Ben LaHood

Presbyopia Solutions. A practical guide from an eye surgeon for patients seeking the holy grail of losing their reading glasses

Ben LaHood — Sun, 23 Aug 2026 10:31:59 GMT

You’ve done everything humanly possible to remain looking young. You’ve had botox; worn sunscreen even in Winter; kept up with the fashion cycles of having appropriately baggy or slim trousers; basically you stopped at nothing to retain your youth apart from drinking the elixir of life from the holy grail (if you get that Indiana Jones reference you are in the right age bracket and the right place to continue reading). But then you put on a pair of reading glasses to read a menu and suddenly became old. Few things age someone so rapidly as slipping on a pair of reading glasses. There’s nothing subtle about magnifying glasses. You may as well start knitting, talking about the cost of movies back in your day, and blame video games for violent teens. In the eyes of the world, needing reading glasses is synonymous with aging. No matter how smooth your forehead, if it’s being used to support a little boost in magnification, you’re officially old.

As the human species is not one to accept it’s fate and attempts to change absolutely everything, we have developed solutions to our design flaws. Our physical inadequacies shall no longer hold us back. We have knives and forks to make up for our lack of fangs, clothes that make up for our lack of fur, and until recently we were satisfied with reading glasses to allow us to see up close. We once respected our elders who had survived and lived to a ripe old age where they needed the help of magnifiers. We perhaps even felt as though these reading glasses gave an air of intelligence and wisdom. But we are now in an era that glorifies youth and there is nothing youthful about having lost the ability to focus at near. As a refractive surgeon I joke (I’m not really joking) that my job is to rid the world of glasses and I am certainly seeing people come to see me at an increasingly young age to regain their focusing ability. We have the technology to solve this problem. The holy grail of eyes would be restoring the ability to change focus easily that is present in young people but gradually degrades over time. This process, known as presbyopia, confuses people and I will spend the first part of this article discussing exactly what it is and why presbyopia affects different people in different ways. We will then consider presbyopia correcting solutions with their pros and cons. I expect this article to be particularly useful for people experiencing presbyopia who are beginning to think about their options, and I also hope it will be of interest to other eye care professionals who want to learn more about which options are available and may be most suitable for their patients who are chasing an elixir of youthful vision.

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PRESBYOPIA

If you are reading this without reading glasses, you may still be presbyopic but simply shortsighted. That last sentence is one of the most confusing pieces of jargon imaginable. So many terms that are not intuitive to understand. I will attempt to break down the terminology so that you can come back to it later feeling smug with understanding.

Presbyopia is the process where the eyeball begins to fail to be able to change focus. The neurological processes behind the control of where you focus and how you subconsciously do so are beyond the scope of this article as they are beyond my understanding and I am an eye surgeon specializing in refractive surgery (operations that enhance your ability to focus).

At the very most basic level, your eyeball can change how far away from you is in focus. This changing of focus distance is known as accommodation. We all have a certain distance where our eyes are in focus at rest with no effort. If you have zero need for glasses then this distance is far away at the horizon. This means that you are emmetropic. With zero effort, your clearest most focused distance is far away. Shortsightedness and longsightedness, also known as myopia and hyperopia respectively are variations of where you are focused at rest. The terminology is confusing. If an eyeball is shortsighted, with zero effort, that eye can see most clearly up close and the distance is a blur. A longsighted eyeball in comparison needs some focusing effort to see even far away, and greater effort to see up close. When we put effort into focusing, we can see closer than our resting state. When we relax, our focus goes back to our resting state. So for an emmetropic person whose resting focus is far away, they can apply effort (accommodate) to see up close. They can also relax and return to seeing well in the distance. For a myopic person who is shortsighted, their resting state is near vision and so they can accommodate or apply effort to see even closer, getting close enough to lick the screen, but when they relax their eye muscles, they will still be shortsighted and the distance remains a blur. They are basically trapped within a bubble of close up vision and the far distance can only be unlocked for them with glasses or contact lenses. A hyperopic or longsighted person needs to apply focusing effort to be able to see even at distance, and needs maximal focusing effort to see up close. When they fully relax their accommodation, even the distance will be a little blurry and reading considerably more blurry.

The way in which the eyeball accommodates or changes focus is by changing the shape and position of the natural crystalline lens within the eye. Internal muscles allow the soft lens to change in thickness and position to provide the eye with increased focusing power. This process usually occurs quite subconsciously to give us the clearest image possible at any distance.

With aging, we all lose our ability to change focus. There is some debate about exactly where and how we lose this but the main culprits are a loss of strength of our internal eye muscles to change the shape of our lens, and more likely, also, a hardening of the natural lens of the eye to be less able to change shape over time. This loss of ability to change focus is presbyopia.

Obviously presbyopia will impact an emmetropic, myopic, and hyperopic eye differently. The emmetropic eye will remain with clear long distance vision long term as presbyopia develops. They will lose their near vision, gradually holding their phone further and further away to read until they need either arm extensions or reading glasses. This is the most common scenario we imagine when we think of presbyopia. A myopic, shortsighted person will retain their resting position of being able to see up close, and will simply lose their ability to see even more near targets. It is hardly noticeable as they will still be able to read their phone and will still need help seeing in the distance with contact lenses or glasses. The hyperopic or longsighted patient is most affected. Remember that they needed to be able to focus even to see in the distance. They will lose their ability to see up close earlier than their friends as the effort to read will become too great earlier.

“Reading glasses” is a terrible term as I am forever hearing from my patients that they do not do a lot of reading so would not mind having to wear reading glasses. It’s as though they think reading glasses are magic and can determine if the person is looking at a book, or their watch, or their phone. No, reading glasses simply mean wearing additional magnification so that they can see up close with the effort they have available. The higher the number on their magnifying glasses, simply indicates the closer they will be able to hold objects. A pair of +1 magnifying glasses should allow a presbyope to hold an object comfortably at 1 meter away and read it clearly, +2 correlates to half a meter, +3 to a third of a meter and so on. It really is that simple.

A common question I am asked is whether beginning to use reading glasses is a slippery slope? i.e. if someone puts on reading glasses early in their presbyopia journey when they are just beginning to notice that they need help seeing up close, will they need reading glasses more often, and rely on them sooner than if they held off as long as they can. Anecdotally I would say that there is some truth to this. I see plenty of patients, especially hyperopes who have struggled and squinted for many years before giving in to the temptation of reading glasses. Once their eye muscles finally retire in the comfort of reading glasses, they are never again resurrected. These are people who describe putting on reading glasses just for near tasks and over a course of months find themselves needing them for all distances. Emmetropic patients usually do not have this same concern as their resting state does not require any accommodative effort.

SOLUTIONS

Achieving great things requires great sacrifices. This is true for presbyopes. We do not currently have the elixir of life to turn back the clock. You are aging. You’ve aged just by reading this article. To be honest as someone who makes a living from solving vision problems, I would hate to see presbyopia completely reversed and solved within my working life but I’m sure it will happen. So for now, we are faced with multiple flawed solutions. There is no free lunch in optics. As I say to my patients, all of the options I will present to them have pros and cons. They can all give you freedom from glasses but they must decide if the trade off is worth it. I am like a character out of a fable, offering a solution but it comes with a terrible price. To be fair, that terrible price is usually just financial and the negative trade offs very tolerable but let’s discuss those trade offs.

Eyes have three potential methods of having their focus changed. We can apply laser to the cornea to change its shape; we can implant a lens inside the eye without removing anything; or we can exchange the natural lens of the eye for an artificial implant. These methods all have their pros and cons as well. I am certain that there will be refractive surgeons who read this article and complain that I have not considered a particular option that they offer their patients, and I’m ok with this. The options that I will discuss here are mainstream, routine options. There will also be non-routine, surgical options that they are welcome to comment on or discuss.

Stop asking for the best IOL on the market. How an eye surgeon should help you decide on the correct IOL for your cataract surgery

Ben LaHood — Mon, 10 Aug 2026 15:52:08 GMT

When people walk into a car dealership to purchase a new car, I don’t imagine they often ask for “the best car in the world”. Instead, they have thought to themselves about what they want from the car, how it will perform in their everyday life and whether the pros and cons weigh up. I have lost count of how many times I explain to patients asking me for the best lens on the market, that just like buying a car, where some people want a four wheel drive, while others want a sportscar, one is not better than the other. It’s all about what suits their needs. Selecting an intraocular lens (IOL) to implant during cataract surgery is exactly the same. There is not one holy grail lens that is the best lens in the world. Certainly, there are better and worse IOLs on the market in my opinion, but it is more about selecting a category of optical design that will suit each eye and each patient, rather than a hierarchy of best to worst lenses. Of course, in many countries, price is also a consideration, just like buying a car, otherwise we would all be driving around in Lamborghinis, and Bentleys. I happen to live and work in Australia, a golden country where insured patients can freely select any category of IOL without worry about price. Picture a car dealership where any model you desire is available for free, simply choose your ride and drive away. So, for any international readers I apologize, and for the moment let’s consider IOLs without the concern of price.

This article is designed both for prospective cataract and lens replacement patients considering their options, and also for eye care professionals to gain insights into the thought processes around IOL selection when all models are freely available. I will start with an overview of the main IOL design categories that I prefer to use, and then look at the key questions which I either ask my patients or myself to help the decision making process. Finally, I will discuss common patient scenarios and what I have found works for them, based on a decade of implanting premium IOLs.

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THE MODELS AT THE DEALERSHIP

Turning up to a car yard, you wouldn’t expect to find a brand new Tesla and a vintage Porsche on sale at the same premises. Similarly, every surgeon will have preferences based on their experience, availability based on their country, and access depending on their relationships with various companies. There are so many different lenses from different companies within each category of optical designs that I will not get into details about subtle differences. Basically a monofocal IOL from one company will differ very little from a monofocal IOL from another company. Yes, there will be differences in asphericity, optic and haptic designs, but for the sake of this article we will group them together as monofocal IOLs.

This grouping for convenience does become a little more difficult with extended depth of focus (EDOF) IOLs. This is a far more heterogenous category. We have IOLs that are diffractive, splitting incoming light to give range; IOLs that use spherical aberration, both positive and negative, to elongate the focal point; asymmetric designs; and IOLs that use proprietary design information, that we do not have full access to or understanding of. Despite their differences, they all aim to provide an eye with an extended, but not full, range of focus.

Full range of vision, or multifocal IOLs, were a simple group to put together up until recently. We had the Henry Ford situation where you can have any colour as long as it’s black, but in this case you can have any multifocal you want as long as it’s a diffractive trifocal. We now add to the catalogue of multifocal options, the Galaxy IOL from Rayner which is a full range of focus lens but instead of being diffractive, it is refractive, meaning that light is not split to give multiple foci.

These are the three groups of models that I offer in my practice, monofocal, EDOF and multifocal IOLs. I’m sure that there will be people reading this asking, what about other lens types, and the obvious group that is missing is “Monofocal plus”. This is a group of lenses designed to give a little extra range of vision while maintaining excellent distance vision quality. I know many surgeons who like to use these lenses and they are somewhat of a gateway drug for anyone venturing into the premium IOL market. Think of them as the Mazda MX5 sportscar sitting outside the dealership just waiting for a midlife crisis to come walking past, taking it for a test drive, and realizing that what they really want is a Ferrari. In my humble opinion, monofocal IOLs give excellent distance vision quality and a touch of intermediate vision, as I have published last year in peer reviewed literature. EDOF IOLs, provide extra range at a minimal cost to distance quality, and so I really see no value to my patients of an intermediate monofocal plus style design.

THE PROS AND CONS FOR EACH MODEL

There is no perfect all round design to suit every situation. This is exactly why there is no point in asking your eye surgeon for “the best” IOL on the market. Until we can either reverse cataract formation (I pray this day never comes as an eye surgeon making a living from doing cataract surgery) or come up with a truly accommodative IOL, we are stuck with trade offs in terms of performance. Just as a four wheel drive is great for off road adventures, you wouldn’t want to race it at speed around corners, and vice versa, a sports car with its low suspension will get stuck going over a curb. It’s horses for courses. So let’s consider the pros and cons of each model as I would explain them to a prospective patient.

Monofocal IOLs

Pros: Without a doubt, unanimously, all eye care professionals would surely agree that monofocal IOLs will provide the best quality of vision in an eye regardless of any pathology. If a patient tells me that their main priority is quality of vision then I immediately think of a monofocal IOL. They provide the lowest risk of visual side effects such as halos, glare and starbursts. This is the simple, quiet achiever of the models. If I have an eye that is in some way compromised, or a personality that would not tolerate side effects, then a monofocal is on the menu.

Cons: The downside of monofocal IOLs is their limited range. This is hard to explain to a young person who can still voluntarily change focus, but to a presbyope, that limited range can be very frustrating. As surgeons we can target a specific focal distance such as far distance, intermediate, or near vision, but that is all you really get and glasses or contact lenses are needed to change focus. This might sound tolerable, but some of my unhappiest patients imagine that they want great quality vision and would be happy to use glasses for near tasks, only to find they have the incredible annoyance of putting on glasses to check the time on their watch, or check a message on their phone. In a sentence, a monofocal IOL is the choice of quality of vision over quantity of vision.

EDOF IOLs

Pros: We have some great EDOF IOLs that provide a very decent range of vision with really very little compromise in quality. I say to my patients that if we aim for distance vision, they can expect 20/20 distance quality (monofocal IOLs often provide even better vision than this) and that their vision will be very reasonable up to the dashboard or the computer. This is a nice functional range of vision. More prolonged near tasks will need reading glasses, which for many patients is acceptable.

Cons: Similarly to monofocal IOLs, the provided range of vision is incomplete. An EDOF will not give you great vision all the way from distance to reading. You can have two out of three, and like the song says, two out of three aint bad. Many will use EDOF IOLs with a degree of modest monovision to give the full range of vision, but of course this raises the issue of tolerance of monovision, adaptation, and pre-operative testing. If EDOF IOLs could provide a very consistent range of vision and a predictable visual outcome with every implantation, I believe their uptake would be incredible. However, we still see a lot of variation in range of vision. In my opinion, this relates to two major factors, the existing aberration profile of the eye, and pupil size. We know that smaller pupils provide a pinhole effect where extended range of vision can be achieved even with a monofocal IOL and so smaller pupils tend to give more EDOF range also. A lot of EDOF IOLs are using optical designs with mechanisms altering spherical aberration of the eye. As we are implanting these IOLs behind the cornea, which has it’s own aberration profile, the combination of aberrations in the cornea and in the EDOF IOL, can eiher combine to be fantastic or tip over the threshold from aberrations being helpful to becoming toxic. Not everyone has the equipment to measure or the skills to interpret aberrometry and so these lenses require a bit more thought than simply using a monofocal IOL. Knowledge of the optical design of your preferred EDOF and how that may interact with an individual eye is something that can be learned with experience but it certainly takes extra effort in the clinic room.

Multifocal IOLs

Pros: Concentrating on diffractive optics options, multifocal IOLs work surprisingly well in a wide range of eyes. There has been talk about multifocal IOLs being more sensitive to biometry abnormalities and pathologies but in my mind, they are actually a lot more simple to work with than wavefront shaping EDOF lenses. As I explained earlier, an EDOF attempts to distort the focal point by elongating it using the induction of higher order aberrations in most cases. This is going to give a poor quality image if the cornea is also causing higher degrees of aberration. Whereas diffractive technology does not distort the wavefront of light entering the eye, it simply splits the light into multiple focal points. In my experience, this means that even in an eye with an irregular cornea where an EDOF IOL may not be a good option, a multifocal lens often works very well. But the main advantage of a multifocal IOL is that it provides a full range of vision. There is no need to consider different targets. Simply implant a multifocal IOL aiming close to emmetropia, and you are blessed with vision from the horizon in to reading distance.

Cons: The trade off is not quite the opposite of a monofocal where you are getting quality at the expense of quantity, but multifocal IOLs do have a quality trade off. Visual side effects of multifocal IOLs are the most common discussion point that my patients get stuck on and have to consider if the trade off is worth it. Halos around lights at night can be annoying for night time driving, especially in the first month, but for many, these halos continue. The rate of bothersome visual side effects remains very low and in a year where I may implant 1000 multifocal IOLs, I would usually only expect to be explanting and replacing one or two. There is a big difference between visual side effects being present, and them being present and annoying enough to justify an IOL exchange. The other negative of multifocal IOLs is needing good lighting to read with. For most multifocal lenses, only a relatively smaller percentage of available light is distributed to near vision. When the lighting is dimmed, sometimes that available light can be inadequate for reading comfortably. An example I often give my patients is that if they want to read in bed at night with very dim lighting so they don’t disturb their partner, this may be one of the rare times they want to use a paid of reading glasses as this will shift the distance focus to near and gain a larger percentage light distribution.

THE FIVE KEY QUESTIONS

I have a natural dislike for used car salespeople. I don’t want to tell you anything about me. I have money and you have a car. We don’t need to get to know each other so let’s get this deal done. However, if I was having cataract surgery, I want my surgeon to know everything about me, my daily routine, what I like to do in my spare time, how far away my computer sits, where I like to read and in what lighting. The list goes on but it really is vital for a surgeon to properly understand the lifestyle of a patient to be able to sculpt an enjoyable visual situation to suit that individual. This surely seems like I am trying to make myself sound caring, lovely, and a real man of the people. But it is also for selfish reasons. I want to get the IOL choice right the first time rather than change things with more surgery or a laser enhancement. Of course I want happy patients who will tell their friends and family about how great their experience was, and return to their referrers singing my praises. But in all honesty, I want what is best for my patients and since we are dealing with trade-offs, I really do need to know what makes each patient tick. I want to know what their goals are, what their acceptance threshold of downsides are like and whether I have the tools to make them happy. I have listed below some of the key questions that I think should occur between a surgeon and a patient having lens replacement or cataract surgery.

1. How bothered would you be by having to use reading glasses for near tasks?

This is such a vital question as it separates the possible options out very quickly. If someone would be quite happy to wear reading glasses when needed, then there is no need to compromise quality with visual side effects, and these days I would steer this patient towards bilateral EDOF IOLs aimed at emmetropia. This gives the brain both eyes doing the same visual task, gives them a good range of functional vision, and doesn’t introduce a high risk of visual side effects such as halos. If, however, the patient would not tolerate reading glasses, then I know we are either going to implant multifocal IOLs or go with a variant of monovision with an EDOF model.

2. Is driving at night a major part of your lifestyle?

This is all about multifocal IOLs causing halos around lights at night. In my experience, nearly everyone implanted with a multifocal IOL will experience halos around lights at night and within the first month after implantation, they are very tolerable. However, there will be certain scenarios such as driving at night, while it’s raining, in an area they are unfamiliar with, and at this moment, they will surely curse me and my multifocal IOL choice. So for most people, they will simply not drive in this situation, and instead have a drink, and let their partner drive home. But if driving is a major part of their lifestyle such as a commercial truck driver, or someone living in a remote, dark, part of the countryside, driving in the dark may be unavoidable, and I will often avoid multifocal IOLs in such patients.

3. Have you ever experienced monovision, where the two eyes are set for two different refractive targets?

Many people, when they become presbyopic, will ask their optometrist how they can avoid reading glasses. Shockingly, surgery is not always the first solution. Monovision is usually provided with contact lenses where the dominant eye is set for long distance vision, and the non-dominant eye set for reading to intermediate vision. We don’t do this with glasses as the differences in lens power gives a difference in magnification, and image size, which makes it harder for the brain to tolerate. Contact lens monovision can be very well tolerated. I notice there is often some confusion between a patient understanding whether they tolerated the visual outcome or the physical feeling of contact lenses so it is important to make this distinction. Similarly, we often strike people who have not tolerated multifocal glasses so are worried about not tolerating multifocal IOLs, until I reassure them that these are two very different beasts. I would not usually give someone monovision who has not experienced it before in contact lenses as not all aging brains have the neuroplasticity to adjust to this change, and in the presence of cataract, it is difficult to provide the brain with an adequate simulation to test it. However, if someone has had a positive experience with monovision previously then I am fairly certain they will enjoy me making it permanent with IOL implantation.

4. Is there any aspect of your life where you need extremely accurate vision?

There are certain people and certain careers where precise, eagle eye vision is a necessity. Naturally every single person I have ever seen in clinic tells me how vital their vision is to their work, or their life and I will agree as to that individual, their vision is extremely important. But there are people where this is objectively true. I want a sniper to see what they are shooting and not be looking for me as their next target. I want an astronomer to find life on distant stars, and not hallucinate halos around planets. I want a microbiologist to discover new antibiotics and not see a fuzz of fungus under their microscope. But don’t get me wrong, your hairdressing is also important. Careers and hobbies where quality of vision trumps everything else should, in my opinion, be getting a monofocal IOL until proven tolerable of other options and a very in depth consent signed.

5. How tolerant are you to minor inconveniences?

I feel as though this question might seem odd but it is probably the most important question for anyone using multifocal and EDOF IOLs if they don’t want to be doing a lot of exchange surgeries. I will ask my patients for example, “if you were on your way to work and you noticed a small stain on your trousers, would this ruin your day, make you go home and change, or would you get on with your day and forget about it?” If a small inconvenience would ruin their day, I know that the visual side effects of a multifocal IOL will be bothersome. When I look back over the cases of patients who have had their multifocal IOLs explanted, they have nearly always been glass half empty people who have been unable to see past the halos at night, to notice their glasses independence. Perhaps if I had asked them this question, and they had answered honestly, then I would have given them a different IOL selection.

SPECIFIC SCENARIOS

The Golfer

I am like an embarrassing broken record in clinic, as with every golfer I meet who is complaining about their distance vision, I can’t resist telling them that they have to stop driving the ball over 300 metres. But I digress. Most golfers want distance vision to track their ball and intermediate vision to putt (as well as socialize at the 19^th hole). Generally, they are happy to keep score, holding their phone at arms length. Depth perception with good binocularity is not absolutely vital as unlike rapid sports like tennis or squash, distances can be judged using other visual cues. Personally, my preference of visual rehabilitation for golfers is bilateral EDOF implantation, sometimes with a small degree of monovision, but often simply emmetropia for both eyes.

The Hairdresser

In my opinion, these are some of the hardest to please people on earth. These are the lawyers and engineers I used to hear about when I was a trainee. They need so many distances to be clear and they truly do need to be able to judge distances comfortably. We are talking arms length, but also in the mirror, but also taking payment up close, and looking at the door to see clients walk in. They need crisp focal points for sharp cuts. Personally, my preference here is for a multifocal IOL in each eye to give a full range of vision. The potential downside of this scenario is not halos but that multifocal IOLs in general have defined sweet spots of vision where everything seems focused. If working distance and these sweet spots do not align, then it can be tricky to make a hairdresser happy. I tend to work around this by making sure that the refractive target for each eye is slightly different so that we have a more continuous range of vision, but the modern generation of multifocal IOLs also do naturally provide a more continuous range anyway.

The Artist or Musician

It is important to ask the artist about their working distance and the musician if they read music or prefer to look at their instrument. Both will often want intermediate to near vision but also long distance to look at their muse or their audience. Artists are often bothered by visual side effects, and musicians may be performing under lights where halos can be annoying. These are usually people who appreciate a range of vision over quality of vision. My preference with these groups of people is EDOF monovision where one eye is focused at distance to dashboard, and the other is intermediate to near. This gives a nice overlap in the functional intermediate range where most of their work is happening but still having a monovision ability to see near and distance. The decreased risk of visual side effects is also very helpful over a multifocal option.

The Computer User

These days this is basically everyone with a job. But honestly, even those who are retired, are glued to a screen. The key factor I think about here is whether the patient is working while using their screen, and if so, what else are they doing. For instance, a graphic designer may just use their screen for prolonged periods, but an accountant may be looking from paper documents to the screen back and forth, and an ambulance dispatcher may be looking at multiple screens at different distances. For the person who is using a single screen distance, bilateral EDOF emmetropia may give them everything they need as they never need to look closer than their intermediate working distance. However, multiple near to intermediate tasks would make taking reading glasses on and off extremely frustrating. I have a preference in these patients for multifocal IOLs as this allows comfortable binocular reading and intermediate vision without glasses, rather than EDOF monovision where one eye is doing the majority of the work.

TAKE HOME MESSAGES

There is not one best IOL on the market. In an age where all major IOL manufacturers are making a good monofocal, EDOF, and multifocal option, the exact model and brand matters far less than choosing the right category and combination for each patient. I rarely discuss with patients the actual IOL model that they will receive. Not because I am hiding anything but because it is extra information that they don’t need to deal with. That can be my concern to find the best IOL within each category.

There are a few simple questions that patients can consider prior to coming and seeing a surgeon to help decide on the best IOL for them, and these questions should be addressed with any patient undergoing lens surgery. They are incredibly simple, and will be especially helpful for surgeons who talk less than me, which would not be hard.

There are certain patient groups who have specific visual demands that require a bit more thought, but I really can’t stress it enough, all of this decision making process becomes so much easier when the surgeon truly wants to get to know their patient, understands their motivations, and can openly discuss the pros and cons of their options available. Nothing beats good communication in all aspects of life. So don’t be like me at a car dealership, trying to stay mysterious. Let your surgeon know everything about you, because after some sedation during cataract surgery, you’re going to tell them all your secrets anyway.

Why AI Created Presentations Are Ruining Scientific Meetings

Ben LaHood — Fri, 31 Jul 2026 13:04:36 GMT

Powerpoint slides where every element is animated, each text box has the rounded corners of an Apple product; there is more text than War and Peace in every slide; and neither you in the audience or the presenter have seen the slides before. These presentations are spreading through conference halls around the world in all of their burnt orange colour palette glory, and I hate it!

As a frequent meeting attendee, presenter, and host, I completely understand the appeal of having someone or something make my presentations for me. It used to be that you could recycle a talk given in one city, like a comedian slightly modifying their routine each night. But these days, I would feel bad rehashing a talk on the other side of the world as often I see the same faces in the audience and on stage whether I’m in Europe, Asia or the USA. So this means creating a lot of new material. For most of us on the speaking circuit, we work full time, and somehow need to find time to make multiple high quality presentations alongside organizing flights, accommodation, and other commitments. Don’t get me wrong, it’s a privilege to get to educate and interact with colleagues, but it does take a lot of effort to do it well. I hear you thinking, “If only there was a way to automate this process”.

Expectations of presentations are also through the roof. In my mind, a lot of this comes from our consumption of social media. We all know that attention spans have shrunk, and the way we consume high impact, rapid fire content has attendees judging scientific content harshly. It’s not enough to present solid scientific research anymore. Like spectators at the Roman colosseum, we want to be entertained. This means high quality videos, interesting graphics, and animations are the bare minimum to avoid looking out over an audience of yawning mouths. All of this lends itself nicely to the capabilities of artificial intelligence. With availability of AI tools growing daily, time poor presenters are handing over the responsibility of putting together presentations. It makes sense in terms of time saving, but it’s a false economy if the point of giving a presentation remains about engaging audiences and disseminating knowledge. The problem is that instead of creating something engaging, as an audience member, as soon as I see the hallmarks of an AI presentation, I turn off completely. I’ll go back to scrolling on my phone, look at the meeting schedule and not expect to learn anything of any interest. Subconsciously, I am thinking, if this presenter wasn’t interested enough to make the presentation themselves, then why would I find it interesting either? This may be harsh, but it’s the truth.

I’ve thought a lot about AI presentations in recent weeks as I’ve seen more and more of them clicked through on stage. They’ve made me reflect on whether I’m a dinosaur stuck in the past and like an old man shaking his fist at kids, I need to move on as this is the future of scientific meetings. Trying to rationalize my dislike for AI presentations, I’ve managed to break my thoughts down to four key questions:

1. Why do we need Powerpoint slides when giving presentations and has AI altered this?
2. When I look back at previous generations of presentations, they also had problems, so are the negatives of AI created content any worse?
3. What is it about AI created presentation content that turns me off?
4. Could I give guidance to someone using AI to create a presentation so that they could still be efficient but also engage an audience?

WHY DO WE NEED POWERPOINT SLIDES WHEN GIVING PRESENTATIONS AND HAS AI ALTERED THIS?

The very best orators can tell an incredible story without need for props and imagery. When you think of Churchill or Obama or JFK speaking words that continue to inspire and give goosebumps, I don’t think of them using a clicker on stage to bring up animations. I can just imagine Winston Churchill saying “We shall fight them on the beaches” and bringing up a powerpoint slide with an animated picture of Brighton beach swiping in with a racecar sound effect. Some statements are most impactful without images as they allow their audiences to imagine something on an individual level. However, scientific presentations are not about imagination or emotion. They should be about facts, comparisons and statements. Simple facts and statements can be given without help from slides. We have all seen the passing obsession during COVID with TED talks and the way these people were able to stand and deliver a lecture that would get shared aggressively as though they were the new messiah. I imagine these speakers trained for months to be able to give such a well structured seamless talk without obvious cues. Maybe there were breaks and stutters cut out before being uploaded to YouTube that we will see on the directors cut one day but they did seem fairly robust. They were like famous musicians singing acapella without backup singers able to rattle off their tunes without mistakes or diversions. I even bought a book titled “How to give a TED talk” before realizing that I really didn’t want to ever do that. The meaning of my rant here though is that it is possible to deliver a serious message without need for slides and animations. However, most TED talks gave enough time for the presenter to have thoughtful pauses and allow audience reactions like an episode of Oprah.

At most scientific meetings, a presenter has to pack the entirety of their five year, peer reviewed PhD thesis into a five minute presentation. This is where graphics and video really shine. They allow the audience to look at a bundle of data and highlight where the relevant and important points fit in. It’s efficient and attention grabbing. There is no better feeling as a presenter than putting up a graphic summarizing your key points and seeing a wave of smartphones and ipads being hoisted into the air to take a photo. Sure, those photos will never be viewed again, but for that moment, you know that your graphic caught their attention.

Artificial Intelligence has not altered this need for graphics and animations, it has simply made the bar to entry lower, and our expectations higher. This is not a bad thing. Realistically, our ability to transform pages of text easily into digestible images has become so much better and should be making presentations far easier to interpret. We are no longer restrained by the chart types of an Excel spreadsheet. As I often say to patients, sometimes it is a problem to have too many options. You can ask AI services to create basically anything you want, so I suggest presenters put some thought into this and actually think about what an audience would want to see. Anyone who has sat through a scientific meeting would tell you the same advice, to put less on every slide, fewer words, and keep things simple. The same goes for infographics. Keep it simple. So my answer to this question, is that AI has the potential to make slides better and convey meaningful messages more clearly. We do benefit from having slides in scientific presentations as we can condense and highlight the information we have gathered and many times they allow us to present something that an audience member can take a photo of to take home and share with a wider audience (even if that photo never makes it out of their iphone photo album, it’s the thought that counts!)

WHEN I LOOK BACK AT PREVIOUS GENERATIONS OF PRESENTATIONS, THEY ALSO HAD PROBLEMS, SO ARE THE NEGATIVES OF AI CREATED CONTENT ANY WORSE?

I’m not one to put down older generations for not being up to date with the latest technology. I try to stay up to date myself but am aware that I am young enough to prefer Instagram to Facebook, but old enough to feel as though TikTok is not my favourite platform in terms of social media. It’s the same with presentation software and styles.

I was raised on Powerpoint. Other options have come and gone but giving a presentation at a major meeting is stressful enough without worrying that your niche software will work. I’ve seen colleagues who have gotten around this by running video presentations or used interactive polling very successfully but in general, we are still talking about Powerpoint at scientific meetings.

When I look at the Powerpoint slides of my elder colleagues, in general, they feel low effort, but it’s more that we didn’t know any better. It’s like watching old special effects in movies and wondering how as a kid this seemed so modern when it’s literally a guy wearing a ninja turtle costume. Most slides would be a single image on one side and bullet points of text on the other. There was no regard for design aesthetics. Most images still had their background colour, and it was acceptable to simply have a white slide background with black text. We would also see actual screenshots where an image had been taken from a phone or laptop screen complete with clock, battery power and other tabs open. Now, all of this sounds horrific, but I would love to see these presentations again. You knew what you were getting. Each slide would have a key message, a few words and a relevant image. They weren’t overwhelming, if anything I look back on these types of presentations with a fond nostalgia rather than cringe.

The generation of presentations between these simple standard slide templates and today’s AI created monstrosities, is where we had to put a huge amount of effort into creating graphics and animations to make everything look customized, yet it was all manual labour. I would spend hours removing backgrounds from images, animating objects, and making slides interesting without being overwhelming. Often, after hours meddling with slides I would remind myself that this presentation was not being nominated for a Nobel prize, and in fact, once I was off stage, the presentation would be forgotten, so stop wasting time making something that would not be fully appreciated in terms of time and effort.

When I look at the potential of AI created presentations, there is scope for beautiful content to be created without all the wasted time. The negatives of previous generations of presentations are significant. Those basic template slides of yesteryear were acceptable, but certainly didn’t set the world on fire. The time wasted in making a modern animated masterpiece is time I will never regain. The jampacked overwhelm of AI slidedecks complete with infographics, text boxes, headings, subheadings, indicators of slides remaining, logos, etc are no worse, like everything that has come before them, they simply need refining to be more palatable, and engaging. Coco Chanel would famously remove one item from an outfit to improve it before leaving the house. These AI presentations could learn from this concept that sometimes less is more. AI slop is not the problem, it is the lack of editing, and judicious use of content that is lacking. Just like previous generations of presentations, a little style and taste can go a long way to improving things.

WHAT IS IT ABOUT AI CREATED PRESENTATION CONTENT THAT TURNS ME OFF?

Let me count the ways! But honestly, it can be hard to put your finger on what it is that alerts you to AI content and then also thinking why don’t I like it. There is a concept of the uncanny valley where creatures that look nearly human are scarier than those that are certainly not human or completely human. This is why humanoid robots can be extremely creepy. Somewhere in our distant past we have learnt not to trust “near human creatures” and that is a topic for a whole other article about where our ancestors may have encountered such beings for us to have retained that gut feeling. As AI quality images and videos continue to improve, we should be worried when we begin to say that we haven’t seen so much AI content recently, as we have lost our ability to discern what is AI anymore. That time is rapidly approaching I am sure.

Powerpoint presentations created using AI have certainly not passed the test yet where we cannot tell if they have been made by a human. In the past few weeks I have been subjected to watching multiple AI created talks. I can tell within the first couple of slides and I am not an AI sensing savant. What strikes me is how easy it would be to make small adjustments and avoid my glaring judgement. The features that signal to me that this is clearly an AI generated presentation are not all negative. There are some shining positives. I actually do like the clean designs and rounded corners. I am a fan of having an indicator for the audience of where we are in the chronology of the the presentation. I enjoy a QR code linking to your website to get further information, and I appreciate readable combinations of text and background colours.

What turns me off is when so much content is packed into a single slide but not in the old fashioned way where a presenter would have graphs and text and everything overlapping in a mess. Now we are seeing perfectly laid out content but so much of it being fitted into a single slide that you don’t know where to start.

The second thing that turns me off is unnecessary words and text boxes that would never have made the cut if a human were making the presentation. If I am watching a presentation, and I see a subtitle “Objective 4”, I know that AI was involved. Even in the pedantic scientific community I am part of, I know that my colleagues would not fill precious slide real estate with meaningless subtitles. This may seem minor but it impacts me in a negative way.

But the big one, the killer, the feature that really makes me switch off from watching a presentation as it has not been created by the presenter, is when they do not know their own slides. Now I realise we have been seeing this for generations. The Professor who gets their underlings to make a slidedeck is nothing new. Every presenter has played a video thinking, “I’m not completely sure which case this is”. But it is extremely obvious when the presenter is as surprised by each slide as the audience is. If each slide had a simple clear design and message, this would be no problem at all as an experienced speaker could expand on the minimal content presented, but with AI generated slides full of information, seeing a presenter come to terms with the content in real time is a train wreck. Instead of expanding on bullet points, we are seeing speakers trying to summarise the mess on the screen behind them. I always have a feeling that if the presenters guilty of this had seen the state of their slides prior to getting on stage, they would have edited and refined them down so this is more proof that they have not seen them before.

COULD I GIVE GUIDANCE TO SOMEONE USING AI TO CREATE A PRESENTATION SO THAT THEY COULD STILL BE EFFICIENT BUT ALSO ENGAGE AN AUDIENCE

After reading this article, I’m sure you will assume that I think my presentations are perfect. This is far from the truth. I am a perfectionist, and I like to make content that people can relate to, consume, and tells a logical story that is easy to follow. Basically I like to make complex topics simple and encourage my colleagues to benefit from my research and teaching. I am very time poor. Sometimes my presentations are made on my flight to the meeting and I wish I had dedicated more time to my presentation. I am also guilty of making an older generation slide or two, where a relevant image lies beside a text box of bullet points. I don’t like an ugly slide like this but they still work. I often describe myself as a late night TV show host as I’m often called upon to educate, interview, and present, while at the same time being entertaining. It’s not always easy to entertain while getting across scientific messaging. So I am trying to build a picture in your mind that I put a lot of effort into creating good presentations and that this is a topic I do not take lightly. I have given literally thousands of presentations during my career and am always trying to improve so I think I am uniquely positioned to be able to give advice on how we can all benefit from AI tools when building presentations.

Firstly, and most importantly, AI tools are fantastic. They can create beautiful graphics in minimal time. While I miss my amateur photoshop work to make memes, and there is still a wholesome place for bad photoshop, AI image generation is here to stay and we all need to embrace it. When I create a 20 minute presentation, it usually takes me over 20 hours of work. I realise this seems absurd, but I am talking about video editing, researching literature, designing a skeleton, finding appropriate images and crafting a beautiful slide deck. This time can be cut dramatically by using AI tools. For instance, I recently created a line graph comparing two different sets of data. I was able to have AI add a third line based on historical published data. This alone would have taken me an extra day to do.

So I’m not saying to avoid AI created presentations, but perhaps instead of relying on the creation of a complete slide deck, in some instances, simply creating the elements and using them judiciously would be a better use of time and still giving scope for individual design ideas.

If however you are looking at having a complete presentation made on a topic, here are a few ideas of how you can make it seem less AI created. First of all, refine everything down to essentials. Have a title, but you don’t need a subtitle for instance. Your slide does not need multiple text boxes each with their own little graphic that adds nothing but clutter. It may seem cool or quirky or trendy, but distraction is your enemy when getting a message across. Let your words be the focus and the slide support you, rather than losing an audience who are too busy trying to work our which part of the slide you are reading from. As I said earlier, less is more. Fewer slides, fewer words, and fewer images. Don’t be afraid to keep things minimalist and saying the key messages out loud. You are not there as a newsreader on a teleprompter. You are the expert on stage and the slides are your backup dancers. But of course, the biggest and most important change you can make to give the impression you hand raised this presentation to give me a reason to tune in, is to truly know your slides and know what is coming next. I’m always impressed when a speaker can indicate what the next slide will be about, because they know their slides and the flow makes sense. I realise that this bar for what pleases me and keeps me engaged is very low but still a lot of presenters are not passing this test.

The very first time I spoke at a scientific meeting, my voice broke, I was a nervous mess who couldn’t breathe, I had jelly legs and felt like I was going to pass out. I completely understand that we all want to do what we can to remove some anxiety, while looking professional. An AI generated presentation can give us all the false impression that we have everything under control. But my advice for anyone wanting to give a memorable presentation, is that going full AI can be detrimental to your engagement, and leaves you feeling as though you are reading someone elses slides. The best presenters really know their topic and are passionate about it. Having some input in the creation of your slides will help you feel more confident and comfortable with your material and ultimately that will be felt by your audience. I’d recommend using AI presentation tools as a co-author rather than becoming an actor in their play.

Which Eye Drop Is Best For Your Dry Eyes?

Ben LaHood — Sun, 19 Jul 2026 15:21:11 GMT

Walk into any pharmacy and the dry eye section looks like a confusing supermarket shelf. Dozens of bottles, colourful packaging to entice you, and words like “new advanced formula” doing an enormous amount of work to grab your attention. Just as consumer psychology works at a supermarket, most people grab whatever sits at eye level, while many long term dry eye sufferers will take whatever they haven’t tried before in search of relief.

The good news is that over the counter lubricating eye drops can give meaningful relief. The bad news is that dry eye is rarely cured and can sometimes need prescription medication from an eye care professional to keep under control. Most importantly, not all artificial tears are the same and it is important to match the drop to your actual problem.

This article aims to cut through the confusion and provide you with information on the few things you need to understand about ocular lubricants. It all really boils down to three main questions: Preservative free or not; Do you need more water or oil; and whether any extra ingredients may help. If you can answer those questions, you’ll be a long way towards choosing the right drop for you.

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Question 1: Preservative-free, or not?

Preservatives stop bottles growing bacteria once opened. This is useful, and basically you can imagine preservatives being like a drop of Toilet Duck where they kill bugs but can be harsh on the ocular surface. Bottles contaminated with microorganisms have been linked to infections and even deaths, so keeping bugs away from your eyes is a good idea. The catch is that the classic one, benzalkonium chloride (BAK), is mildly toxic to the ocular surface with repeated use. Ironically, the very drops you’re using to soothe your eyes can start irritating them if you’re reaching for them frequently throughout the day. It is uncommon but not rare for a patient to actually be allergic to preservatives so if I see a patient who has a lot of allergies or describes eye drops causing irritation or itchiness in the past, I straight away recommend preservative free options.

Here’s the rule of thumb I give patients:

Up to four times a day: a preserved drop is generally fine.
More than four times a day: go preservative-free.
If you have a lot of allergies: go preservative free

That threshold isn’t a magic number so much as a sensible line. If you’re dosing frequently, the cumulative preservative exposure starts to matter, and preservative-free removes the problem entirely. The same logic applies if you’re already on glaucoma drops, wear contacts, or have had laser vision correction, your ocular surface is doing enough work already just trying to survive, so be kind and minimise the extra chemicals.

Modern “softer” preservatives (polyquad, Purite and friends) are far gentler than old-school BAK, so a low-BAK or BAK-free preserved drop is kinder than the rule implies. And for genuinely mild dry eye symptoms, the evidence that preservative-free is clinically superior is thinner than people assume. Basically, an occasional preserved lubricant drop usually does more good than the harm of not using one at all.

This used to be a choice between the hassle of using single use vials of preservative free drops or a preserved multidose bottle. However, now with the advent of multi-use preservative free bottles, the only thing stopping most people always reaching for the preservative free option should be price.

Question 2: Water or oil?

This is the most important decision in my mind. It is where artificial tears can be customised to your individual cause of dry eyes. Your tear film has two main components that can be deficient. Either you do not produce enough of the watery, aqueous, layer, or the lipid producing glands on your eyelid margins are functioning poorly and not providing a stable lipid layer to your tear film allowing evaporation to occur.

Aqueous-deficient: you’re not making enough tears

The watery layer is thin and insufficient, so the eye feels dry, gritty, and tired. The fix is a straightforward lubricant that tops up volume, with drops based on carmellose (CMC), sodium hyaluronate, or HP-guar. Good examples on the Australian shelf: Hylo-Forte (0.2% sodium hyaluronate, preservative-free), Systane Hydration (preservative free available), and Refresh. This is the biggest, most reliable category, and for a lot of people it’s the whole answer. Interestingly, true aqueous deficiency is the less likely of the two conditions, yet has the highest number of drops targeting it. My impression is that often despite the underlying cause of dry eyes, for more mild cases, all eyes feel better with a simple aqueous replacing lubricating drop. However, the relief may be temporary.

Evaporative / Meibomian Gland Dysfunction (MGD): you make tears but they evaporate too fast

This is actually the more common cause of dry eye signs and symptoms, and the one people most often get wrong. The oily (lipid) layer that’s meant to seal the tear film and stop evaporation is disrupted, usually because the tiny oil glands in your lids, the meibomian glands, aren’t behaving. This can be for many reasons. Watery drops feel nice for about ninety seconds and then you’re dry again, which is the classic tell.

What these eyes need is a lipid-containing drop that replaces the oil. Systane Complete is the obvious example, using a nano-droplet emulsion of mineral oil to coat and stabilise the surface. Cationorm, a preservative-free cationic lipid nanoemulsion, sits in the same bucket and is a good option if you’re dosing frequently. NovaTears works a little differently again, a preservative-free, water-free drop that spreads a thin protective film to slow evaporation and many patients with evaporative dryness get on well with it. If watery drops have been disappointing you, a switch into this category is often the fix.

The quiet lesson of this whole article: matching the subtype matters more than picking the fanciest bottle. A $10 drop aimed at the right problem beats a $30 one aimed at the wrong one.

Given that evaporative dry eye is the far more common problem, and lipid containing drops are unlikely to not be tolerated, I will often start dry eye patients on one of these options as my primary choice. There have been concerns voiced that supplementing the lipid layer of the tear film could teach the meibomian glands to become lazy, but the opposite appears to be true. Providing a healthy tear film with lipid supplementation has been shown to promote good meibomian gland function long term.

Question 3: Do you need anything extra?

Once the basics are covered, a few options offer benefits beyond simple lubrication. These are add-ons, not starting points.

Manuka honey (Optimel)

As a kiwi, I am used to hearing about the medicinal benefits of Manuka honey, however it may sound odd to think of applying it to your eyes. Medical-grade Leptospermum honey is antibacterial, and aspects of MGD are driven by an overgrowth of bacteria along the lid margin. Australian Optimel drops (16% honey) and the stronger eye gel have been through several randomised trials showing improved gland function and reduced lid bacteria, used alongside warm compresses and lid hygiene. A genuinely useful adjunct for stubborn evaporative dry eye. Fair warning: a brief but fairly severe sting on instilling is normal and expected.

Omega-3 fatty acids (As a drop)

You’ve probably heard omega-3 pitched for dry eye, usually as fish-oil capsules. The swallowing route is where the evidence gets awkward: the large DREAM trial found oral omega-3 no better than an olive-oil placebo. Topical omega-3 is a more interesting proposition, because it skips the digestive detour and delivers the oil straight to where the problem is, the tear film.

The accessible Australian example is NovaTears+Omega-3, the same perfluorohexyloctane carrier as the plain NovaTears we met earlier, now carrying plant-derived omega-3. It’s preservative-free and water-free, spreads across the surface as a thin film, and is aimed squarely at evaporative dry eye and meibomian gland dysfunction, where the goal is to stabilise the lipid layer and settle the low-grade inflammation underneath.

Evidence check, in my usual spirit: promising but not settled. Studies show improvements in ocular surface staining and tear break-up time against controls, with more equivocal effects on symptoms and the overall evidence base is still thin, with few head-to-head human trials. So, a biologically plausible option worth trying for evaporative dry eye, particularly if the oral route left you unmoved.

Combination Therapy

I have seen some good success with people replicating the natural tear film by placing a drop of aqueous-replacing Hylo-Forte beneath a drop of lipid replacing Nova Tears and this seems to give good prolonged relief in certain eyes. The consistent feedback I have heard from this method is that it gives a more prolonged period of comfort than either drop by themself.

A word on sprays and bottles

Sprays

Liposomal sprays are spritzed onto closed eyelids, where the lipid migrates into the tear film as you blink. They’re a neat option for mild evaporative dryness and for anyone who finds aiming a dropper into their own eye a small daily humiliation. Not a replacement for drops in moderate-to-severe cases, but a genuinely handy tool. Personally I do have some concerns about dripping bacteria and oils from the skin of the face into the tear film and causing further irritation but I have no evidence to indicate that this could be a problem. As someone who has produced an eyelid cream with SPF protection (Eyelid Defence), I am always thinking about whether anything applied to the eyelids could impact the ocular surface.

Bottle types

The container matters more than people realise:

Single-use vials: preservative-free by design, one dose each. Gold standard for frequent or post-surgical use where infection is to be avoided at all costs. They are slightly fiddly and usually pricier than multi dose bottle alternatives.
Multi-dose preservative-free bottles: clever one-way-valve designs give you preservative-free convenience without the vial clutter. My default recommendation for most frequent users. Also, in my opinion better for the environment than throwing away hundreds of single use vials over time.
Standard preserved bottles: cheapest and perfectly fine at low frequency. Just mind the four-a-day line. These bottles can be kept mostly free of contamination with microorganisms by keeping the tip away from lashes when applying each drop.

The cheat sheet

If you only read one part of this article, this should be the part!

When drops aren’t the answer

Drops manage symptoms; they don’t always fix the cause. If you’re still struggling after a few weeks of the right drop used properly, that’s the signal to escalate rather than keep buying bottles. Warm compresses and lid hygiene do the heavy lifting for meibomian gland dysfunction. Beyond that sit prescription anti-inflammatories, in-clinic gland treatments, and a proper look at what’s actually driving it. Persistent dryness, pain, or blurred vision that clears when you blink all deserve a professional assessment, not another trip down the pharmacy aisle.

But for most people, most of the time, the fix is smaller than they feared: the right drop, at the right frequency, aimed at the right problem. Now you know which is which.

Dry Eye and Laser Vision Correction: Demystifying but Not Dismissing

Ben LaHood — Sun, 12 Jul 2026 10:10:23 GMT

As a laser eye surgeon, I would love to see conversations about laser eye surgery beginning where they rarely do, with how successful it usually is. For the vast majority of people who undergo laser vision correction, the result is quietly life changing in an extremely positive way. Often I am surprised on day one post-op just what it is that excites my patients most, as we are usually talking about things that most of us take for granted. Waking up able to read the clock, being able to see while swimming, the thought of not packing a suitcase full of contact lenses for holidays, and simply buying a pair of sunglasses off the shelf and being able to see how they look. Reported satisfaction from LASIK back in 2009 ran at around 95%, which places it among the most successful elective operations there are, and laser vision correction surgery has come a long way since then [11].

You would not guess there was anywhere near this much happiness resulting from laser eye surgery based on recent headlines. There has been a wave of global media attention stemming from recent documentaries and articles linking LASIK to chronic dry eye, depression, and even suicide. The suffering those stories describe is real, and it deserves to be taken seriously. But it is the rare exception, not the rule, and treating the exception as though it were the rule does its own quiet harm, it frightens people away from a change that, for the great majority, is life-improving rather than life-ruining. In this article I am not trying to convince anyone to have laser eye surgery, but rather explain that as with any procedure, there are risks which must be clearly discussed, risk factors that need consideration, and that a good surgeon will know when to operate and when to say no.

I am a laser refractive and cataract surgeon. I have working relationships with companies who produce laser devices, and I perform these procedures for a living. So you can reasonably ask whether I am the right person to discuss this topic in an unbiased fashion. Fair. My aim here is not to reassure you, it is to be accurate and have an honest discussion of the published evidence. That means neither dismissing these stories as scaremongering nor accepting their most alarming claims at face value. From a professional perspective it is important for you to know that I often decline to perform laser eye surgery on certain patients due to risk factors for dry eyes that I think could lead to detrimental outcomes. These decisions are always in the best interest of the patient, even if they are disappointed.

I plan to guide you through the discussion about laser vision correction and dry eyes in a logical manner from discussing the recent controversies, to thinking about the underlying mechanisms at play, and then an analysis of the current evidence.

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The honest starting point

Two things are simultaneously true, and most of the public conversation collapses them into one.

The first: serious, life-altering outcomes from laser vision correction are real. Chronic dry eye, corneal neuropathic pain, and reduced night vision quality do occur, they are not always reversible, and the people living with them are not exaggerating. Dry eye disease is independently associated with psychological distress and even suicidal ideation, at an odds ratio of around 1.24 in the general dry eye population [1]. That link is not purely due to laser vision correction and it predates many people’s surgery.

The second: these serious outcomes are rare. The most careful review of suicide after laser refractive surgery could identify six documented completed cases in the entire world literature, against a denominator of many millions of procedures, and concluded the incidence is lower than the background suicide rate in the general population [1]. To attribute a suicide to LASIK is, as those authors put it, a single-cause fallacy as suicide is almost never a single cause event. The American Academy of Ophthalmology said much the same after a recent high profile tragedy, and one in which the role of the surgery itself is unknown.

From personal, anecdotal experience having performed laser eye surgery for over a decade, I am dealing with young people every day, and this is the same population at highest risk of suicide. There is certainly some overlap of the Venn diagram but this does not provide a causative link. I have been devastated once in my career to have a patient of mine commit suicide months after I performed their laser vision correction. They were seemingly thrilled with their visual outcomes, had no discomfort, and their death came as a shocking surprise to their own family also. I realise a single case does not let laser vision correction off the hook, but it does illustrate that potentially a patient can be very happy with the outcome of their surgery, and still suffer from severe mental health problems.

Holding both truths is uncomfortable. It is also the only intellectually defensible position. The documentaries may be wrong about scale and causation. They are not wrong that the harm is real, that informed consent has sometimes been thin, and that patients who develop complications have too often been told their symptoms are unrelated to the operation. Dry eye sits at the centre of all of it so let’s understand it properly.

Why laser surgery causes dry eye at all

Your cornea is the most densely innervated tissue in your body. Those nerves do three jobs that matter here: they trigger reflex tearing, they drive your blink, and they keep the surface epithelium healthy. Every laser vision correction procedure cuts, burns, or destroys some of them. That is the mechanism, and almost everything else follows from it.

Damage corneal nerves and you get reduced corneal sensation, which means less reflex tearing and a lazier blink, which means a less stable tear film, which means the surface dries and the epithelium heals poorly, which in a feedback loop irritates the remaining nerves. On top of the neurotrophic story sit the usual tear film insults: transient inflammation, goblet-cell disturbance, meibomian gland changes, and a subtly altered corneal shape that changes how the lids spread tears across the surface. But the nerve injury is the engine. The three procedures differ mainly in how they injure the nerves.

LASIK creates a corneal flap. Historically this was done with the mechanical microkeratome blade, but now almost always with a femtosecond laser. This thin flap is lifted to ablate the stroma beneath and change it’s shape. That flap slices through the sub-basal corneal nerve plexus and the stromal nerves around almost the entire circumference, sparing only the hinge. This is the deepest, most complete denervation of the three. Hinge position matters (a superior hinge, which is by far the most common option, cuts both arms of the long corneal nerves; a nasal hinge spares one), and, crucially, flap nerves regrow slowly and incompletely, as density can remain reduced five years and more after surgery [2].

PRK takes the opposite approach: no flap. The epithelium is removed and the laser ablates the stroma directly, or the laser ablates from the surface epithelium down into the stroma. This still destroy the sub-basal plexus across the whole treatment zone, and the nerves have to regrow centripetally through a surface that is actively healing. The result is a rougher early ride with more pain and slower visual recovery in the first weeks, but no deep stromal transection, and reinnervation that is faster and more complete, reaching over 90% of baseline density in roughly two years [2]. Different pattern, not simply “better” or “worse.”

SMILE is flapless and does not involve ablation of the stroma. Instead of lifting a flap, the surgeon shapes a lenticule of tissue inside the intact stroma and removes it through a small incision. The anterior cornea and much of the sub-basal nerve plexus are left in place. Of the three, SMILE disrupts the fewest nerves, and, as we’ll see, this shows up consistently in the data.

So before looking at a single number, the mechanism predicts the shape of the answer: SMILE should be gentlest on the nerve; LASIK should carry the biggest objective tear-film penalty with the slowest recovery in terms of dryness; PRK should be symptomatically rough early but on a better long-term nerve trajectory. That is more or less exactly what the evidence shows, provided you are careful about what you are measuring.

It is important here to consider the difference between speed of visual recovery and speed of recovery of nerves. LASIK has an incredibly rapid visual recovery and response to treatment with eyes seeing well within hours of treatment. PRK has a much slower visual recovery as the corneal epithelium must regenerate and remodel to a smooth refractive surface. SMILE is a little in between where visual recovery is not as rapid as LASIK but much faster than PRK. Like all things in life, laser surgery is a balance of pros and cons where certain benefits come with trade-offs and this is where discussion between surgeon and patient is vital.

How common is it, really? (It depends how you ask)

I say to every patient undergoing eye surgery, whether it is cataract surgery, pterygium excision, PRK, LASIK, or SMILE, you will have a period of irritation or dryness post-operatively. We are really disturbing the ocular surface having the eye open, pouring on chemicals, burning and cutting things. We can minimise the impact but ultimately there will be at least a speed bump of dryness before returning to baseline.

Here is the single most important thing to understand about post-surgical dry eye statistics: the incidence figure you see is mostly a fact about the instrument, not about the eye. Quote a number without saying how it was measured and you are basically making it up.

Ask three different ways and you get three different answers, all correct:

● What patients feel, early. Almost everyone is dry in the first fortnight. Symptom surveys put transient dryness at roughly 69–85% within the first one to two weeks [3]. This is near-universal and, for most people, temporary.

● What patients report at the symptom peak. At the two-to-three-month mark, structured questionnaires find dry eye in something like 40% of eyes, with one large series reporting 41.4% [4] and the well-known PROWL studies found that around 28% of people with a normal pre-op surface had developed dry eye symptoms by three months [5].

● What gets formally diagnosed, coded, and treated. In a registry of nearly 49,000 eyes, coded dry eye disease ran around 7% early and about 16% cumulatively [5]. This is the floor: only the dry eye that a clinician diagnosed, documented, and treated.

None of these numbers is lying. The 80% and the 7% are describing different things, a symptom almost everyone notices briefly, versus a diagnosis that warranted treatment. Most post-operative dry eye is real, mild, and gone by three to six months. A minority is not, and I’ll come to that.

Now, the question everyone actually asks: which procedure causes the most dryness? One end of the answer is settled. SMILE spares the most nerve, and it wins wherever nerve preservation is what’s being measured, better corneal sensitivity recovery and better tear-film stability than LASIK, with the sensitivity gap narrowing as nerves regenerate (a mean difference of about 18 points at one month shrinking to about 8 by six months in meta-analysis) [6]. A large three-way comparison of SMILE, femtosecond LASIK and Trans-PRK found patient-reported ocular surface scores were lowest after SMILE, intermediate after FS-LASIK, and highest after Trans-PRK, and that ranking held all the way out to 18 months [7].

The other end of the answer, PRK versus LASIK is where honest people should stop pretending there’s a clean winner, because the ranking flips depending on what you measure:

● On symptoms, surface ablation looks worse in the first months (that healing surface again), and that disadvantage can persist [4][7].

● On objective tear tests, it’s the reverse. A meta-analysis of tear break-up time and tear production found LASIK produced the only statistically significant reductions in both; PRK and SMILE did not reach significance [8]. By that measure PRK looks benign and LASIK looks worst.

This isn’t a contradiction, it’s simply two different rulers. PRK’s problem is discomfort, haze and slow surface healing, not measured tear loss. LASIK’s problem is a genuine, measurable, slowly-recovering tear-film and tear-production penalty from that deep nerve cut. Which procedure is “driest” depends on whether you ask the patient or the Schirmer strip, and on whether you ask at three months or three years. There is no universally correct answer.

So, based on evidence about laser eye surgery causing dry eyes, SMILE has a clear advantage. LASIK has objectively worse tear production and less stable tear film, but PRK may be more symptomatic. From a clinician’s perspective, I am often discussing with patients that PRK has a long recovery time and during that recovery they will be uncomfortable. If the patient is suitable for LASIK or SMILE, I tend to advise that SMILE will cause fewer dry eye symptoms. However, anecdotally, we must also weigh up that in my experience it is very uncommon that after six months I can tell the difference in dry eye symptoms between those who had SMILE or LASIK. Also, LASIK has certain advantages including the ability to relift the flap and alter or enhance the outcome, which is especially helpful for unusual refractive targets or treatments.

Who develops chronic dry eye

For most people dry eye is a speed bump. The clinically important question is who is at risk of the version that doesn’t resolve, because that is the population in the documentaries, and the population worth screening for.

The strongest predictors are not the ones patients expect. It is not mainly your age, your degree of myopia, or your astigmatism. In multivariable analysis those largely drop out. It is the state of your ocular surface before anyone touches it. The two most powerful independent risk factors in a large cohort were a low pre-operative tear meniscus height (odds ratio ~1.58) and a low pre-operative tear break-up time (odds ratio ~1.45) and roughly a quarter to a third of surgical candidates already had abnormal values before surgery [4]. In other words, a lot of “post-LASIK dry eye” is pre-existing dry eye that surgery unmasked or worsened. Reported rates of dry eye already present in refractive candidates run anywhere from about 26% to 53% [5].

The other consistent markers:

● Female sex: an independent risk factor across multiple datasets (odds ratio ~1.24) [4], and associated with a markedly higher likelihood of still needing lubricants beyond a year after surgery [9].

● Higher myopia / deeper ablation: one cohort found dry eye in 56% of eyes with high myopia versus 5% of lower corrections, plausibly a proxy for the volume of tissue and nerve disrupted [10].

● A pre-existing symptomatic or unstable surface: blepharitis, meibomian gland dysfunction, low tear volume. All of it contributes.

And it can last. A population study of young patients found that the odds of still needing lubricant drops more than twelve months after surgery were roughly six times higher in men and eleven times higher in women who’d had refractive surgery versus those who hadn’t [9]. Separately, the most sobering figure in this whole area: prospective studies using patient-reported outcomes find persistent, neuropathic-type pain in somewhere around 10–13% of eyes at the later time points, a number that barely registers in diagnostic coding, because corneal neuropathic pain is under-recognised and hard to code [5]. That gap between what patients live with and what the record captures is the story the documentaries are groping toward. They just wrap it in conspiracy instead of nuance.

What actually reduces the risk

This is the part that matters, and it is where the profession genuinely can do better. Almost all of it comes back to one principle: the surface you operate on determines the surface you’re left with.

Screen the ocular surface before you cut, properly. Not just a slit-lamp glance. Measure tear break-up time and tear meniscus height, look at the meibomian glands, stain the surface, and use osmolarity and inflammatory markers where you have them. The strongest modifiable risk signals, low TBUT, and low tear meniscus height, are the ones you’ll miss if you don’t go looking [4]. This is the single highest-yield change most practices could make.

Optimise before operating, not after. If the surface is abnormal, treat it first: lid hygiene and warm compresses for meibomian dysfunction, anti-inflammatory therapy, punctal occlusion, treat to a target, then re-measure.

Match the procedure to the surface. For a patient with a marginal or already-dry surface, the nerve-sparing profile of SMILE, or a shallower correction, is a rational preference, not because the others are unsafe, but because you are spending less of a limited nerve budget. Surface ablation has its own strong indications (thin corneas, borderline topography), with the trade-off of a rougher early surface.

Manage the perioperative surface aggressively. It is worth noting that essentially every study in this field puts everyone on artificial tears, which both helps patients and quietly flatters the outcome data. Preservative free artificial tears to avoid benzalkonium-preserved drops, topical steroids to control inflammation, and reaching for ciclosporin, or autologous serum in patients who need them.

And counsel patients properly. Tell people the truth: nearly everyone is dry for a few weeks, most are settled by three to six months, a minority take longer, and a small number develop something chronic. Set that expectation before surgery, not after a patient turns up frightened. Much of the anger in the complications community is not about the dryness itself, it is about being told it wouldn’t happen, and then being told it wasn’t real. The fix for that is not better lasers. It is honest consent and taking the distressed patient seriously the first time. When someone is drowning in symptoms and despair, the response is escalation and referral when necessary to dry eye specialists, to pain services, to mental health support, not reassurance that everything is fine.

The bottom line

The sensational version of this story says laser eye surgery is a reckless industry maiming people and hiding the bodies. The complacent version says it’s 99% safe, dry eye is trivial, and the critics are crazy. Both are wrong, and both in the same way: they refuse to hold two true things at once.

Laser vision correction is one of the most successful elective procedures in medicine, with very high satisfaction and a low rate of serious complications. And it causes dry eye in almost everyone briefly, in a meaningful minority for months, and in a small unlucky group for years, occasionally severely, occasionally with neuropathic pain, occasionally in people who were never properly screened or honestly counselled. The mechanism is corneal nerve injury. The risk is concentrated in people whose surface was already compromised before surgery. The mitigations, screen, optimise, select, counsel, treat are real and mostly underused.

Demystify it: the catastrophe is rare, and most dry eye is manageable. But don’t dismiss it: the people it happens to are not lying, and we owe them a surface examined before the laser fires, a consent conversation that includes the bad outcomes, and a door that stays open when things go wrong.

References

1. Salimi A, et al. Suicide and laser refractive surgery. Beyoglu Eye J. 2020. (DED–suicidal ideation OR ~1.24; six documented completed suicides after LRS; single-cause fallacy.)

2. Nerve-density recovery figures (PRK ~2 yr to >90%; LASIK reduced at 5 yr+) as cited in Zhang M, Photodiagn Photodyn Ther. 2026;58:105354; primary sources Erie 2005 / Calvillo 2004 / Garcia-Gonzalez 2019.

3. Transient early dryness 69–85% at 1–2 wk, per Nair et al. 2023, as cited in He R, et al. Sci Rep. 2025;15:31798.

4. Zhang M. Dry eye syndrome incidence and prognostic factors in 778 patients following refractive corneal surgery. Photodiagn Photodyn Ther. 2026;58:105354. (41.4% at 2 mo; surface ablation vs lamellar OR 1.32; low pre-op TMH OR 1.58; low pre-op BUT OR 1.45; female OR 1.24.)

5. Kang S, Persad LS, Woreta FA, Yoo SH. Temporal incidence of dry eye disease, visual disturbances, and ocular pain after LASIK versus PRK. Am J Ophthalmol. 2026;288:66–74. (IRIS Registry, 48,892 eyes; ~7% early / 16.1% cumulative coded DED; PROWL ~28% and neuropathic-tail 10.5–13.3% figures cited therein.)

6. Chen K-Y, Chan H-C, Chan C-M. How effective is KLEx in reducing dry eye outcomes compared to LASIK? J Refract Surg. 2025;41(8):e839–e854. (Corneal sensitivity MD 18.48 at 1 mo → 7.56 at 6 mo; TBUT favours SMILE; Schirmer difference clinically trivial; OSDI not significantly different.)

7. Aljaberi HA, Rahmani S, Alrikabi HH. Comparative clinical outcomes of SMILE, femtosecond LASIK, and transepithelial PRK: a multicenter Iraqi study. Front Ophthalmol. 2026;6:1787176. (Three-way OSDI: SMILE < FS-LASIK < Trans-PRK, sustained to 1.5 yr.)

8. Sambhi R-DS, Sambhi GDS, Mather R, Malvankar-Mehta MS. Dry eye after refractive surgery: a meta-analysis. Can J Ophthalmol. 2020;55(2):99–106. (TBUT and Schirmer significantly reduced with LASIK; non-significant for SMILE and PRK; nerve-transection mechanism.)

9. Nitzan I, Heller D, Chan CC, Mimouni M, Safir M. Dry eye disease treatment following refractive surgery among young patients. Eye (Lond). 2025. doi:10.1038/s41433-025-03783-5. (Persistence >12 mo aOR ~5.8 men / ~11.6 women.)

10. He R, Wang Q, Du F, et al. Clinical analysis of dry eye after refractive surgery in army recruits in 2024. Sci Rep. 2025;15:31798. (High myopia 56% vs 5%; conventional-LASIK OR 2.467 — note microkeratome technique.)

11. Solomon KD, Fernández de Castro LE, Sandoval HP, et al.; Joint LASIK Study Task Force. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116(4):691–701. (Overall satisfaction 95.4%, range 87.2–100%; among the most successful elective procedures.)

The New Generation of Multifocal IOLs: A Field Guide for Anyone Considering Cataract or Refractive Lens Exchange Surgery in 2026

Ben LaHood — Sun, 05 Jul 2026 10:45:22 GMT

I have personally been implanting multifocal intraocular lenses (IOLs) inside people’s eyes at the time of their cataract or refractive lens exchange surgeries for over a decade now. I have built up experience with different multifocal technologies and wanted to share my experience in the hope that it helps patients make decisions and helps surgeons consider their options. In the correct eyes of the correct patient, multifocal IOL technology can be life changing. It can offer true spectacle independence, which is what most patients are wanting. I can hear myself saying to every patient I see in clinic, “if it sounds too good to be true, it usually is”. This refers to the trade off in terms of potential visual side effects that must be discussed when considering a multifocal option. That freedom from glasses or contact lenses comes at a price. As we commonly say in ophthalmology, “there is no such thing as a free lunch in optics”. Basically, if we are providing an eye with a greater range of vision, there is generally a negative impact on quality of vision in some way, whether that is the actual crispness of vision, or visual side effects such as halos and starbursts.

The first multifocal IOL I ever implanted was a FineVision lens, a trifocal designed by French ophthalmologist and optical genius, Dr Damien Gatinel. It was ahead of its time, an elegant solution and a lens that remains popular today. FineVision has undergone changes in material from being hydrophilic to hydrophobic, which has broadened its appeal and recent entry into the US market will surely see its popularity grow.

I then moved to using the AT LISA tri from Zeiss. This remains in my experience, a lens that provides exceptional visual outcomes. When you think of Zeiss as a company, I think of precision optical engineering. I don’t think I have ever had such great day one post-operative visual outcomes as I experienced with this lens. Another plus for this lens is the impressive range of powers and options available. Cylinder steps come in 0.5 dioptre (D) ranges and spherical powers can be manufactured to fit nearly any eye you can imagine. It probably has not seen the same popularity as other trifocal IOL options due to two factors. Firstly, it is manufactured using a hydrophilic material, and secondly, it has a square haptic design. I have never found this to be an issue, but there is the general consensus of it feeling odd to implant a square peg into a round hole. People have often discussed the idea that capsular contraction over time may lead to warpage of the square lens, but I have never seen such an issue myself.

The next multifocal IOL I chose as my regular tool, was the Panoptix from Alcon. I liked the platform that I was used to using routinely, the material and shape had benefits and it was nice to be using the most popular multifocal IOL in the world as when I went to meetings, it felt comforting to be using a technology that everyone was researching and discussing. My visual and refractive outcomes were excellent and the change in material from Acrysof to glistening free Clareon felt like a very welcome and reassuring change to a technology I was already very fond of.

Now, in 2026, a new generation of multifocal IOLs has emerged. These are lenses that seem like genuine upgrades to predecessors. When we have multiple options in the same category, it can be difficult for anyone to make a choice, surgeon or patient. The bottom line is that all of the major manufacturers now have in their arsenal a good multifocal IOL and the differences between them are subtle. There are considerable differences to consider such as refractive optics vs diffractive, and hydrophilic material vs hydrophobic, but also more minor differences such as light distribution to distance, intermediate, and near vision that may influence what an individual patient wishes to have implanted.

This article is my attempt to make sense of these options, highlight the similarities and the differences for patients who want to understand what they’re being offered, and for colleagues who want a useful overview in one place.

The Basics: What Problem Are We Actually Solving?

The natural crystalline lens inside your eye does two things. It focuses light at distance and it accommodates, meaning it changes shape to bring near objects into focus. When you’re young, this happens automatically and effortlessly. As we all get older, the ability to change focus is lost, and depending on our glasses prescription, most of us begin to need glasses for near tasks. We talk about reading glasses but this is a terrible term to use as most of our near tasks are not reading, but looking at close objects such as our watch, our phone, and simply the food on our plate. I always hate in clinic when a patient tells me that they do not read much so aren’t bothered about reading glasses. I must remind them about all of the up close activities they do that are not necessarily “reading”.

This growing inability to focus at near tasks is a loss of accommodation. It occurs as we all age. It is the lens losing it’s ability to change shape. Simply replacing the lens for this reason, to return the ability to change focus or see a greater range unaided by glasses or contact lenses, is known as refractive lens exchange surgery. This is a very common scenario for a patient to want a multifocal IOL implanted as often distance vision is already very good and the patient simply wants to gain the ability to see near tasks once again.

Cataracts on the other hand, are clouding of the natural lens. Cataract surgery removes the cloudy lens and replaces it with an artificial version. Cataract surgery was once reserved for dire situations where the eye was basically blind from clouding of the lens and the risky procedure of cataract surgery replaced the cloudy lens but likely meant the patient would still be wearing glasses to give a range of functional vision. Cataract surgery has become much more refined in the 76 years since the first IOL was implanted by Sir Harold Ridley. As the procedure has become safer, the threshold for performing it has lowered also. We are now at a stage where all cataract surgeries should also be considered refractive procedures where we are not only aiming to replace the cloudy lens, but to improve on vision and provide a personalised visual outcome that each patient wants. Many thanks must be given to the pioneers of cataract surgery. As each generation has stood on the shoulders of these giants to refine every step from making the surgery safer, to more precise calculations, and to improved optical designs for IOLs.

IOL classification is controversial as all things are where money is involved. In many countries, only the most basic IOL design is funded and lenses that provide a greater range of vision or other features are classified as premium IOLs. The terminology we use to describe these lenses is also hotly debated as some argue we should consider the range a lens provides, and others would rather focus on the optical design. There is no right answer here but to make things simpler for this discussion, I like to break down the options as follows: Monofocal IOLs provide one focal point which is usually targeted for distance vision. The quality of the vision is optimal but the range is minimal. This will give an eye good quality vision at a certain distance but glasses would be needed to give more range. It is the least likely to give visual side effects such as halos or glare. Personally this is a lens I would use in an eye with compromise to certain structures that may mean the visual outcome is guarded. For instance, in an eye with macula degeneration, we want to optimise the quality of vision we provide this eye, knowing that it is already compromised. Potentially a more advanced technology in this eye could be detrimental to overall vision quality. Monofocal plus IOLs attempt to give a little extra range, usually at minimal compromise to vision quality. Often this is done with adjustments to higher order aberrations. This is not a lens category I prefer personally as the potential gain seems quite minimal for using something other than a monofocal IOL, however, many surgeons do use these regularly, and I see them as a good, soft entry point for using presbyopia correcting options. Extended depth of focus (EDOF) IOLs provide a greater range of vision (usually distance to dashboard) where an eye with a distance focused EDOF IOL should have great distance, and intermediate (computer) vision, and may be able to read their phone but prolonged near tasks require reading glasses. The compromise to quality of vision is minor in most cases but these lenses do need a little more thought in matching to eyeball characteristics than other options due to their manipulation of higher order aberrations. The final category which we will concentrate on in this article is the multifocal IOL. This provides a full range from distance to intermediate to near vision. We will discuss the potential visual compromise or side effects associated with this. In my experience, there is synergy between the two eyes with a multifocal implant where there are significant visual benefits to having both eyes have the same multifocal design. Mixing and matching between styles is a known and published about technique but not something I commonly do unless eye health or other circumstances require it.

One other consideration in choosing IOL types while attempting to provide a full range of vision, is the concept of monovision. This is where one eye is set more for distance vision and the other provides near vision. With the advent of EDOF IOLs, this monovision setup can now also provide good intermediate range vision. The downsides of monovision include a potential loss of depth perception and simply intolerance of some brains to accept the two eyes having different focal targets. The beauty of multifocal IOLs is that both eyes are doing the same job, and this provides some synergy where the total visual gain with both eyes working together provides better vision that each eye individually.

Different Types of Multifocal IOLs

Within the multifocal category of lenses that are attempting to provide a full range of vision through distance, intermediate and near targets, we have two distinct methods of achieving this, refractive and diffractive optical designs.

Diffractive optics describe the concept where light hits the lens surface and is split by gratings on the lens. These ridges split light and with very precise engineering allow it to recombine to give a distance focal point, an intermediate focal point and a near focal point. The brain is able to discern which of these is in focus to use for vision. The splitting of light by these diffractive rings is what gives the visual side effects of halos, glare, and starbursts.

Refractive optical designs do not split light but have different segments on the lens that provide different focal points. These can be targeted for different distances. The lack of light splitting means that light should not be lost and ultimately this design should give fewer visual side effect problems.

One design is not better than the other. It is really what best suits the eye. I often say to my patients, “it is like buying a car, some people want a sports car and others want a ute. One is not better than the other, it’s just whether the pros and cons of that choice suit you.”

The New Generation of Multifocal IOL Designs

Clareon PanOptix Pro (Alcon)

The latest evolution of the world’s most-implanted trifocal. PanOptix Pro carries the same intermediate and near add powers as its predecessor, but its optical design enhancement lifts light utilisation from 88% to 94%. Alcon’s framing is that they’ve recovered 50% of the light previously lost to scatter. Less scatter means less halo, starburst and glare. This has been proven to be the case both in published literature and anecdotally. I have certainly found fewer visual side effects reported from my patients implanted with Panoptix Pro compared to the predecessor Panoptix.

Expert corner: The refinement here is in diffractive structure fidelity rather than a change to the core optical layout. Basically the optical design of the diffractive gratings have been made more precisely so that light scatter halved from 12% to 6%. For surgeons already comfortable with PanOptix patient selection, the transition is essentially frictionless.

Who it suits: Patients who want the deepest evidence base behind their lens. The underlying platform has a decade of global real-world data, now with meaningfully cleaner optics. This is a solid choice where the reliable refractive and visual outcomes of Panoptix are combined with improved visual side effect profiles.

enVista Envy (Bausch + Lomb)

FDA approved in October 2024. The Envy’s distinguishing technology is the ActivSync optic, an apodized, pupil-adaptive diffractive profile providing intermediate and near add powers. In bright (photopic) conditions it distributes light relatively evenly across all three focal points; as the pupil enlarges in dim (mesopic) conditions, it progressively prioritises distance, which is precisely when halos matter most, driving at night.

Expert corner: Envy inherits the enVista platform’s glistening-free hydrophobic acrylic material. Clinical data on dysphotopsia tolerance is among the best published for a conventional trifocal format. In March 2025 Bausch + Lomb issued a voluntary recall of multiple enVista platform IOLs, including Envy, following an increase in TASS reports in the USA. This issue is now resolved.

Who it suits: Patients for whom night-time visual quality is the primary anxiety, but who still want a full trifocal range. One of the main off-putting features of any multifocal IOL is the description of halos around lights at night. Envy has potential to provide less obvious halos at night due to its unique optical design.

TECNIS Odyssey (Johnson & Johnson)

Odyssey replaces Synergy in J&J’s presbyopia-correcting portfolio as it’s most up to date full range of vision IOL. Odyssey appears to be providing excellent distance, intermediate, and near vision with good continuity across the whole range. Tecnis’ established chromatic aberration correction is also a strength that should provide enhanced vision quality.

Expert corner: Odyssey’s predecessor, Synergy had a reputation for demanding neuroadaptation to attain good distance visual acuity. Odyssey itself appears to have greatly improved, or learned from this, and provides better quality of vision without the wait.

Who it suits: Patients wanting excellent near vision without gaps in their range from distance to near. Less emphasis than other options about decreasing visual side effects so may not be the primary choice for those with concerns about night time driving.

RayOne Galaxy (Rayner)

The outlier of the group, and the most fundamental optical departure. The Galaxy is non-diffractive: a spiral optic, designed with the assistance of AI-driven optimisation, that creates a continuous range of vision with 0% loss of transmitted light. No diffractive rings means the classic mechanism that generates halos simply isn’t there. This is also the only IOL from the new generation to be hydrophilic.

Expert corner: Because the spiral phase profile redirects rather than splits light, the dysphotopsia conversation changes character entirely. Early clinical experience reports a different, milder visual phenomenon profile rather than classic concentric halos. The trade off for this lack of halos is potentially not having the same crisp focal points that a classic diffractive multifocal IOL provides.

Who it suits: patients for whom halo avoidance is non-negotiable such as professional night drivers who still want spectacle independence.

Vivinex Gemetric / Gemetric Plus (Hoya)

Hoya’s entry brings something no one else offers: a complementary pair. Gemetric and Gemetric Plus share identical +3.50 D near and +1.75 D intermediate add powers, differing only in how they distribute light between the focal points, one version favouring distance, the other near. The intended strategy is contralateral implantation: matching the light distribution in each eye to the patient’s visual priorities.

Expert corner: This is blended vision reimagined for the trifocal era, a “mix and match” philosophy built into a single product family on the proven Vivinex hydrophobic platform, rather than improvised across manufacturers. It rewards surgeons who take a detailed visual-lifestyle history and are comfortable with binocular summation planning.

Who it suits: patients who have had a thorough consultation, know their visual priorities, and value a genuinely personalised approach, and surgeons willing to plan both eyes as a system. There may be some benefits in terms of reading in dim conditions given that one eye in a mixture of implantations, will provide enhanced reading light distribution.

The Comparison Table

So How Would You Actually Choose?

If you’re primarily concerned about halos and night vision quality: In terms of reducing the likelihood of halos at night, Galaxy with it’s refractive optical design is your best bet. However, with the refractive design, some patients may feel as though their vision does not have the crispness of a diffractive design which gives defined focal points. Panoptix Pro with it’s impressive light utilisation and reduced light scatter certainly gets an honourable mention in terms of evidence to suggest night time halo should be minimised for a diffractive design.

If you want the sharpest near vision and the widest range: The Odyssey’s continuous profile and 33 cm near reach, combined with its low-light contrast data, make it compelling for patients who genuinely need demanding near acuity such as small print, fine needlework, and precision tasks.

If you want an established, well-characterised platform with optically meaningful improvements: The PanOptix Pro gives you a decade of global real-world data on the underlying platform, now with 50% less scatter. For surgeons and patients who value depth of evidence, that’s significant.

If you value surgical personalisation: Gemetric’s bilateral customisation strategy is unlike anything else available. It’s particularly well-suited for patients who’ve had a detailed consultation and know what their visual priorities are, and for surgeons who want to match the optics precisely to lifestyle demands.

And critically: none of these lenses belong in the wrong eye.

Multifocal IOLs require excellent pre-operative screening. Patients with significant macula disease, advanced glaucoma, irregular corneas, or severe dry eye will not get the outcomes the trials demonstrate. The lens is only part of the equation. The eye it goes into matters at least as much. So for any patients reading this, it is vital to discuss what lens suits your individual eye rather than going into a consultation and demanding a particular lens. As you will have read, all of these lenses are very good and some of the decision comes down to how comfortable your surgeon is with each lens design and their own experience.

A Final Word

Ten years ago, when I was implanting my first multifocal lenses, the landscape looked very different, with a handful of trifocal lenses, limited by the physics of diffractive ring design, excellent for many patients and complicated for a meaningful minority. The conversation was often about managing expectations around halos.

The conversation is changing. The Galaxy genuinely sidesteps the halo mechanism and PanOptix Pro has pushed light efficiency to a new benchmark. Hoya has introduced surgical flexibility that didn’t exist before. None of these are perfect and many of the previous generation of IOLs including FineVision and AT Lisa remain excellent multifocal IOL options. A new generation generally means an improvement on the past, and we are seeing this with both Panoptix and Synergy seeing significant upgrades by their respective companies evolving into Panoptix Pro and Odyssey.

For patients facing cataract surgery, this is genuinely a good time to be making this decision. The technology is the best it has ever been. Ask your surgeon which of these lenses they’re offering, which they’d choose for a family member, and why. The answer will tell you a lot about where you’re at.

Keep Your Eyes Peeled

Ben LaHood — Sun, 28 Jun 2026 15:49:13 GMT

If you’ve found your way here, chances are you care about your eyes or your skin, and probably both. You’re in exactly the right place.

I’m Dr Ben LaHood, an ophthalmologist based in Australia, where I specialise in cataract and laser refractive surgery. I’ve been recognised in lists of the top 100 most influential people in the eye world and my daily life involves helping people see more clearly, literally. Whether that’s removing a cataract that’s clouded someone’s world, or performing laser surgery for someone wanting independence from their glasses or contact lenses, it’s a privilege I genuinely don’t take for granted.

But my interest in eyes extends well beyond the operating theatre. Growing up, I watched my grandfather go completely blind from glaucoma. Those visits to eye clinics as a child, seeing how many people had conditions that were preventable or treatable, planted a seed that eventually grew into a career. It took a nudge from a wise mentor in New Zealand, the late Professor Gordon Sanderson, who tracked me down when I’d briefly quit medicine and gently steered me towards ophthalmology. I think about him often and the sliding doors moments like this that change your life.

Specialising in refractive surgery means staying up to date with the very latest technology, interacting with research and development from industry partners, and often having early access to exciting products for my patients. Over the years, my work has taken me around the world, speaking at conferences across Europe, Asia, Africa, and North America, completing a PhD at the University of Adelaide, hosting popular ophthalmology podcasts, and landing on The Ophthalmologist magazine’s Power List in both 2023 and 2024. I share that because I want you to know that when I talk about eyes, I’m speaking from experience, both clinical, and research based.

As an eye surgeon I know that up to 10% of all skin cancers occur on the eyelids. That number stayed with me. People weren’t protecting that delicate skin around their eyes, not because they didn’t care, but because there was no product truly designed for it. So after eight years of development, I launched my own cosmetics brand, with Eyelid Defence being my first product. It’s a scientifically formulated eyelid moisturiser with SPF and active anti-aging ingredients created specifically for the eyelid area to keep that delicate skin protected, and youthful without stinging or burning your eyes. It’s the first product under my own name, and there are some exciting things in the pipeline including an ophthalmologist formulated eyelash growth serum.

Which brings me to why I started Keep your eyes peeled.

I’m already active on LinkedIn, where I share professional articles, research, and talks aimed at my peers in the medical world. On Instagram, I try to make eye and skincare education genuinely entertaining, quick, visual, and hopefully a little fun. Both of those platforms have their place, and I enjoy them for what they are.

But they have limits. A caption isn’t the place to really dig into an idea. A professional article isn’t where you explore a tangent or sit with a question that doesn’t have a clean answer yet.

This is that place. Keep your eyes peeled is a long-form conversation, a space where I can explore interesting ideas in eye health and skincare properly: the nuance, the debate, the things I find genuinely fascinating that don’t fit neatly into a caption or a peer-reviewed abstract. Think of it less as a publication and more as pulling up a chair.

I’m so glad you’re here for it. Now, keep your eyes peeled.

Until next time,

Dr Ben LaHood, Ophthalmologist

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