In moments of uncertainty, trust becomes both our most valuable asset and our greatest vulnerability. Whether it is a new product release, an unexpected complication, or a product recall, the relationships among industry, physicians, and patients are built on a foundation that must remain strong: that patient care is our North Star.
Several cases of toxic anterior segment syndrome (TASS) associated with the enVista IOL platform (Bausch + Lomb) were recently reported. In situations like this, a delicate balance must be maintained. Surgeons must be able to trust that the company is listening carefully to feedback from the field. Industry must be able to trust that physicians are voicing concerns with sincerity and accuracy. Both physicians and industry must trust that their decisions are guided by doing what is right for the patient—regardless of financial or reputational cost.
In my view, Bausch + Lomb’s voluntary recall of the enVista IOL platform was a difficult decision but also the right one. A voluntary recall is a costly undertaking, both financially and in terms of stakeholder confidence. When trust is your currency, however, maintaining it becomes a simple equation: if patient safety is or might be at risk, the cost of inaction far exceeds the cost of withdrawing a product.
In situations like this one, a diligent investigation nearly always reveals a specific root cause. Many surgeons who have used this lens platform—including myself—have obtained excellent visual outcomes. I remain optimistic that, after a thorough review and resolution, clinical use of the enVista IOL platform can safely resume.
A defining feature of this TASS outbreak has been the speed at which information has spread. Initial concerns emerged within private physician chat groups but quickly—and somewhat surprisingly—began appearing in public and patient-facing forums. This allowed frontline surgeons to compare observations, connect patterns early, and raise concerns faster than ever before. At the same time, these events highlight how porous the boundaries between professional discourse and public conversation have become. Of concern is that anecdotes can spread more rapidly than evidence, creating the potential for misinterpretation, reputational harm, and the premature loss of a valuable innovation. The medical community must remain committed to amplifying facts—not speculation—and upholding professionalism and perspective, even in moments of heightened concern.
I am reminded of something I did not read in a journal or encounter in a chat group but heard around the dinner table. My father, now a retired ophthalmologist, practiced during the era of the Azar 91Z lens, a product once seen as cutting-edge. Complications—what we now recognize as uveitis-glaucoma-hyphema syndrome—arose. He witnessed trusted colleagues and company representatives downplay or even conceal the data rather than discuss them and take timely action. Patients were harmed, reputations were damaged, and the people my father trusted the most failed to speak up. He cried when he told me about it.
The current situation is far different. When concerns were raised, conversation began. When a pattern emerged, action was taken. When the stakes were high, trust prevailed.
The product recall is not a setback for innovation but a validation of the values that should underpin it. We physicians should all strive to work with companies that listen, respond, and lead with transparency. We must report concerns, reflect openly, and support one another in the shared pursuit of optimal outcomes.
Ultimately, our most important product is not a lens, a device, or a technology—it is trust. When we protect that, we protect everything.
