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Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent...
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Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 30 July 2025 | Viewed by 3135

Special Issue Editor

Prof. Dr. Ehud I. Assia

E-Mail Website
Guest Editor
1. Ein Tal Eye Center, Tel Aviv, Israel
2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: premium IOLs (multifocal and toric); IOL power calculation; biometry and imaging; complications and management; laser vision correction; phakic IOLs; femtosecond laser assisted cataract surgery; AI (Artificial intelligence) and cataract/refractive surgery; accommodative lenses

Special Issue Information

Dear Colleagues,

This year, we will be celebrating 75 years of intraocular lenses, first implanted by Sir Harold Ridley in November 1949. Cataract surgery, the most common surgical procedure in medicine, is still rapidly evolving and new surgical technologies and techniques continuously emerge. The advanced optics of premium lenses not only improve  patients’ quality of vision but also their quality of life and spectacle independence. Laser technology advances the accuracy and safety of refractive surgery as well as the efficacy and quality of cataract surgery. Artificial intelligence introduces a new line of formulae with unprecedently accurate IOL power calculation. Modern technologies, such as the new generations of OCT, have revolutionized anterior segment imaging, the accuracy of intraocular measurement, and the quality of corneal topographical analysis. Cataract surgery is now considered a refractive procedure, using a variety of multifocal lenses. Refractive surgery extends beyond laser vision correction and lens implant surgery—the use of phakic and aphakic lenses is constantly increasing. The holy grail of effective accommodative lenses is, hopefully, around the corner, and we expect major developments in the near future.

The goal of this Special Issue is to provide readers with the newest developments and current knowledge in cataract and refractive surgery. Original research, clinical experiences, and comprehensive reviews related to (but not limited to) the suggested topics are welcomed.

We look forward to hearing from you.

Prof. Dr. Ehud I. Assia
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • premium IOLs (multifocal and toric)
  • IOL power calculation
  • biometry and imaging
  • complications and management
  • laser vision correction
  • phakic IOLs
  • femtosecond-laser-assisted cataract surgery
  • AI (artificial intelligence) and cataract/refractive surgery
  • accommodative lenses

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Published Papers (7 papers)

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Research

10 pages, 885 KiB  
Article
Visual Results After Extended Depth-of-Focus Lens Implantation in Patients Undergoing Clear Lens Surgery
by Emanuel Barberá-Loustaunau, Felipe Couñago, Miguel A. Sánchez-Tena and Nuria Garzón
J. Clin. Med. 2025, 14(8), 2795; https://doi.org/10.3390/jcm14082795 - 18 Apr 2025
Viewed by 141
Abstract
Background/Objectives: To evaluate the efficacy and visual quality provided by the extended depth-of-focus AcrySof IQ Vivity lens (Alcon Laboratories, Inc., Fort Worth, TX, USA) in patients undergoing refractive lens exchange (RLE) surgery for presbyopia correction. Methods: This descriptive prospective single-arm clinical [...] Read more.
Background/Objectives: To evaluate the efficacy and visual quality provided by the extended depth-of-focus AcrySof IQ Vivity lens (Alcon Laboratories, Inc., Fort Worth, TX, USA) in patients undergoing refractive lens exchange (RLE) surgery for presbyopia correction. Methods: This descriptive prospective single-arm clinical study included 30 patients (60 eyes) aged 49–69 years (mean 60.2) who underwent clear lens surgery for presbyopia correction. Postoperative 3-month assessments included uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA) measurements. Patient satisfaction and visual disturbances were evaluated using a standardized questionnaire. Results: Postoperative binocular visual acuity results were as follows: UDVA, 0.00 ± 0.06 logMAR; UIVA 0.08 ± 0.07 logMAR; and UNVA, 0.18 ± 0.10 logMAR. Refractive outcomes showed mean spherical equivalent values of −0.15 D ± 0.28 diopters (D) for the right eye and −0.18 D ± 0.30 D for the left eye postoperatively. Most patients (93.2%) were satisfied or very satisfied with the surgery, and 63.3% never needed glasses at any distance postoperatively. Mild and non-disabling photic phenomena were reported by 23% of patients for halos and 30% for glares. Conclusions: The study IOL provides excellent visual acuity for far and intermediate distances, as well as functional near vision under photopic conditions, with high levels of patient satisfaction and minimal visual disturbances. This lens is a promising option for non-cataract patients undergoing RLE for presbyopia correction. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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10 pages, 671 KiB  
Article
Comparative Analysis of Intraocular Lens Power Calculation Formulas (Kane, Barrett Universal II, Hill–Radial Basis Function, and Ladas Super Formula): Which One Is More Accurate?
by Ionela-Iasmina Yasar, Servet Yasar, Leila Al Barri, Diana-Maria Darabus, Andreea-Talida Tîrziu, Mihnea Munteanu and Horia Tudor Stanca
J. Clin. Med. 2025, 14(7), 2443; https://doi.org/10.3390/jcm14072443 - 3 Apr 2025
Viewed by 254
Abstract
Background: The most widely used contemporary intraocular lens power calculation formulas are the Kane formula, Barrett Universal II formula, Hill–Radial Basis Function, and Ladas Super Formula, each of which was developed to improve postoperative refractive accuracy. This study aims to conduct a comprehensive [...] Read more.
Background: The most widely used contemporary intraocular lens power calculation formulas are the Kane formula, Barrett Universal II formula, Hill–Radial Basis Function, and Ladas Super Formula, each of which was developed to improve postoperative refractive accuracy. This study aims to conduct a comprehensive comparative analysis of these formulas to evaluate their predictive accuracy across diverse biometric profiles. Methods: A total of 210 eyes that met the inclusion criteria were analyzed in this study. This study was designed as a retrospective observational investigation. The biometric parameters of the intraocular lens were evaluated using the ARGOS optical biometer. Refractive intraocular lens power calculations were performed using the formulas, and the resulting values were systematically compared to assess predictive accuracy. In our research, a parametric approach was adopted by applying ANOVA repeated measures analysis. Multiple measurements were evaluated through homogeneity of covariances. Pairwise comparisons between formula-derived values were conducted using the Bonferroni test to identify significant differences. A paired-sample t-test was used to compare the spherical equivalent levels calculated at the first and last controls. Potential correlations were examined using Pearson correlation analysis. Results: A statistically significant difference was observed between formulas. The differences among the formulas were caused by the values obtained from the Ladas Super Formula being significantly higher than the others. There was a statistically significant positive correlation between the data obtained from the formulas. The spheric equivalent values were similar, with no statistically significant difference. Conclusions: This study reinforces the notion that modern intraocular lens power calculation formulas exhibit a high degree of accuracy and correlation in predicting postoperative refractive outcomes. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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11 pages, 1021 KiB  
Article
Clinical Outcomes of Combined Phacoemulsification, Extended Depth-of-Focus Intraocular Lens Implantation, and Epiretinal Membrane Peeling Surgery
by Ho-Seok Chung, Dabin Lee and Jin-Hyoung Park
J. Clin. Med. 2025, 14(7), 2423; https://doi.org/10.3390/jcm14072423 - 2 Apr 2025
Viewed by 321
Abstract
Background/Objectives: To evaluate the clinical efficacy and safety of combined phacoemulsification, extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and epiretinal membrane (ERM) peeling during vitrectomy surgery for treating patients with ERM, cataracts, and presbyopia. Methods: Patients with preexisting low-grade ERM who [...] Read more.
Background/Objectives: To evaluate the clinical efficacy and safety of combined phacoemulsification, extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and epiretinal membrane (ERM) peeling during vitrectomy surgery for treating patients with ERM, cataracts, and presbyopia. Methods: Patients with preexisting low-grade ERM who underwent cataract surgery with the implantation of an EDOF IOL were included. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), autorefraction and keratometry, manifest refraction, and central foveal thickness (CFT) were measured before surgery and at postoperative months 3 and 6. A monocular defocus curve was measured 6 months postoperatively. Furthermore, patients were instructed to report symptoms of photic phenomena at each visit. Results: In total, 16 eyes of 16 patients (median age, 59.5 years) were included in this study. Compared with those at baseline, the CDVA, UDVA, UIVA, UNVA, and CFT significantly improved at 3 and 6 months postoperatively. The defocus curve revealed that a visual acuity of 0.12 logarithm of the minimal angle of resolution or better was maintained from +0.5 to –1.5 diopters. No patients reported visual disturbances suggestive of photic phenomena, such as glare or halo. Conclusions: EDOF IOL implantation had excellent outcomes, including improved distance and intermediate visual acuity, functional near visual acuity, and absence of visual symptoms in patients who received phacovitrectomy to treat low-grade ERM. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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11 pages, 1808 KiB  
Article
Clinical Outcomes Following Toric Intraocular Lens Implantation: A Case Series Study
by Arie Y. Nemet, Olga Reitblat, Adi Levy, Achia Nemet and Ehud I. Assia
J. Clin. Med. 2025, 14(7), 2316; https://doi.org/10.3390/jcm14072316 - 28 Mar 2025
Viewed by 186
Abstract
Purpose: This study aimed to assess the efficacy of for PODEYE TORIC intraocular lenses (IOL). Methods: This study was a retrospective, non-randomized, interventional case series. Inclusion criteria comprised diagnosis of an age-related cataract and a corneal astigmatism equal to or higher than 0.9 [...] Read more.
Purpose: This study aimed to assess the efficacy of for PODEYE TORIC intraocular lenses (IOL). Methods: This study was a retrospective, non-randomized, interventional case series. Inclusion criteria comprised diagnosis of an age-related cataract and a corneal astigmatism equal to or higher than 0.9 D and undergoing implantation of toric IOLs (TIOL). A single toric lens model (PodEye Toric, BVI) was used in all cases. Results: The study includes 51 eyes of 35 patients with TIOL implantation with a mean follow-up time of 45.7 (±36.5) days. Fourteen patients were targeted for mono-vision. Eight eyes had previously undergone refractive surgery (five post Myopic Lasik/PRK, two post RK/AK and one post RK). The mean postoperative adjusted spherical equivalent (SEQ) was −0.57 D ± 0.31 and the residual postoperative refractive astigmatism was −0.49 D ± 0.50. Only 2% of patients had a preoperative subjective astigmatism lower than 1.0 D whereas postoperatively, 94% of the patients had a residual astigmatism of 1.0 D or lower. The average deviation from the planned axis was 2.66 ± 0.26 degrees. None of the IOLs rotated to 10° or higher and 88% remained at 5° or less on the intended IOL axis. Twenty-six (63%) of IOL rotations were counterclockwise. Conclusions: PODEYE TORIC intraocular lenses provide exceptional refractive precision, reliable rotational stability, and consistently strong postoperative vision outcomes. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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9 pages, 382 KiB  
Article
Comparison of Traditional and AI-Based Methods: Barrett Universal II vs. Ladas Super Formula in IOL Power Calculation
by Ionela-Iasmina Yasar, Servet Yasar, Leila Al Barri, Nadina Mercea, Mihnea Munteanu and Horia Tudor Stanca
J. Clin. Med. 2025, 14(6), 2023; https://doi.org/10.3390/jcm14062023 - 17 Mar 2025
Viewed by 396
Abstract
Background: Pursuing optimal visual outcomes following cataract surgery remains a cornerstone of modern ophthalmology. Central to this objective is the precise calculation of intraocular lens power. However, despite significant advancements in biometric measurements and computational algorithms, variability in refractive outcomes continues to pose [...] Read more.
Background: Pursuing optimal visual outcomes following cataract surgery remains a cornerstone of modern ophthalmology. Central to this objective is the precise calculation of intraocular lens power. However, despite significant advancements in biometric measurements and computational algorithms, variability in refractive outcomes continues to pose a challenge. This study aims to analyze the outcomes comprehensively by reviewing established and newer techniques. Methods: The eyes included in this study were evaluated based on various criteria, and a total of 210 eyes which met these criteria were included in the research. Our study is a retrospectively designed observational research study. The study included individuals who had experienced successful IOL implantation to correct refractive errors or cataracts. The ARGOS SS-OCT device, a spectral-domain optical coherence tomography system, was used in this study. In measuring the lens power, values were obtained using the Barrett Universal II and Ladas Super Formulas. These values were compared. Postoperative assessments were conducted at 1–3 months and 3–12 months, including spherical equivalents. Results: The mean age of the participants was 63.44 ± 11.62 years. The study’s two most frequently used lens brands were ALCON and ZEISS. The lens powers calculated using the Barrett Universal II and Ladas Super Formulas were compared. The mean values calculated using both formulas were highly similar, with no statistically significant differences observed. We compared the spherical equivalent values calculated during the participants’ first and second postoperative follow-ups. The spherical equivalent values were similar, with no statistically significant differences. Conclusions: Formulas represent significant advances in ophthalmology and significantly improve visual outcomes; however, differences in their methodology and predictive accuracy warrant further analysis. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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13 pages, 1180 KiB  
Article
Evaluation of Refractive Predictive Accuracy in Intraocular Lens Power Calculations: A Comparative Study of Swept-Source Optical Coherence Tomography and Optical Low-Coherence Interferometry
by Leila Al Barri, Nadina Mercea, Yasar Ionela-Iasmina, Mihnea Munteanu and Horia T. Stanca
J. Clin. Med. 2025, 14(4), 1201; https://doi.org/10.3390/jcm14041201 - 12 Feb 2025
Viewed by 564
Abstract
Background/Objectives: Precise intraocular lens (IOL) power calculations are essential for achieving optimal refractive outcomes in cataract surgery. This study compares the predictive accuracy of swept-source optical coherence tomography (SS-OCT) and optical low-coherence interferometry (OLCI) in biometry measurements and refractive outcomes. Methods: This retrospective [...] Read more.
Background/Objectives: Precise intraocular lens (IOL) power calculations are essential for achieving optimal refractive outcomes in cataract surgery. This study compares the predictive accuracy of swept-source optical coherence tomography (SS-OCT) and optical low-coherence interferometry (OLCI) in biometry measurements and refractive outcomes. Methods: This retrospective study included 170 eyes from 102 patients undergoing cataract surgery. Biometry was performed using Argos® (MOVU Inc., Komaki, Japan) (SS-OCT) and Aladdin® (Topcon Corp., Tokyo, Japan) (OLCI), measuring axial length (AL), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), and keratometry. Results: Postoperative outcomes, including uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SE), and refractive error, were assessed at one and six months. Predictive accuracy was evaluated by mean error (ME), mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25 D to ±1.00 D of predicted SE. Conclusions: Both technologies achieved high refractive accuracy, with 97.7% (SS-OCT) and 97.2% (OLCI) of eyes within ±1.00 D of target SE. SS-OCT demonstrated superior axis alignment, while OLCI provided enhanced postoperative SE. Significant differences were observed in LT (p = 0.030) and ACD (p = 0.009). Postoperative UDVA of 20/20 or better was achieved in 98% of SS-OCT eyes and 100% of OLCI eyes. SS-OCT and OLCI provide comparable refractive outcomes and high reliability in cataract surgery. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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9 pages, 905 KiB  
Article
Predictive Accuracy of Intraocular Lens Formulas Calculated by Biometers with Multiple Refractive Indices According to Axial Length
by Yeo Kyoung Won, Young-Sik Yoo, Hee-jee Yun, Tae-Young Chung and Dong Hui Lim
J. Clin. Med. 2024, 13(22), 6815; https://doi.org/10.3390/jcm13226815 - 13 Nov 2024
Viewed by 752
Abstract
Background/Objectives: This study aimed to analyze the accuracy of the SRK/T, Haigis, Barrett Universal II (BUII), Kane, and EVO intraocular lens (IOL) formulas for normal and long axial length (AL) groups using an ARGOS (Alcon, Fort Worth, TX, USA), which uses the specific [...] Read more.
Background/Objectives: This study aimed to analyze the accuracy of the SRK/T, Haigis, Barrett Universal II (BUII), Kane, and EVO intraocular lens (IOL) formulas for normal and long axial length (AL) groups using an ARGOS (Alcon, Fort Worth, TX, USA), which uses the specific refractive indices. Methods: We performed a review of patients who underwent uneventful cataract surgery with the implantation of an Acrysof IQ SN60WF IOL (Alcon, Inc.) between January 2020 and December 2021. Biometry was obtained with the ARGOS; patients were separated into subgroups based on AL as follows: normal (22.0 ≤ AL < 26.0 mm) and long (AL ≥ 26.0 mm). Outcomes included the mean error (ME), the mean absolute error (MAE), the median absolute error (MedAE), and the proportion of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 diopters (D) of the prediction error. Results: A total of 191 eyes of 191 patients were included: 162 eyes of 162 patients in the normal AL group and 29 eyes of 29 patients in the long AL group. The EVO formula was the most accurate for the normal AL group, which had the lowest MAE and MedAE. The MAE and MedAE of EVO were the lowest in the long AL group; EVO showed the highest percentage of eyes within ±0.25, ±0.75, and 1.00 D compared with other formulas. Conclusions: When using an ARGOS, the EVO formula had the lowest MAE and the highest proportion of eyes within ±1.00 D of the predicted target in both the normal and high myopia groups. Full article
(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)
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