Leading ophthalmic practices must embrace innovation to stay competitive. Adopting cutting-edge solutions such as premium IOLs can enhance patient outcomes and reinforce a practice’s commitment to excellence.
Wayne Caulder is a trailblazer in ophthalmology whose pioneering work has helped shape patient care and surgical practices. The insights he shares in this article underscore the importance of embracing change and striving for excellence in a competitive landscape.
Tracy J. Kenniff, MBA, OCS
Premium IOLs have moved from the margins of cataract surgery into the mainstream of modern ophthalmic practice. What was once a niche offering is now a core growth engine for practices across the United States and a meaningful driver of patient satisfaction, practice differentiation, and long-term sustainability. Understanding why this market is expanding and how to respond thoughtfully is essential for any surgeon focused on the future.
A MARKET POISED FOR CONTINUED GROWTH
The United States is, by far, the largest premium cataract surgery market in the world; it accounts for approximately 36% of global manufacturer revenue.1 Of the estimated 5.2 million cataract and refractive lens exchange procedures that were expected in 2025, Market Scope projected that roughly 38%—or about 1.98 million cases—would include at least one premium component.1
Several factors explain why the US market has reached this scale. First, the country has a large and relatively affluent patient population with high expectations for visual performance. Second, US surgeons and patients were early adopters of refractive surgery. More than 20 million LASIK and other refractive procedures have been performed since the early 2000s, conditioning patients to view vision correction as an investment in their quality of life rather than solely a medical necessity.1 Notably, 86% of refractive surgeons in the United States also perform cataract surgery, creating a natural bridge between refractive and cataract care.1
A third, equally important factor is the reimbursement environment. Many European countries have national health systems, which can limit the options available to surgeons and patients. In the United States, since 2005, CMS has prohibited balance billing in both Medicare and Medicaid, allowing patients to pay out of pocket for the incremental cost of premium technologies such as toric and presbyopia-correcting IOLs above the standard reimbursed amount.2 This rule has provided clarity to both surgeons and patients and enabled innovation to flourish.
THE DEMOGRAPHIC TAILWIND
Demographics are strengthening the growth outlook for premium IOLs. In 2025, the US population that is 60 years of age or older was approximately 84.3 million, and it is projected to reach 90.6 million by 2030—a 7.5% increase in just 5 years.1,3 By the end of the decade, more than one-quarter of Americans will be older than 60 years of age.1
This cohort is also healthier, more physically active, and more visually demanding than previous generations. Many people in this age group continue to work, travel, drive at night, and engage with digital devices. They are therefore motivated to pursue surgical options that deliver a broad range of vision and reduce their dependence on glasses and contact lenses.
EXPANDING AND DIVERSIFYING PREMIUM LENS OPTIONS
Ophthalmic surgeons can choose from an expanding portfolio of multifocal, toric, extended depth of focus, postoperatively adjustable, and other advanced technology IOL designs. The growing array of options allows more customized treatments for presbyopia, astigmatism, and decreased visual quality.1
Market surveys have indicated that surgeons expect premium IOL volumes to continue rising across categories. Postoperatively adjustable IOLs are projected to show the strongest growth, with two-thirds of surgeons anticipating increased usage and none expecting a decline.1 Presbyopia-correcting IOLs and toric platforms are also expected to grow steadily, reflecting both improved technology and rising surgeon confidence.1
Market feedback at Bausch + Lomb reflects these projections. We regularly hear from surgeons that cataract surgery patients desire a full range of vision with minimal visual disturbances in all lighting conditions as well as precise astigmatism correction.
PRACTICE STRUCTURE ENABLES ADOPTION
Unlike in many international markets, more than 90% of US cataract surgeons practice in private settings.1 This autonomy enables faster adoption of new technologies, diagnostic tools, and patient education strategies. With more than 4,000 private ophthalmic practices nationwide and more than 90% of them offering cataract surgery, the infrastructure for premium care is already in place.1
Practices are increasingly using digital education platforms, counseling protocols, and diagnostic-driven workflows to help patients understand the value of premium options. These tools not only support informed decision-making but also enhance consistency throughout the patient journey.
WHY PATIENTS CHOOSE PREMIUM IOLS
From the patient’s perspective, the appeal of premium IOLs is multifaceted.
Improved Visual Outcomes
Many premium lenses provide functional vision at near, intermediate, and distance ranges, significantly reducing patients’ spectacle dependence.
Lifestyle Alignment
Patients increasingly prioritize convenience and freedom from glasses, especially for daily activities such as reading, computer use, and travel.
Long-Term Value
Although premium IOLs typically require an out-of-pocket payment, many patients view the technology as a long-term investment that reduces their ongoing eyewear costs.
High Satisfaction With Appropriate Candidate Selection
Advances in diagnostics, surgical planning, and lens design have hastened postoperative recovery and increased patient satisfaction when their expectations are properly managed before and after surgery.
ASTIGMATISM: AN EXPANDING OPPORTUNITY
Astigmatism management currently represents one of the most significant opportunities within premium cataract surgery. A large clinical study found that nearly 38% of cataract surgery patients present with more than 1.00 D of preoperative astigmatism.4
At the same time, surgeons’ perceptions of what constitutes clinically significant astigmatism are shifting. In the past 5 years, the proportion of surgeons who consider 0.75 D or less of cylinder to be significant has increased markedly.1 Because nearly half of the patients with astigmatism fall below this threshold, the shift in surgeons’ mindset could meaningfully expand the treatable population, particularly given the availability of low-cylinder toric solutions.1
BENEFITS FOR AND RESPONSIBILITIES OF PRACTICES
For surgeons and their practices, premium IOL technology can offer clear advantages, including enhanced competitiveness, stronger financial performance, and deeper patient engagement. Success, however, requires commitment.
Advanced diagnostics, precise biometry, and team-based training are essential to optimize outcomes. Equally important is patient counseling. Clear communication about benefits, limitations, and potential dysphotopsias is critical to achieving satisfaction and building long-term trust. At Bausch + Lomb, we believe manufacturer partnership plays a vital role here—not just through product innovation but also through dedicated practice development support, education, and patient counseling resources designed to help practices grow responsibly.
STRATEGIES TO MAXIMIZE ADOPTION
Practices that succeed in premium cataract surgery tend to share several characteristics:
- No. 1: Structured patient education in the form of consistent counseling programs supported by visual aids, videos, and decision tools;
- No. 2: An investment in technology, such as high-precision diagnostics and digital planning platforms, that supports patients’ and surgeons’ confidence in lens selection;
- No. 3: Clear, thoughtful marketing of premium offerings across digital channels in alignment with realistic expectations; and
- No. 4: Strong referral relationships built through the ongoing education of and collaboration with optometrists and referring providers.
LOOKING AHEAD
The growth of the premium cataract surgery market reflects broader shifts in patient expectations, demographics, and technology. This is not simply a revenue opportunity for surgeons but also a chance to redefine the cataract experience and deliver outcomes that align with how patients live today. Practices that invest in education, precision, and partnership position themselves to thrive as the field evolves.
1. Market Scope. 2025 Premium Cataract Surgery Market Report. Market Scope; 2025.
2. Centers for Medicare & Medicaid Services. Ruling No. 05-01. May 3, 2005. Accessed February 6, 2026. https://www.cms.gov/regulations-and-guidance/guidance/rulings/downloads/cmsr0501.pdf
3. US Census Bureau. National population projections by age group, 2025–2030. Accessed February 13, 2025. https://www.census.gov/data/tables/2023/demo/popproj/2023-summary-tables.html
4. Hill W. The toric intraocular lens: successful strategies. In: Hovanesian J, ed. Premium Cataract Surgery: A Step-by-Step Guide. 1st ed. Slack; 2012:chapter 1.
