Last month, Bausch + Lomb invited a select group of cataract surgeons from across the country to Denver, Colorado, for a faculty-led education program built around a proprietary "IOL Compass" framework designed to simplify the premium intraocular lens (IOL) decision process—for the entire practice staff.
Let’s begin with the basics: education.
As seen in the company’s Consumer and Vision Care Summits held earlier this year—see here and click here for those recaps, respectively—education was at the forefront of the IOL Compass Summit.
“Education is a key component to orienting the surgeons and the ECP community into our innovations—how it fits into clinical practice and determining the right patient,” said Mohamed Yassine, MD, vice president of Global Medical & Scientific Affairs at B+L.
He added that partnerships with clinical experts provide the company with the “credibility and relevancy” to support its consumer-centric focus and education programs targeting patient care.
And from the clinician’s perspective?
For that, we turn to one of the event’s co-chairs: Eric Donnenfeld, MD, a cornea, laser cataract and refractive surgeon in practice at Ophthalmic Consultants of Long Island (OCLI) Vision.
“B+L provides extraordinary technology—not only from the surgical side, but also from the pharmaceutical side, looking at the ocular surface,” said Dr. Donnenfeld.
But just as importantly, he emphasized, is the company’s commitment to educating and supporting ophthalmology on a national basis.
- “This deep devotion to funding education is what makes B+L special: They have the technology and the right perspective on what’s important for me, as an ophthalmologist: advanced education.”
Which brings us to this IOL Compass Summit?
Precisely. Below, Dr. Yassine, offered a quick rundown.
Let’s talk event details.
The one-day-only program opened with co-chairs Drs. Donnenfeld and Cathleen McCabe, MD, of The Eye Associates in Sarasota, Florida, sharing the primary goal surgeons should strive to achieve.
- That goal: prioritizing the patient's best outcome by viewing premium lens options as an opportunity to improve the patient's quality of life.
“Patients sense indecision,” Dr. Donnenfeld noted. “They gravitate toward doctors who exude confidence in the waiting room. So when you’re talking to a patient about (IOL) opportunities … communicate with confidence what you think is in their best interest.”
Below, he offers a look at “the magic” of cataract surgery for patients.
What other recommendations did they offer?
The co-chairs advised surgeons to avoid “paralysis of choice” by offering clearer, more expert-driven IOL recommendations—as well as emphasizing the benefits of:
- Mentorships for shaping clinical mindsets, technical skills, and patient outcome deliveries
- Evaluating the entire ocular surface before focusing on the cataract itself
- Utilizing accurate diagnostic data for patient-specific decision making
- Establishing industry partnerships with companies aligned to their ideals (and committed to supporting future ophthalmic advancements)
- Setting realistic patient expectations for IOL outcomes
Duly noted. Next up: the program agenda.
In an introductory session, Drs. Donnenfeld and McCabe identified a "more choice, more complexity" issue facing not just today’s cataract surgeons, but their entire team (staff included):
- Expanding premium IOL options have made cataract decision-making harder—not easier.
- Consistent outcomes depend on the full patient journey (selection, expectation-setting, surgical planning, and post-op management)—not just lens choice.
Expand on this, please.
Let’s take a look at current reimbursement rates:
The U.S. physician payment for cataract removal with IOL insertion (CPT 66984) has seen a ~15% drop over the last few years ($528.84 in 2022 to $462.94 in 2026).
- The steepest single-year cut (11%): between 2025 and 2026 ($521.75 to $462.94)
And on top of this, advanced technology IOL adoption is still trending low—accounting for less than 20% of procedures:
- By procedure volume: 81.2% (monofocal); 9.5% (presbyopia-correcting [PC]); and 9.3% (toric)
- By procedure value: 44.8% (PC); 36.2% (monofocal); and 19% (toric)
So what’s the solution?
The presenters introduced attendees to a five-category lens (“IOL Compass”) framework geared toward addressing the various lens types currently available in B+L’s own portfolio:
- Monofocal: enVista
- Monofocal plus: enVista Aspire
- See here for recent research on this
- Extended depth of focus (EDOF)
- Full visual range: en Vista Envy
- Supporting data here
- Small aperture: Apthera / IC-8
- Acquired from AcuFocus in 2023
Tell me more about this framework.
Drs. Donnenfeld and McCabe laid out the IOL Compass Decision Tree, built around four key questions:
- Is the eye a candidate?
- What does the patient want?
- What trade-offs are acceptable?
- What technology best matches priorities?
Tell me more about this.
There are two possible routes for surgeons to take depending on the patient type: based on health and based on astigmatism-correction.
The healthy eyes pathway begins with an ocular health evaluation using topography / tomography and optical coherence tomography (OCT).
- The follow-up question for this: Does the patient want more freedom from glasses?
- From there, their visual priorities are considered.
And that second route?
The astigmatism-correction pathway begins with an evaluation of the cornea followed by two key questions to determine their toric versus non-toric IOL options:
- Does the patient have corneal astigmatism in one or both eyes?
- Is the astigmatism regular anterior corneal astigmatism?
One note on B+L’s toric options: Small-aperture (Apthera) candidacy is capped at up to 1.5 diopter (D) of corneal astigmatism (anterior curvature only).
Duly noted. So how can surgeons set their patients up for success?
For those insights, we’ll turn to the preoperative diagnostics and ocular-surface-optimization workshop portion of the program, organized around a "measure twice, recommend once” principle.
- The presenters: Alice Epitropoulos, MD, FACS; Karolinne Rocha, MD, PhD; and Mitch Shultz, MD
Their message to surgeons: Preoperative communication is imperative to prevent postoperative dissatisfaction, and preop diagnostics aren’t just about ruling patients in (or out).
In other words: Patients want a confidence recommendation from their surgeon—not a menu of options.
Hone in on that principle you mentioned.
This “measure twice, recommend once” foundation advises surgeons to take advantage of their preop diagnostics to:
- Trust the measurements used for IOL power and astigmatism planning.
- Identify factors that may limit visual quality.
- Optimize modifiable issues before surgery.
- Set expectations when findings can't be fully corrected.
- Recommend the best-fitting lens based on a patient’s eye, goals, and risk profile.
So what should this diagnostic patient workflow look like?
Referred to as “non-negotiable objective testing,” the presenters offered a look at each of the four components to this workflow—along with real-world patient cases for context.
- Optical biometry / keratometry
- Goal (for optical biometry): to obtain accurate axial length and anterior segment measurements for IOL power selection
- Goal (for keratometry): to accurately measure corneal power and characterize astigmatism for IOL power selection and astigmatism management
- Corneal topography / tomography
- Goal: to identify quality of the ocular surface and corneal shape abnormalities, quantify astigmatism, and rule out corneal pathology
- Macular assessment
- Goal: to identify macular pathology which could limit postoperative vision quality, influence IOL selection, or require additional retinal evaluation prior to surgery
- Word of advice: tailor interpretations to a patient’s refractive status and retinal risk profile.
- Slit-lamp exam (fluorescein staining and a dilated exam)
- Goal: to assess the health of the ocular surface, cornea, anterior chamber, iris, and crystalline lens
And what’s really at the foundation of refractive-cataract surgery?
That would be the ocular surface. As the presenters noted: an issue with the ocular surface can morph into three categories of consequences:
- Measurement accuracy: an unstable ocular surface can produce unreliable measurements (i.e.: variable keratometry, inconsistent topography).
- Surgical planning: unreliable measurements lead to less reliable surgical decisions (ie: inaccurate IOL power calculations, incorrect toric planning)
- Visual outcome: the same ocular surface may continue to affect vision post-surgery (ie: fluctuating vision, reduced vision quality, amplified dysphotopsias)
Any non-negotiables for ocular surface evaluations?
Three: Slit lamp exams, staining (tear breakup time [TBUT], tear lake, staining), and topography.
And a few honorable mentions ("additional value drivers”) include incorporating questionnaires (such as the Dell Questionnaire), osmolarity, tear film analysis, and meibography.
Before we move on, give me the key takeaways from this.
A few we already mentioned … but definitely worth reiterating for clinicians:
- Trust your measurements before developing a surgical plan.
- Optimize the ocular surface before making any permanent refractive decisions.
- Don’t rely on symptoms alone—identify pathology affecting visual outcomes.
- Tailor preop evaluations to patients’ anatomy, risk factors, and visual goals.
- If measurements are inconsistent: identify the cause, treat it, then repeat diagnostics.
- Always look for early signs of progressive diseases.
And the last clinical pearl: The quality of a preop evaluation is one of the strongest predictors of postop patient satisfaction.
Next up: the consultation … right?
Correct. But before we get to that session, Dr. Yassine shared his insights on not just the importance of a proper consultation with patients—but also on the need for education.
The aim: To ensure surgeons are having the highest level of discussion and offering the best premium IOL options available to fit their specific conditions and lifestyle.
… now onto that session …
For that, we turn to Marjan Farid, MD, and I. Paul Singh, MD’s role-play discussion on reframing premium IOL counseling as a recommendation exercise—not a sales pitch.
As the presenters emphasized: The consultation isn’t about selling the lens to a patient; it’s more about making a confident recommendation that clearly connects to their individual needs.
So how can surgeons do this?
Drs. Farid and Singh introduced attendees to a preop consultation framework in which the goal is to MATCH the patient to the best lens for them:
Measure the eye.Assess lifestyle and goals.Translate findings. Choose the best fit.Harmonize expectations.
And to set a patients’ expectations?
Their core message for surgeons to relay: “No lens is perfect. Our goal is to select the option that best aligns with your vision goals and your eye health.”
- The idea, they noted, is to achieve postoperative success aligning a patient’s expectations with the likely—and more realistic—outcomes before surgery.
Among the topics to discuss during consultation: Benefits, limitations, tradeoffs, potential visual phenomena, postop visual healing variability and potential need for glasses, financial considerations, and success metrics.
Let’s talk fundamentals.
When it comes to cataract consultations, Drs. Farid and Singh reiterated the meeting’s common theme: Patients want a confident IOL recommendation—not a menu of options.
Also beneficial for surgeons to keep in mind:
- It is not their responsibility to judge what a patient can (or cannot) afford.
- Not needing glasses to see postoperatively doesn’t translate to patients having excellent image quality.
- Pseudophakic vision isn’t the same as phakic vision (for quality or quantity).
- Correcting astigmatism will improve vision quality at all distances, even if a patient wears glasses for near vision post-surgery.
- Unmanaged OSD or irregularity will reduce image quality after cataract surgery.
Following this discussion: Attendees put the MATCH framework to the test by participating in two patient scenarios (one for OSD and the other for astigmatism) under the guidance of the program’s faculty members.
Now turn to postop: How should surgeons approach this?
Dr. Donnenfeld joined Zaina Al-Mohtaseb, MD in leading the discussion on planning for (and executing) an effective postop management strategy to achieve optimal patient satisfaction.
Their first suggestion: Work with practice staff to develop a consistent framework for patient evaluations ahead of their follow-up visits—including structuring these to collect input (satisfaction) and testing results before a surgeon steps into the room.
And while postop patient satisfaction is reportedly around 92.1%, the remaining 20% often have predictable concerns related to one of six recognizable diseases (each with a systemic evaluation and management pathway).
- The most common: residual refractive error (~50-57%) and OSD (~25-35%)
So with this in mind: A three-step, “six Cs” framework is recommended to troubleshoot these postop concerns.
I’m listening …
Step 1: Listen to a patient’s complaint.
Step 2: Evaluate the “six Cs”:
- Cornea
- Correction
- Capsule
- Cystoid macular edema (CME)
- Centration
- Condensation
Step 3: Consider the lens (but only after excluding or treating the “six Cs”).
Take a closer look at the impact of these “six Cs”.
Starting with the cornea (OSD) and capsule (capsular opacities), their potential impact on outcomes include decreased visual acuity (VA) and contrast sensitivity as well as increased glare / halos.
With correction (residual refractive, spherical, or cylinder error), there’s the risk for reduced uncorrected VA, decreased spectacle independence, and increased glare / ghosting as well as reduced patient satisfaction.
As for CME, the outcome impact includes reduced VA, decreased contrast sensitivity, metamorphopsia, and delayed visual recovery.
And the last two?
With a lack of centration (focusing on the pupil / IOL relationship), this may cause reduced vision quality, increased dysphotopsia, decreased contrast sensitivity, and a reduced tolerance of advanced technology optics.
And lastly: Condensation (vitreous changes / posterior vitreous detachment [PVD]) may lead to the risk of increased floaters and visual disturbance, reduced subjective visual quality, and decreased patient satisfaction—despite good objective outcomes.
So what should clinicians keep in mind with such issues?
As Drs. Donnenfeld and Al-Mohtaseb emphasized, they should be asking a few crucial questions before pinning the blame on an advanced technology IOL:
- Is the ocular surface optimized?
- Is the refractive target achieved?
- Is the capsule clear?
- Is the macula healthy?
- Is the IOL centered and stable?
- Has vitreoretinal pathology been excluded?
And if the answer is “yes” to all of the above, then it’s time to take a look at the lens-patient relationship—from expected optics to unrealistic expectations and a potential true lens intolerance.
Shifting gears … let’s look at this from a practice perspective.
For that portion of the meeting, Dr. Donnenfeld led a roundtable discussion with three clinicians on what residency did and—more importantly—did not teach surgeons.
The panelist of surgeons: Matt Brink, MD; Sahas Narain, MD; and Rupa Shah, MD
The consensus: Residency may have taught them how to operate—but it didn’t cover how to build a practice around advanced-technology IOLs.
From increasing patient expectations amidst the premium IOL landscape to a declining physician payment (remember those reimbursement numbers from earlier?), the panelists dove into the plethora of concerns—and opportunities—facing today’s surgeons.
Give me a look at this discussion.
Declining cataract surgery reimbursement hinges on shifting from a pure “procedure” model to a value-and-education-driven “vision outcomes” model, the panelist said.
Speaking of education: Patients are coming in far more informed on their IOL options. “It’s on us to be educated enough to be able to answer all of their questions,” said Dr. Shah.
So when it comes to discussing premium lens options, frame the conversation as what’s best for the patient—not as an upsell—and lead with confident recommendations, the panels advised.
- “Offer patients what’s in their best interest. Don’t give them a laundry list of everything that’s available,” Dr. Donnenfeld emphasized. “Start with what you think they’re going to be best with, and make a strong recommendation.”
How about from a digital perspective?
Consider systematizing patient education with standardized pre-visit prep and a reinforced message across the staff team: “Education is our goal—that’s our job.”
As Dr. Donnenfeld noted: “Patients need multiple touch points when they come in for cataract surgery.”
- His advice: Record and give patients access to a personalized video that speaks “matter of factly” about their options.
Along with this: Utilize social media as a trust builder by focusing on education and culture— not self-promotion tactics. “Social media is tricky because there's a balance between promoting yourself and promoting the practice, but also not being too cringy.”
Most often: Simple, authentic educational videos—and even staff-led culture content—can go a long way.
So what goes into building a premium IOL practice?
Dr. Shah identified three key pillars to keep in mind with cataract surgery:
- Appropriate patient selection
- Managing patient expectations
- Out-of-pocket discussions
The hardest part: “Bridging that gap between being confident and saying ‘this is what’s best for you and I think you’ll be happy with this,’ without sounding like a used car salesman,” she said.
The advice: Normalize these conversations and center them around long-term vision outcomes, patient safety, and managing any postop issues.
The phrase to consider using: “Your surgery is covered by your insurance, but your vision correction is not.”
What else goes into a successful operation?
Optimizing clinical tactics, such as treating ocular surfaces aggressively ahead of measurements to improve outcomes, as well as relying on outside partners for IOL exchanges and LASIK / PRK enhancements.
This ties into the next recommendation: Invest in learning and networks that support premium care via local or targeted meetings, peer groups, and industry partnerships.
… how does that translate to in-practice?
If a surgeon doesn’t offer LASIK or PRK, consider sending patients to another practice to take on those patient cases.
Develop that relationship,” with other ophthalmologists in the community, Dr. Donnenfeld advised.
And their advice for clinicians looking to start their own IOL practice?
The panelists' takeaways centered around three themes:
- It’s easier to start than you might think.
- Embrace discomfort—and ask for help early.
- Seek environments that expand your skills.
Dr. Donnenfeld emphasized one additional—but equally important—component: happiness. “If you're not happy, everything else falls by the wayside,” he said. “Make the practice a representation of what you look forward to, so that when you go to work, you're happy to be there.”
And sticking with these takeaways … let’s talk big picture.
To round out the meeting, Drs. McCabe and Donnenfeld returned to the “more choice, more complexity” reality facing today’s cataract surgeons.
The solution: The IOL Compass framework—from its structured evaluation and repeatable selection process to offering better patient conversations and a systematic postop management approach.
Joined by faculty members, they offered a few soundbite-worthy takeaways for attendees to keep in mind when returning to their practices:
- Don’t run away from complications and complex situations.
- Practice confidence and competence.
- Get out of your comfort zone and try different lenses.
- Maintain good patient communication.
- Pay attention to preoperative assessments.
- “Trust your skillset, trust yourself.”
- Empower your staff.
Emphasizing that last bullet, Dr. Donnenfeld said: “That's what patients really want: They want to hear from you—and from the people around you—a unified message on what you think is going to be in their best interest.”
How about from an industry perspective?
Wrapping up, Dr. Donnenfeld referred to industry partners as integral for surgeons, noting that “the relationship between industry and ophthalmology is probably the strongest relationship in all of medicine.”
“Working with companies like B+L, who want your input on innovations, is going to allow us all to have an impact on future patient care.”