Modern Iol Selection In Post-Lvc Patients In 2026: Integrating Functional Analysis And Digital Decision-Support Tools

Post laser vision correction (LVC) patients represent a growing proportion of candidates for lens surgery. Although intraocular lens (IOL) power calculation has significantly improved, dissatisfaction remains frequent in this population. In 2026 the challenge is no longer limited to biometric accuracy but involves functional visual profiling, corneal asphericity analysis, and an individualised implant strategy. This study presents a structured decision pathway integrating digital tools including IOL MATCH and AIOLsci to optimise IOL selection in post LVC patients.

Private refractive and cataract surgery center, Centre IRIDIS, Albi, France.

A structured workflow was applied in a single post LVC patient undergoing lens surgery. The protocol included functional visual needs assessment using IOL MATCH, corneal Q value analysis, and optical simulation using AIOLsci. Optical performance was evaluated through modulation transfer function area (MTFa) simulation and depth of focus modelling. The discussion was illustrated by a case of a 64-year-old woman with prior hyperopic LASIK, asymmetric corneas, and high expectations for spectacle independence. Decision making integrated functional objectives, corneal asphericity, pupil size, and tolerance to photic phenomena rather than relying on a simplified extended depth of focus (EDOF) versus multifocal lens classification.

Corneal analysis revealed asymmetric profiles with Q values of -0.17 in the right eye and -0.70 in the left eye. MTFa simulation demonstrated that an EDOF design alone would not provide an adequate functional range in the eye with lower negative asphericity. A diffractive continuous Full DoFi design (FineVision HP, BVI, Belgium) was therefore selected in the right non-dominant eye to enhance intermediate and near performance. In the left eye with higher negative asphericity, optical modelling predicted improved depth of focus and greater tolerance with a non-diffractive continuous Full DoFi profile (Lucidis 124MT, SAV IOL, Switzerland). 

In post LVC patients, modern IOL selection must extend beyond formula optimisation towards integrated functional and corneal optical analysis. The combination of IOL MATCH and AIOLsci supports safer decision making, improved patient counselling, and reduction of dissatisfaction risk in presbyopia correcting IOL implantation. A corneal asphericity driven functional strategy may represent an evolving clinical standard in 2026.