Making IOLs a More Personal Choice

During her presentation at the ESCRS Winter Meeting in Athens, Athina Lazaridou MD asked the audience a fundamental question: “What if it is up to cataract and refractive surgeons to choose a lens for themselves?”

The increased personalisation and standardisation of the most performed surgical procedure in Europe have allowed further patient involvement in the decision-making, particularly in selecting the desired intraocular lens, she observed, especially given the plethora of lenses and options available.

Informative devices such as virtual reality and smart devices can now grant the patient the opportunity to be an even greater participant in the process. “Still, what can be said about the patients who possess the highest level of knowledge?” she asked.

To answer this question, Dr Lazaridou and her team conducted a prospective study asking 72 male and 28 female Greek ophthalmologists to complete a 20-item, multiple-choice questionnaire. Of the 100 eye doctors, 47 were myopes, 17 were hyperopes, and 36 were emmetropes. By age, 61% of the doctors involved were 45 to 55, 24% were 55 to 65, and 15% were older than 65.

The majority of participants had more than 20 years of experience, with 44% performing 40 phacoemulsifications per month, while 28% of doctors performed more. Two-thirds of the doctors declared they did implant premium IOLs in their everyday practice but mostly preferred monofocal plus and toric lenses for their patients, followed by EDOF and multifocal IOLs.

However, Dr Lazaridou observed a discrepancy. Of the 38 surgeons that do implant multifocal lenses, only 15 would choose them for themselves. Almost 50% prefer EDOFs and the vast majority reject the idea of refractive lens exchange.

A mix-and-match approach was divisive, with 50% in favour and 50% either against or hesitant.

According to Dr Lazaridou, these results may differ between countries. Citing a similar study conducted in Spain and South America, 60% of Spanish and Latin ophthalmologists would more likely opt for a multifocal lens, with only 15% more prone to choose an EDOF. On the other hand, recent research conducted in the United Kingdom showed a preference for EDOF lenses, with 60% of doctors rejecting mix and match for their patients.¹ Moreover, a study conducted by Hercules Logothetis and Robert S Feder in the United States showed a preference for monofocal plus, also concluding the higher the number of premium lenses implanted by a surgeon, the higher the possibility of choosing them for themselves.²

The study confirmed a general lack of consensus about surgeon preference regarding intraocular lenses.

“There is a tendency to minimise refractive errors and presbyopia after cataract surgery,” she said. “And despite the lack of consensus, there seems to be a correlation between years of experience with a specific technique and the type of IOLs used.”

Dr Lazaridou presented at the 2025 ESCRS Winter Meeting in Athens.

Athina Lazaridou MD is an ophthalmology resident at the Aristotle University of Thessaloniki, Greece. alazaridou11@gmail.com

1. Kabbani J, Price L, Patel R, Din N, Bizrah M. “A survey of intraocular lens preferences of UK refractive surgeons for cataract surgery and refractive lens exchange,” BMC Ophthalmology, 2024; 24(1): 397. doi:10.1186/s12886-024-03639-8

2. Logothetis HD and Feder RS. “Which intraocular lens would ophthalmologists choose for themselves?” Eye, 2019; 33(10): 1635–1641. doi:10.1038/s41433-019-0460-9