The Living Framework

The recently achieved global consensus on the evidence-based functional classification of simultaneous vision IOLs (SVIOLs) is a crucial milestone for focusing on what really matters to surgeons and patients: clinical outcomes, according to Joaquín Fernández MD, PhD, ESCRS secretary and European coordinator for the global consensus group.

Initially an ESCRS project, the evidence-based functional classification of IOLs spread to other regional sister societies such as the ASCRS, the Asia-Pacific Association of Cataract and Refractive Surgeons, and the Latin American Society of Cataract and Refractive Surgeons. It developed into a collective and synergistic effort to create a global framework to classify SVIOLs based on the similarity of their clinical results, improving the understanding for ophthalmologists, patients, and stakeholders.

The societies formalised their efforts at the ESCRS Annual Meeting in Copenhagen, where all groups recognised overlapping objectives and a need for harmonisation. The global consensus was finally published in the Journal of Cataract & Refractive Surgery (JCRS) in March 2026.¹

As Professor Fernández highlighted in his presentation at the ESCRS Winter Meeting in Helsinki, the global consensus aimed to advance a new classification based on evidence rather than opinions, as the latter can vary according to prior knowledge and interests. Instead, evidence is objective. The weight of strong evidence and more than a decade of scientific literature naturally propelled the consensus.

“Scientific societies across the world didn’t need to be convinced of its validity; they recognised it,” Prof Fernández commented.

Science is objective and solid, but how can the consensus transmit the same concepts to different languages, cultures, and targets? The semantics behind the terminology was the main topic of discussions, but in the end, the group reached consensus, replacing the term ‘range’ with ‘depth of field’ and maintaining precise language that represents mutually exclusive categories.

Learning a new language

For a language to be widely understood, it must be used regularly, and the same is true of a new scientific framework that is robust, reproducible, and clinically meaningful. According to Prof Fernández, this is how the new classification will spread in the scientific literature, gradually becoming the language of research as authors find it useful. What truly matters, he said, are the current endpoint thresholds that establish the functional categories, as those come from the scientific method, which allows an objective classification based on clinical outcomes.

Moreover, the understanding provided by the new functional classification serves not only professionals, but also patients and the relationship of trust they should have with their surgeon. Before, preoperative explanations relied on subjective language and subjective reception of concepts. A significant and dangerous gap may form when there is a mismatch between what the surgeon intended and what the patient understood, inevitably leading to failed expectations, dissatisfaction, and, in a way, failure. The functional classification lays the groundwork for conversations about probabilities and measurable outcomes, with surgeons clearly explaining the level of visual acuity a patient is likely to achieve at certain distances.

As Prof Fernández pointed out, when a patient sees that the outcomes align with the preoperative prediction, confidence in technology, science, and surgeons grows. Trust in medicine is one key ingredient in the recipe.

Such transformative work does not involve physicians alone, but other stakeholders, such as those in industry. While the ISO classification is focused on a pre-market assessment meeting with strict, highly controlled, and often limited approval standards, the functional classification embraces variability, integrating real-world experiences, postmarketing studies, and a broader spectrum of outcomes.

Industry members may have a different perspective due to their priorities. The functional classification, however, is more for clinicians and patients than manufacturers, and the two views are complementary rather than contradictory. And while the starting point might differ, collaboration and convergence become logical, especially if the new patient-centred approach guides innovation to meet clinical needs, Prof Fernández said.

The path forward is mapped out, and the work to realise it is underway. There are still some unanswered questions that may directly or indirectly include other endpoints such as contrast sensitivity, photic phenomena, dysphotopsia (and how often they occur), patient-reported outcome measures, and the psychometric validation of visual quality. The same scientific approach may be applied, and this will not be done in isolation.

By now, constructive collaboration between regional and sister societies around the world is well established and anchored to the same principle of how well professionals will understand what patients will see, rather than how they name the lenses. This is the true meaning of functionality, and this global consensus demonstrated that it can be reached, shaped, and allowed to grow and expand together.

“Collaboration will expand the evidence base, refine models, and ensure the classification evolves with global input—not as a static system, but as a living framework,” he concluded.

Joaquín Fernández Pérez MD, PhD is CEO and Medical Director in the Ophthalmology Department at Qvisión in Vithas Virgen del Mar Hospital, Almería, Spain. joaquinfernandezoft@qvision.es

1. Fernández J, et al. J Cataract Refract Surg, 2026; 52(3): 219–222. doi:10.1097/j.jcrs.0000000000001880