Refractive: Rewind. Refresh. Refine.
Fall 2026
by Liz Hillman
Editorial Co-Director
First-generation presbyopia-correcting IOLs established categories based on range of vision. Since then, there have been several iterations and additions within these categories, refining vision profiles, improving quality of vision, and reducing unwanted side effects.
When it comes to true presbyopia-correcting lenses, there are two main categories, which have been recently described by the ESCRS and ASCRS Functional Vision Working Groups based on what its members think best fits and standardizes academic discussion of these IOLs: extended depth of field and full depth of field. Both of these categories have new additions (at least new to the U.S. market), and physicians with experience are excited about the results.
The new kid: full depth of field
Source: George O. Waring IV, MD
George O. Waring IV, MD, implanted the first FDA-approved FineVision HP IOL (BVI Medical) in the U.S. This lens, Dr. Waring said, has a long history in Europe, being the first trifocal IOL worldwide designed by Damien Gatinel, MD, PhD. “This lens has enjoyed very productive utilization globally. We were excited and relieved to receive FDA approval earlier this year,” Dr. Waring said.
The lens has some attributes making it unique in the U.S. market, Dr. Waring said. It utilizes a combination of two optical technologies, apodization and convolution. “This combination of optical features harmonizes light energy and reduces side effects,” Dr. Waring said. He also mentioned that it has a four-footplate haptic design that allows for auto-centration, which he said could improve effective lens position and make refractive drift less likely. Once a toric version is available in the U.S., Dr. Waring said the haptic design will be helpful for rotational stability.
Robert Weinstock, MD, also hailed the stability of the four-point fixation of the double C-loop haptic design. “It unfolds quickly and centers beautifully inside the capsular bag. This is a huge value feature especially in a multifocal where IOL centration on the visual axis is critical. I find that conventional C-loop design IOLs tend to decenter more easily and often tilt or shift position slightly as the capsule heals and contracts around it. The design of the FineVision IOL is more stable,” Dr. Weinstock said.
He also said the FineVision HP has a “very regular pattern to its diffractive steps with a smooth transition between steps,” to which he credits the lens’ quality of vision with minimal dysphotopsias.
What sets the FineVision HP apart for Priya Mathews, MD, is its quality of distance vision and level of near vision. “It achieves better reading than most multifocals that I have experience with, so that’s been nice for those patients who value not having to wear glasses as much as possible, even for fine print,” she said.
New in extended depth of field
In the extended depth of field category, the newcomer is TECNIS PureSee (Johnson & Johnson Vision), which received FDA approval in March 2026. This lens, Dr. Waring said, has a novel optical approach. “It’s the first truly non-diffractive range of field lens available by using a continuous power change on the posterior surface of the IOL, which elongates the range of field while maintaining contrast sensitivity and distance on par with a monofocal IOL.” Dr. Weinstock explained that the optic of PureSee, being non-diffractive, features a blended change of power/curvature from the center to periphery of the lens on the posterior surface.
Dr. Waring also said that by optimizing and redistributing contrast sensitivity across the visual range, patients with this lens appear to have a greater tolerance to refractive error. “Early data suggests PureSee might be one of the most effective lenses to mitigate refractive error,” he said.
PureSee has been a great addition to the category for patients who historically would not have been a good candidate for a diffractive IOL, Dr. Waring said. “It’s quickly becoming the lens of choice for post-myopic LASIK patients, and that’s due to tolerance of refractive error.”
One of the things that puts PureSee on a different level, according to Dr. Mathews, who has been implanting this lens since April 2026, is the established TECNIS platform, which she said has good contrast sensitivity. “If I’m going to use an EDOF lens, it’s going to be the PureSee lens,” she said. She said this lens also appears to be a better fit for patients who are concerned about glare and halos, if they’re willing to wear readers for small print after surgery. However, Dr. Mathews said she has had success achieving more near vision for her patients by offsetting the non-dominant eye by –0.5 D.
Evolution of IOL subcategories
“We have more choices than ever, and it’s an amazing time to be a refractive cataract surgeon,” Dr. Waring said, noting that it’s natural in the innovation evolution cycle for new technology to join the category while at times, leading to retirement of older technology.
Overall, Dr. Waring said he thinks these “new kids on the block” may appeal to ophthalmologists who were not offering presbyopia-correcting IOLs in general or who were being very conservative in offering them to select candidates due to being burned or hearing about less than ideal outcomes from colleagues using older technology. “If they are looking for something new but less likely to cause issues, these new lenses could bring them off the fence.”
Dr. Weinstock acknowledged that all of these options in the presbyopia-correcting IOL subcategories can carry some level of “sensory overload.” What’s more, he said patients come in with a range of knowledge, from knowing nothing about advanced-technology IOLs to those who come in asking for a specific lens. “For refractive cataract surgeons, probably one of the most challenging aspects has become the preoperative consult, diagnostic testing, and the ocular and medical history that could affect candidacy for IOL choices,” he said.
With the nuances for successful presbyopia-correcting IOL selection not well covered in residency, Dr. Weinstock said there are more practices offering fellowships in refractive cataract surgery. He said that modern cataract surgeons need to be open to trying new things because “if you don’t, you fall behind.” “You just have to do it thoughtfully and be trained in an environment that has that philosophy,” he said.
When it comes to refractive lens exchange, Dr. Mathews thinks these patients desire greater spectacle independence than most cataract patients. Therefore, she’s reaching most often for full range of vision IOLs. “My two favorites are the Odyssey [Johnson & Johnson Vision] and the FineVision,” she said. Over time, she has seen her conversations evolve with these IOLs when it comes to dysphotopsias; she still discusses these visual side effects but finds fewer of them compared to earlier IOLs. “We’re not having to handhold as much. … The neuroadaptation process is quicker with these newer lenses,” Dr. Mathews said. Dr. Weinstock also said he has become so comfortable with how some of the full depth of field IOLs work that he’s implanting in clear lens exchange patients at a rate that he would not have 10 years ago with earlier generation multifocal IOLs. He’s also more confident performing clear lens exchange on patients with lesser degrees of refractive error thanks to advances in IOL options.
Dr. Weinstock said that even with more options in the presbyopia-correcting IOL subcategories, there is no one-size-fits-all option, though he’s finding that more patients are having success with these lenses, requiring fewer enhancements or IOL exchanges. He’s exchanging (his preferred method for addressing an unhappy patient) at a rate of 1–2 lenses out of 100. “It’s no longer taboo or considered high risk to do an exchange. In today’s world, it’s part of the arena and not considered a failure or complication. It’s part of the process in a small percentage of patients who need it,” he said.
About the physicians
Priya Mathews, MD, MPH
Assistant Medical Director
Director of Cornea and Ocular Surface Disease
Center for Sight
Sarasota, Florida
George O. Waring IV, MD
Waring Vision Institute
Mt. Pleasant, South Carolina
Robert Weinstock, MD
Medical Director
Eye Institute of West Florida
Regional Medical Director
EyeCare Partners
Largo, Florida
Relevant disclosures
Mathews: Alcon, Johnson & Johnson Vision, RxSight
Waring: BVI Medical, Johnson & Johnson Vision
Weinstock: Alcon, Bausch + Lomb, BVI Medical, Johnson & Johnson Vision
Contact
Mathews: priya.m.mathews@gmail.com
Waring: gwaring@waringvision.com
Weinstock: rjweinstock@yahoo.com
