ONLINE EXCLUSIVE
December 2025
by Liz Hillman
Editorial Co-Director
It was a successful year for the Journal of Cataract & Refractive Surgery (JCRS), the official journal of the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS), and JCRS Online Case Reports (JCRO), an online-only companion journal to JCRS.
To celebrate the end of another successful year for the journals, EyeWorld is featuring some of the most-viewed papers. Read the recaps, and click to see the full articles in JCRS and JCRO.
Most-viewed papers from JCRS
Standards for analyzing astigmatic outcomes: Part I: astigmatism basics
This article by Kohnen et al., as part of a working group formed by JCRS, sought to define astigmatism, identify sources of astigmatism, pull together information about imaging technologies and their nuances, and discuss the impact of the ocular surface, irregular corneal astigmatism, and more. The effort was to “bring clarity to the topic of astigmatism analysis for all current and future researchers … to (1) establish astigmatic reporting guidelines based on sound optical principles and (2) provide new astigmatism calculation tools that simplify the process and allow researchers to reliably calculate accurate and reproducible results.”
Standards for analyzing astigmatic outcomes: Part II: recommended statistical methods
This was the second paper produced as part of the JCRS astigmatism working group. Authored by Koch et al., it “describes the recommended methodology for analyzing astigmatic outcomes” based on optics of corneal and lenticular astigmatism, vector analysis, and statistical approaches. The paper includes information about nonvector metrics, vector metrics, and using and evaluating these metrics.
Assessment of measurement variability across automated biometry devices
This prospective, single-center, bilateral, nonrandomized, open-label observational study by Morgan Micheletti, MD, and Brad Hall, PhD, evaluated variability among automatic biometric devices—Orbscan II (Bausch + Lomb), Argos (Alcon), Atlas 9000 (Zeiss), caliper, IOLMaster 500 (Zeiss), IOLMaster 700 (Zeiss), iTrace (Tracey Technologies), Lenstar LS900 (Haag-Streit), Pentacam HR (Oculus), and Pentacam AXL Wave (Oculus). The intent was to see whether these could improve decision-making for phakic IOL sizing (ICL, STAAR Surgical). White-to-white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT) measurements among the devices were compared to the Orbscan II. According to the authors, all mean white-to-white measurements, except that with the Pentacam AXL Wave, were significantly different when compared to Orbscan II measurements. Mean ACD and central corneal thickness measurements were also significantly different among all devices when compared to the Orbscan II measurements. The authors reported adjustment factors for white-to-white, anterior chamber depth, and central corneal thickness at −0.65 to 0.24 mm, −0.21 to −0.16 mm, and 19.9 to −36.0 μm, respectively. With this, the authors concluded that “the biometers tested were not interchangeable with the Orbscan II,” but “adjustment factors for WTW and ACD may compensate for differences between devices and adapt ICL sizing recommendations.”
Comparing optical quality and simulated defocus curves: head-to-head analysis of hydrophilic and hydrophobic trifocal intraocular lenses
Labuz et al. in a laboratory investigation examined the optical function of the AT ELANA trifocal IOL (Zeiss), which is made from a hydrophobic material, comparing it to the hydrophilic AT LISA IOL (Zeiss). According to the paper, both IOLs had comparable optical quality, but there was a 4% improvement at distance with the AT LISA trifocal and a 5% higher “modulation transfer function (MTFa), [which] served as a quality criterion.” The authors reported a marginal difference with intermediate distance. “Both IOLs reached simulated VA of 0.0 logMAR far vision, 0.10 logMAR at 80 cm, and 0.05 logMAR at 40 cm,” the authors wrote, but noted that the “near range was slightly expanded with the hydrophobic model.” Light distribution around a light source was similar between the two IOLs. Labuz et al. concluded that while “the hydrophobic trifocal IOL may provide visual range comparable with its hydrophilic counterpart … the asphericity change may facilitate the selection of a model that more effectively addresses specific corneal aberrations.”
Most-viewed papers from JCRO
Modified Canabrava technique with a 4-closed loop intraocular lens injected into the anterior chamber
The efficacy of a modified Canabrava scleral-fixated IOL technique for a 4-eyelet foldable IOL delivered directly from a preloaded injector into the anterior chamber was the subject of an uncontrolled case series of 12 patients by Canabrava et al. Follow-up was between 1–13 months. CDVA improved significantly from 0.38 logMAR preoperatively to 0.31 logMAR postop. Average and median cell counts decreased. While the original 4-flanged Canabrava technique was established as a stable, long-term secondary IOL implantation method, this modified technique showed that direct implantation of the IOL into the anterior chamber could be safely performed. The modification, according to the authors, “[avoids] the possible risk of crossing over of the sutures associated with the insertion of pre-passed sutures through the sclera before implanting the IOL.” The preloaded IOL in this modification also reduces the risk of lens damage and contamination and could decrease the corneal incision size and related surgically induced astigmatism.
Topical losartan and systemic vitamin C to mitigate corneal fibrosis after superficial keratectomy complicated by infection
A case report of a 72-year-old woman with epithelial basement membrane dystrophy who experienced decreased vision, corneal opacity, and mild infiltrates after superficial keratectomy was subsequently treated with topical losartan 0.8 mg/mL and oral vitamin C 1000 mg. This patient, whose treatment was tapered and monitored over 9 months, was described in a case report by Heun Min, BS, and Balamurali Ambati, MD, PhD. After 2 months on the treatment, the authors observed significant improvement of the corneal opacity and near complete resolution at 9 months. The patient’s visual acuity improved over this period by 1 line on the Snellen chart. This, according to Min and Ambati, is “one of the few reported cases of successful treatment of corneal scarring using topical losartan and systemic vitamin C.” They advocate for future studies to focus on optimal dosage strategies and treatment duration, as well as how to prevent regression.
Safety of acrylic intraocular lenses in patients with methyl methacrylate allergy
With increased rates of contact dermatitis from methyl methacrylate (MMA) exposure, but no publications about hypersensitivities from acrylic IOLs, Rana Khalil, MBBChBAO, MCh, GradDipOphthSc, and David Lockington, MBBChBAO, FRCOphth, PhD, were presented with a cataract candidate who had a known MMA allergy who wondered if an acrylic IOL would be a safe option for cataract surgery. The authors found only one report of a patient with an MMA allergy in the literature; this patient had a silicone IOL to avoid acrylic. The authors noted that acrylic monomers responsible for the MMA allergy are polymerized in acrylic IOLs and thus should pose a low risk for a reaction. The authors reported taping the IOLs (Rayner RAO800C and RAO200E) to the patient’s skin to assess for a reaction. Both patch tests were uneventful, and the patient had the sequential cataract surgeries without any postop reaction. The authors concluded that “acrylic IOLs should not cause any adverse reaction in patients with MMA allergies. This was our clinical experience, which should reassure patients and clinicians.”
New surgical technique for in-the-bag intraocular lens implantation in infants with microspherophakia and congenital cataracts
This new technique that enables in-the-bag implantation of an IOL in infants with microspherophakia and congenital cataract involves partially amputating both haptics of a 3-piece IOL. Ventura et al. described using this technique in a 6-month-old with an equatorial lens diameter of 6.5 mm in both eyes. Over a 2-year follow-up period, the authors reported that the IOL remained stable and centered without pseudophacodonesis. There was also no sign of glaucoma. Most importantly, the patient’s vision went from light perception to “within normal range for her age.”
Editors’ note: The papers featured in this article are among the most viewed from JCRS and JCRO between January and October 2025. This is not a complete list of the most viewed papers from the journals but rather a selection.
