Refractive cataract surgery has never been more advanced—or more complex—than it is today. We have entered an era in which the number of tools at our disposal—from diagnostic instruments to surgical devices—borders on overwhelming. As I reflect on how to navigate this space, a central truth keeps surfacing: there is more than one way to do this well. In fact, there is rarely just one right answer.
We ophthalmologists often talk about surgery as a science, but I am becoming increasingly aware of how deeply artistic this work truly is. The patient becomes our canvas. The IOL platforms, laser systems, diagnostic instruments—these are our paints and brushes. As in art, success does not come from following a formula. Rather, it comes from seeing the person in front of us, interpreting subtle cues, and understanding not only their anatomy but also their lifestyle, expectations, and tolerance for risk. That is not a skill set we learn from a product insert but from experience, humility, and a willingness to engage with each case as something new.
The technological landscape in 2025 is staggering. Laser-assisted lenticule extraction is gaining momentum globally. Patients who receive an EVO ICL (STAAR Surgical) continue to surprise me with how well they see postoperatively. Categories of IOL options have broadened to include enhanced monofocal lenses such as the Tecnis Eyhance (Johnson & Johnson Vision); extended depth-of-focus IOLs such as the Tecnis Symfony OptiBlue (Johnson & Johnson Vision) and Clareon Vivity (Alcon); adjustable lenses such as the Light Adjustable Lens+ (RxSight); and trifocals such as the Clareon PanOptix Pro (Alcon) and the forthcoming FineVision HP (BVI). None of these, however, is foolproof. Any of them can perform spectacularly in the right patient, and in the wrong one, none of them works. That is a hard truth in this field: most unhappy outcomes are not a failure of technology but a misalignment of the patient and the solution we chose.
Practical issues are that access to all these technologies is expensive and that achieving and maintaining proficiency in their use can be challenging. Joining a large group may give us the tools but perhaps not the culture we want. Building something smaller and more personalized can be fulfilling, but the cost and training curve warrant deep consideration. For young surgeons especially, this balancing act is one of the biggest hurdles.
In the end, refractive cataract surgery is about much more than technical execution. It is about perception, dialogue, and judgment. It is about making choices that are both personal and precise, and that, to me, is where the true artistry lies.
