Spectacle Independence And Patient Satisfaction With Pseudophakic Mini-Monovision Using Aberration-Free Intraocular Lens

Outcome of a Mix-and-Match Approach with a Monofocal Aspherical and a Bifocal Extended Depth-of-Focus Intraocular Lens to Achieve Extended Monovision in Cataract Patients

BACKGROUND

Extended monovision is a novel mix-and-match approach that has been recently introduced. It involves implanting an aspherical monofocal intraocular lens (IOL) for distance vision in the dominant eye, and a bifocal extended depth-of-focus (EDOF) IOL in the nondominant eye. The target refraction for the nondominant eye is - 1.25 diopters (D), and provides good intermediate vision at 80 cm, with an additional 1.5 D power for near vision at 36 cm. This study evaluates the visual outcomes and patient-reported experiences with this extended monovision strategy in cataract patients.

PATIENTS AND METHODS

Patients underwent uneventful conventional or femtosecond laser-assisted cataract surgery and implantation of an aspherical monofocal IOL (Hoya Vivinex XC1-SP, Hoya Surgical Optics, Tokyo, Japan) in the dominant eye [with a target refraction closest to the spherical equivalent (SE) of 0 D] and a rotationally asymmetric refractive bifocal EDOF IOL with an additional power of + 1.5 D (Lentis Comfort-LS-313 MF15, Teleon Surgical B.V, Spankeren, Netherlands) in the nondominant eye (target refraction closest to SE - 1.25 D). These patients were included in this retrospective study. Uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, and UNVA, respectively), and binocular defocus curves were determined. Additionally, uncorrected contrast sensitivity, stereoscopic depth perception, and halometry were measured. Patient satisfaction was evaluated using the PRSIQ and NEI-RQL-42 questionnaires.

RESULTS

A total of 26 eyes from 13 patients were included in the study. The mean postoperative binocular UDVA, UIVA, and UNVA were 0.05 ± 0.09, - 0.08 ± 0.11, and 0.06 ± 0.07 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m), with a mean visual acuity of 0.04 ± 0.09 logMAR. Functional vision above the cutoff value of 0.3 logMAR extended across the defocus steps from + 1.0 to - 3.5 D. The mean dependence on correction score reached a mean of 89.4 ± 23.9, with an overall satisfaction rate of 83.1 ± 13.2.

CONCLUSIONS

To our knowledge, this is the first study to describe the combination of a monofocal IOL for distance vision and a rotationally asymmetric refractive bifocal EDOF IOL for intermediate and near distances, with the aim of achieving extended monovision. This approach demonstrated good visual acuity for all distances and a high patient satisfaction. It may be considered a promising alternative to multifocal IOLs.

Patient-reported Outcome Measures for Assessing Spectacle Independence after Implantation of Monofocal or Extended Depth of Focus (EDOF) Intraocular Lenses with Various Degrees of Monovision

PURPOSE

Cataract surgery aiming for emmetropia in one eye and various degrees of myopia in the contralateral eye (monovision) is a popular strategy to improve spectacle independence. The aim of this study was to use patient-reported outcome measures to assess spectacle independence after implanting aspheric monofocal or extended depth of focus (EDOF) intraocular lenses (IOLs) with various degrees of monovision.

METHODS

All patients with bilateral cataract surgery between 2021 and 2024 aiming for micromonovision (- 0.5 to - 0.75 D), mini monovision (- 1.0 to - 1.5 D) or full monovision (- 1.75 to - 2.5 D) after cataract surgery with implantation of either aspheric monofocal IOLs (Tecnis ZCB00, Johnson & Johnson) or EDOF-IOLs (Tecnis Eyhance, Johnson & Johnson) were included in this study. Patients were implanted with either a monofocal IOL or an EDOF IOL in both eyes, and were aiming for emmetropia in the dominant eye. Six months postoperatively, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their overall satisfaction.

RESULTS

Thirty-two patients in the monofocal group and 88 patients in the EDOF group completed the questionnaire. In both groups, 22% of patients reported that they were entirely spectacle independent for all daily activities. However, the proportion of patients who used spectacles for at least 50% of the time was 41% in the monofocal group and 16% in the EDOF group. The percentages of patients who were able to perform computer work without spectacles with micro-, mini-, or full monovision were 27%, 67%, and 77% in the monofocal group and 61%, 60%, and 90% in the EDOF group, respectively. Spectacle-free reading of a smartphone or tablet was possible for 17%, 75%, and 71% of all patients with monofocal IOL and for 38%, 50%, and 90% with EDOF IOL, depending on the degree of monovision. Patient satisfaction was generally high with a maximum score of 4.9 out of possible 5.0 points in the full monovision EDOF group.

CONCLUSION

Patients aiming for spectacle independence with monovision achieve better results when implanted with EDOF IOLs than with aspheric monofocal IOLs. Even with EDOF IOL, it is necessary to aim for full monovision (- 1.75 to - 2.5 D) in order to achieve spectacle independence for computer work.

Monovision versus multifocality for presbyopia during primary phacoemulsification: systematic review and network meta-analysis

This systematic review and network meta-analysis (NMA) focuses on comparing monovision and bilateral multifocal lenses (bMFIOL) implantation methods in treating presbyopia, a common age-related condition often seen in post-cataract surgery patients. This review focuses on evaluating the efficacy, user satisfaction and limitations of these two approaches through direct or indirect comparison. A comprehensive search was conducted in Medline, Embase, and Cochrane library, considering studies up to 15 July 2022, with direct or indirect comparisons between any monovision and bMFIOL implantation with bilateral cataract surgery. The study protocol has been published in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022340257). Thirty-two studies (3082 patients) were included in the NMA for the primary outcome, complete post-operative spectacle independence. NMA showed monovision to be inferior to bMFIOLs, as bMFIOL was more likely to provide complete spectacle independence (RR = 2.06, 95% CI = 1.34 to 3.15, p = 0.002) compared to monovision. Monovision resulted in less glare compared to bMFIOL (RR = 0.343, 95% CI = 0.181 to 0.651, p = 0.001). There was no statistically significant difference between monovision and bMFIOL for binocular unadjusted distance visual acuity (MD = 70.01, 95% CI = -19.88 to 4.60, p = 0.437) and binocular unadjusted near visual acuity (MD = 5.46, 95% CI = -5.24 to 10.94, p = 0.191). When compared to monovision, bMFIOL provided greater complete spectacle independence at the expense of greater glare. This study was limited by data heterogeneity, and further studies with standardized reporting would be useful.

Evaluation of Intermediate Visual Outcomes in Eyes Implanted with Bilateral Advanced Monofocal Intraocular Lens Targeting for Mini-Monovision and Its Association with Age and Corneal Asphericity

Purpose

To assess the visual outcomes in patients bilaterally implanted with novel Clareon® intraocular lens when targeting mini monovision post-operatively.

Setting

The study was conducted at Laxmi Eye Institute; it is a tertiary care eye institution in Panvel, India.

Design

This is an investigator initiated, prospective, single-centre longitudinal study of 45 patients to assess the visual outcomes in patients who were implanted with Clareon ® IOL bilaterally.

Methods

Patients with corneal astigmatism of ≤0.75 D who underwent bilateral cataract surgery with pseudophakic mini-monovision and implanted with novel Clareon® intraocular lens were included. Patients having post op manifest refraction >±0.25 D in the dominant eye and <-0.5 D or >-0.75 D in the non-dominant eye were excluded. The main study outcomes were assessed at 1 and 3 months; it included uncorrected visual acuities assessment, defocus curve, and patient reported spectacle use.

Results

The mean (SD) binocular distance corrected intermediate visual acuity at 3 months was 0.22 (0.09) LogMAR. At 3 months, 54% of patients enjoyed 0.4 LogMAR or better BUCNVA. The defocus curve showed good distance and intermediate visual acuity with >0.2 LogMAR vision from +0.50 D to -1.50 D. We found a positive correlation between the Q value of the dominant eye and the BCIVA at 3 months postoperatively, however it was not statistically significant. The Q value was more negative when the intermediate vision was closer to 0 LogMAR. Post operatively, at 3 months, 95% patients did not need glasses for distance and intermediate vision and 73% of patients were comfortable for intermediate vision without glasses all the time.

Conclusion

Mini-monovision with Clareon® monofocal IOL implantation can offer overall satisfactory vision for far and intermediate distances with minimal need for use of spectacles for near vision.

Intraocular lens selection in diabetic patients: How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

[Outcomes of extended depth of focus intraocular lenses implantation]

Extended depth of focus (EDOF) intraocular lenses (IOLs) are the latest IOL designs. In recent years, several models of EDOF IOLs have become available in Russia, two of which (Tecnis Symfony and Acrysof IQ Vivity) are implanted in our clinic. Comparative studies devoted to the results of implantation of the new EDOF IOLs are rare in the available literature.

PURPOSE

This article compares the outcomes of implantation of two EDOF IOLs in patients with presbyopia and/or cataract.

MATERIAL AND METHODS

The prospective study included 60 patients (81 eyes) after implantation of EDOF IOL Tecnis Symfony (32 patients, 45 eyes; group 1) or EDOF IOL AcrySof IQ Vivity (28 patients, 36 eyes; group 2). The mean follow-up period was 3.9±1.3 months.

RESULTS

All groups showed a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), intermediate visual acuity (UCIVA), and distance visual acuity (UCDVA) at the maximum follow-up time compared to preoperative values. In group 1, the best corrected near visual acuity (BCNVA) increased from 0.61±0.10 to 0.82±0.16 at the maximum follow-up time, and in group 2 - from 0.58±0.08 to 0.67±0.12 (p>0.05). Both groups showed a significant increase in best corrected intermediate and distance visual acuity (BCIVA and BCDVA) at the maximum follow-up time. The increase in the indicator compared to the preoperative period was not significant in both groups (p>0.05). The frequency of side optical phenomena was low in both groups. No significant differences were found between the groups (p>0.05).

CONCLUSION

This study presents a comparative analysis of the results of implantation of two different EDOF IOLs. Both lenses were comparable in most of the studied parameters, including providing good distance and intermediate vision, functional near vision, as well as a low frequency of side optical phenomena. In all cases the patients were satisfied with the results of the surgical intervention.

Comparing Visual Performance and Subjective Outcomes with an Enhanced Monofocal Intraocular Lens When Targeted for Emmetropia or Monovision

Purpose

To evaluate relative visual performance and subjective outcomes after implantation of the TECNIS Eyhance™ intraocular lens (IOL) targeted for bilateral emmetropia or monovision.

Methods

This was a prospective, single-center randomized, patient-masked trial. Patients were implanted with the enhanced IOL targeted for bilateral emmetropia or slight monovision (-0.75 D in the non-dominant eye). At 3 months the binocular visual acuity (VA) was measured at distance, intermediate and near, along with low contrast VA in photopic and mesopic conditions, and the distance corrected defocus curve. Questionnaires related to spectacle independence, satisfaction, visual symptoms, and functional vision were administered.

Results

Data from 71 subjects (34 Emmetropia, 37 Monovision) were analyzed. There was no difference in the mean uncorrected distance VA (p = 0.11), but uncorrected intermediate and near VAs were one line better in the Monovision group (p = 0.02 and 0.01, respectively). Mesopic and photopic low contrast VA were similar between groups. There was a trend for less difficulty and higher satisfaction with near and intermediate vision in the Monovision group, but no significant differences in any of the subjective questionnaires. Difficulty reading was the most reported concern in both groups, though 93% of all subjects reported "little" or "no" difficulty with daily activities. Overall, 82% of subjects were "completely" or "very" happy with their lens choice.

Conclusion

Using this enhanced IOL with slight monovision in the non-dominant eye increased intermediate and near VA with no apparent effect on low contrast distance VA, subjective visual quality, or satisfaction.

IRIS® Registry (Intelligent Research In Sight) Analysis of the Incidence of Monovision in Cataract Patients with Bilateral Monofocal Intraocular Lens Implantation

Purpose

To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved.

Patients and Methods

This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ±0.25 diopters [D] in one eye and a myopic offset of ≥0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes.

Results

Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75-1.24 D and 18.0% within 1.25-1.74 D. A myopic offset ≥1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision.

Conclusion

Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D.

Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia

PURPOSE

To evaluate long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) after bilateral cataract surgery.

SETTING

Private practice in Barcelona, Spain.

DESIGN

Retrospective, noncomparative case series.

METHODS

Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs between 2008 and 2018. Main outcomes analyzed were uncorrected distance visual acuity (UDVA), uncorrected near distance visual acuity (UNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5 and 10 years (Y10) postoperatively.

RESULTS

The study enrolled 463 patients. Both UDVA and UNVA significantly improved postoperatively ( P < .05). The mean binocular UDVA improved from 0.47 ± 0.3 logMAR preoperatively to 0.096 ± 0.14 at POD1 to 0.16 ± 0.2 at Y10 ( P = .0033). The binocular UNVA was 0.05 logMAR at Y10, whereas in preoperative visits, all patients needed spectacles. The mean UDVA for the dominant eye ≤0.20 logMAR was achieved in 84.29% at the Y10. Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively, in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena.

CONCLUSIONS

Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.

The Effect of Spectacle-Induced Low Myopia in the Non-Dominant Eye on the Binocular Defocus Curve with a Non-Diffractive Extended Vision Intraocular Lens

Purpose

To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles.

Patients and Methods

This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (−0.50 D, Setting B and −1.00 D, Setting C). Subjects were patients implanted with the AcrySof^® IQ Vivity^® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA).

Results

Forty subjects were enrolled. The mean spherical equivalent refraction was −0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at −0.25 D or at −0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at −2.00 D, −2.50 D and −3.00 D, where higher myopia in the non-dominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better.

Conclusion

Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.

Visual Performance of Two Diffractive Trifocal Intraocular Lenses: A Randomized Trial

PURPOSE

To compare two trifocal intraocular lenses (IOLs), the RayOne Trifocal RAO603F IOL (closed-loop haptic IOL; Rayner Intraocular Lenses Limited) and the AT Lisa tri 839 MP IOL (plate-haptic IOL; Carl Zeiss Meditec AG), concerning optical and capsular bag performance.

METHODS

Patients scheduled for cataract surgery received either a closed-loop haptic IOL or a plate-haptic IOL in the first eye and the other IOL in the second eye. Three months postoperatively, autorefraction and subjective refraction, uncorrected and corrected distance visual acuity at 4 m, 80 cm, and 40 cm, an objective reading test (Salzburg Reading Desk; SRD Vision), a defocus curve, IOL tilt and decentration, a questionnaire about dysphotopsia, and grading of halos with a halometer were performed.

RESULTS

Eighty-eight eyes of 44 patients were included. Visual acuity was comparable between both IOLs. The closed-loop haptic IOL performed better in the defocus curve at -1.50 diopters (D) (0.08 ± 0.10 vs 0.12 ± 0.09 logMAR; P < .01). The plate-haptic IOL had better contrast sensitivity without glare under mesopic and photopic conditions in miosis (P = .0018 and .002, respectively) and mydriasis (P = .017 and .003, respectively). Significant differences were found for less overall subjective disturbance (P = .047) and starbursts (P = .039) for the plate-haptic IOL, but not for the other positive dysphotopsia symptoms.

CONCLUSIONS

Both trifocal IOLs delivered good and comparable visual function with low degrees of disturbing dysphotopsia. The closed-loop haptic IOL was slightly superior in the defocus curve, whereas the plate-haptic IOL was slightly superior concerning contrast sensitivity and positive dysphotopsia. [J Refract Surg. 2021;37(7):460-465.].

Correlation of Central Macular Thickness and the Best-Corrected Visual Acuity in Three Months After Cataract Surgery by Phacoemulsification and With Intraocular Lens Implantation

Purpose

To estimate the incidence of central macular edema (CME) following cataract surgery and to correlate the central macular thickness (CMT) to the best-corrected visual acuity (BCVA).

Methods

This cohort study in 2018-2019 included cataract grades I and II. They were operated by phacoemulsification and intraocular lens implantation. CMT was measured using spectral-domain optical coherence tomogram (OCT) before and for three months at one-month intervals after surgery. The change in BCVA and CMT were correlated at three months after surgery. Incidence of CME (more than two SD of pre-surgery CMT) was calculated.

Results

The mean CMT for 138 eyes operated for cataracts measured before and at one, two, and three months after uneventful surgery was 213 ± 24.9, 222.7 ± 25.5, 217.8 ± 34.8, and 215 ± 28.3 µ, respectively. The median BCVA at three follow-ups was 0.2 (interquartile range [IQR] 0.1; 0.2), 0.1 (IQR 0.0; 0.1), and 0.0 (0.0; 0.03), respectively. The incidence of CME at one and three months was 18% and 4.3%, respectively. The CMT and VA (LogMAR) one month after cataract surgery were significantly correlated (r = 0.4, Pearson P < 0.001). The visual improvement between one and two months post-surgery was not significantly correlated with CMT decline (r = 0.06, Pearson P = 0.5). The BCVA at one, two, and three months was 0.0 LogMAR in 28 (20.3%), 52 (37.7%), and 104 (75.4%) eyes, respectively. Linear regression model, age and diabetes are the risk factors at one month. At two and three months, no significant risk factors were found.

Conclusion

CME post-cataract surgery seems to be transient. CMT changes correlate with best-corrected vision changes and seem to be affected by age and presence of diabetes in the 1st month after surgery.

Comparison of the visual performance between Oculentis MF30 and Tecnis ZMB00 multifocal intraocular lenses

Background

To compare the visual performance of MF30 asymmetric refractive multifocal intraocular lenses (MIOLs) with ZMB00 all optic zone diffractive MIOLs.

Methods

This is a prospective study. Patients that underwent phacoemulsification were divided into two groups according to the type of MIOLs used: 35 patients were implanted with asymmetric refractive MIOLs and 35 patients with all optic zone diffractive MIOLs. Visual acuity (VA), refraction, defocus curves, objective optical quality, and a questionnaire evaluating quality of life were measured at 3 months postoperatively.

Results

There were no significant differences between the two groups in uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), best-corrected distance visual acuity (BCDVA), or distance-corrected near visual acuity (DCNVA). However, the uncorrected intermediate VA was 0.24±0.10 in the refractive group and 0.31±0.13 in the diffractive group (P<0.05), and the distance-corrected intermediate VA was 0.22±0.09 in the refractive group and 0.31±0.14 in the diffractive group (P<0.05). Defocus curves showed two peaks of maximum vision in both groups. However, the curve between the two peaks in the refractive group was smoother than that of the diffractive group. The modulated transfer function cut-off frequency was 22.74±12.29 c/d in the refractive group and 30.50±10.04 c/d in the diffractive group (P<0.05). The Optical Quality Analysis System (OQAS) values 100% (OV100%) was 0.75±0.41 in the refractive group and 1.02±0.34 in the diffractive group (P<0.05), while the OV20% was 0.52±0.34 in the refractive group and 0.71±0.25 in the diffractive group (P<0.05). There was no significant difference between the two groups in overall satisfaction, spectacle independence ratio, or visual interference phenomenon.

Conclusions

Both MIOLs achieve good VA at distance and near vision. Oculentis MF30 showed better intermediate VA, and Tecnis ZMB00 appears to have better objective visual quality.

Trial registration

NCT02234635 (http://www.clinicaltrials.gov).

Matching the Patient to the Intraocular Lens: Preoperative Considerations to Optimize Surgical Outcomes

The intraocular lens (IOL) selection process for patients requires a complex and objective assessment of patient-specific ocular characteristics, including the quality and quantity of corneal astigmatism, health of the ocular surface, and other ocular comorbidities. Potential issues that could be considered complications after surgery, including dry eye disease, anterior or epithelial basement membrane dystrophy, Salzmann nodular degeneration, and pterygium, should be addressed proactively. Aspheric IOLs are designed to eliminate the positive spherical aberration added by traditional IOLs to the pseudophakic visual axis. Spherical aberration may be a consideration with patient selection. Patient desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal IOLs and extended depth-of-focus (EDOF) IOLs. However, no one single multifocal or EDOF IOL suits all patients' needs. The wide variety of multifocal and EDOF IOLs, their optics, and their respective impact on patient quality of vision have to be understood fully to choose the appropriate IOL for each individual, and surgery has to be customized. Patients who have undergone previous LASIK or who have radial keratotomy and ocular pathologic features, including glaucoma, age-related macular degeneration, and epiretinal membrane, require specific considerations for IOL selection. Subjectively, patient-centered considerations, including visual goals, lifestyle, personality, profession, and hobbies, are key elements for the surgeon to assess and factor into an IOL recommendation. This holistic approach will help surgeons to achieve optimal surgical outcomes and to meet (and exceed) the high expectations of patients.