IOL Choice: 5 Key Diagnostic Tools for Optimal Patient Flow

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Five Key Diagnostics Optimize Cataract Surgery planning, Improve Patient Satisfaction

advanced imaging adn testing – including OCT, topography, and dry eye assessments – are critical for achieving optimal outcomes in modern cataract surgery.

WAIKOLOA, Hawaii – Surgeons have a growing arsenal of diagnostic tools at their disposal to refine cataract surgery planning and maximize patient satisfaction. Five diagnostic modalities – macular OCT, corneal topography/tomography, biometry, aberrometry, and meibography – are proving invaluable for ensuring the most appropriate intraocular lens (IOL) selection and efficient clinic flow, according to a presentation at Hawaiian Eye 2026.

At the conference, Marjan Farid, MD, emphasized the importance of a comprehensive diagnostic approach. “There is a lot of facts to think about when evaluating a patient for cataract surgery,” she said. “A lot of data goes in, and ultimately the processor is the surgeon’s mind in figuring out how to put all of this together to match the correct lens to our patient while maintaining clinic flow.”

The Importance of Comprehensive Assessment

dr. Farid highlighted the need to identify subtle macular and vitreous pathologies that might potentially be missed during a standard exam. “Unless you do [macular OCT] before and show the patient they have a level of pathology in their retina,if it gets worse after surgery,which oftentimes it can,then the blame falls on the surgeon,” she explained.

Macular OCT – This imaging identifies retinal pathology *before* surgery, establishing a baseline to differentiate post-operative changes from pre-existing conditions.

Corneal topography is also crucial for uncovering hidden irregularities. Physicians should meticulously lift eyelids and examine the superior cornea, considering in-office excision when appropriate. Re-evaluation of topography before IOL planning is also recommended.

Corneal Topography – Detailed mapping reveals corneal irregularities frequently enough missed in standard exams, aiding in accurate IOL calculations.

Modern biometry provides axial length, K values, and total corneal power using fourth-generation formulas. Aberrometry can further refine IOL selection by distinguishing corneal and internal aberrations, and serves as a valuable educational tool for patients. “You can realy show the patient what the difference is going to look like when you address the astigmatism,” Dr. Farid noted.

aberrometry – This test differentiates corneal and internal aberrations,improving IOL selection and patient expectations.

Dry Eye: A Major source of Postoperative Dissatisfaction

Rounding out the essential diagnostics are meibography and comprehensive ocular surface disease assessment.Dr. Farid stressed the importance of recognizing that every patient is unique, and that lifestyle questionnaires, thorough medical histories, and biomicroscopy exams are also vital for optimal outcomes. She advised conducting osmolarity and MMP-9 testing before dilation, direct contact, vital dyes, or shining lights are used.

Meibography – Assessing meibomian gland function identifies dry eye disease, a leading cause of post-operative dissatisfaction.

Empowering staff to perform initial testing can expedite diagnosis and facilitate timely ocular surface disease management. “The number one, two and three causes of dissatisfied postoperative cataract patients are ocular surface disease and dry eyes,” Dr. Farid stated. “Look for signs.Many patients will come in and are not complaining about the traditional symptoms of dry eye, but they have signs of ocular surface disease.”

Dr. Farid reports being a consultant or advisor to Alcon,AbbVie,Allergan,Aurion Biotech,Bausch + Lomb,Bio-Tissue,Carl Zeiss Meditec,CorneaGen,Glaukos,Harrow,Johnson & Johnson Vision Care,Kala Pharmaceuticals