal shadows, this series makes a compelling case that ROC is a viable first-line surgical option that may allow patients to keep their presbyopia-correcting IOL rather than undergoing exchange.
Refractive miss is an unavoidable reality in cataract surgery, and among the
The trial enrolled 113 EDOF and 110 monofocal subjects at 9 US sites, with bilateral implantation and subject/evaluator masking. Defocus curves were generated at 6 months using a direct testing method across a range of +1.0 to –2.5 D. At ±0.25 and ±0.5 D of induced defocus, comparable proportions of EDOF and monofocal subjects—at least 94% in each group—maintained distance-corrected visual acuity of 20/25 or better, indicating closely matched tolerance to small refractive errors across both platforms.
Leading cataract surgeons Zach R. Balest, MD, and Lisa K. Feulner, MD, PhD, discuss their comprehensive approach to IOL counseling, exploring how they bridge expectation gaps and tailor premium lens strategies to each patient's unique anatomy, goals, and lifestyle.
The subgroup analysis, which focused on the 62 EDOF and 54 monofocal subjects who had an absolute postoperative spherical equivalent greater than 0.25 D in one or both eyes, is perhaps the more clinically relevant finding. Mean absolute spherical equivalent was similar between groups (0.40 ±0.27 D for EDOF; 0.36 ±0.23 D for monofocal). Despite that residual error, mean binocular uncorrected distance visual acuity was –0.01 ±0.08 logMAR for EDOF patients vs -0.04 ±0.11 logMAR for monofocal. Patient satisfaction and spectacle independence for distance were high in both groups: 97% vs 94% satisfied and 92% vs 87% not needing distance spectacle correction, respectively.
For surgeons counseling patients about realistic expectations with the refractive EDOF platform, these data offer a useful message: that even when the refractive target is not perfectly met, visual and satisfaction outcomes with this lens are comparable to a monofocal.
The post-keratorefractive cataract patient has historically been approached with caution when it comes to premium IOL selection. Biometric uncertainty, altered corneal shape, and reduced tolerance for dysphotopsia have made many surgeons reluctant to offer diffractive multifocals in this population. Whether nondiffractive EDOF IOLs can thread that needle more comfortably is the question that Jimmy Y. Hu, MD, ABO, addressed in a prospective, noninterventional observational study of the Alcon Vivity IOL in patients with prior myopic LASIK or PRK. 3
The study analyzed 40 eyes from 24 patients (16 bilateral, 8 unilateral), with outcomes including monocular and binocular corrected and uncorrected acuities at distance, intermediate, and near, along with a defocus curve and the IOLSAT patient satisfaction questionnaire. The visual results were strong. Mean monocular corrected distance visual acuity was 0.009 ±0.042 logMAR, approximating 20/20. Mean binocular uncorrected distance visual acuity came in at approximately 20/22, with distance-corrected intermediate acuity at approximately 20/25, a particularly important metric given that intermediate vision is the primary functional advantage of EDOF over monofocal. Near vision was functional at approximately 20/40.
Spectacle independence at distance and intermediate was reported by 87.5% and 100% of binocular patients, respectively, though near spectacle independence was more modest at 43.75%, which is consistent with the known profile of EDOF IOLs that extend depth of focus without fully replacing near correction. Patient satisfaction was high overall, with 93.75% of participants saying they would choose the same lens again, a benchmark figure that is particularly meaningful in a population where premium IOL disappointment has historically been more common.
These results reinforce the emerging consensus that nondiffractive EDOF technology represents a well-suited option for the post-LASIK and post-PRK cataract patient who wants freedom from spectacles at distance and intermediate distances without accepting the photic phenomenon risk associated with diffractive designs.
Managing astigmatism at the time of cataract surgery in post-LVC eyes has long been complicated by the unreliability of standard keratometry in corneas with altered power distribution. Julie M. Schallhorn, MD, ABO, presented real-world outcomes from a large retrospective series that tested whether pairing IOLMaster 700 total keratometry with the Barrett True-K formula and VERACITY surgical planner could overcome that limitation.4
The study drew on 399 cataract cases from the VERACITY database, including a mix of monofocal (MON) and multifocal (MUL) toric IOLs and both with-the-rule (WTR) and against-the-rule (ATR) preoperative astigmatism patterns. The headline result was that mean postoperative cylinder across the full cohort was 0.48 ±0.45 D—a level of residual astigmatism that would likely be considered acceptable in routine cataract surgery, let alone in the more complex post-LVC context. Postoperative spherical equivalent was -0.14 ±0.54 D, and mean logMAR uncorrected distance visual acuity was 0.05 across all subgroups, approximating 20/22.
Importantly, outcomes were consistent regardless of IOL type or preoperative astigmatism direction. Residual cylinder was 0.50 D in the monofocal subgroup and 0.45 D in the multifocal subgroup, and 0.48 D in ATR and 0.46 D in WTR. The uniformity across these categories is clinically meaningful; it suggests that the combination of anterior and posterior keratometry with AI-assisted planning can neutralize many of the variables that have historically made toric IOL selection in post-LVC eyes unreliable.
For surgeons who have been hesitant to offer toric IOLs to post-LASIK and post-PRK patients, Schallhorn's series provides an evidence base for reconsidering that posture, provided appropriate biometric tools and planning platforms are in use.
