ASCRS News
Fall 2025

by Sumit “Sam” Garg, MD
Chief Medical Editor

Whether it is a difficult patient, a complication that you are inheriting from colleague, a self-created complication, or something else, we all experience challenging clinical scenarios. I was always taught that embracing these difficult patients is the way to go, especially when they are your own patient. However, I also think it is important to help patients who feel abandoned from other providers and those who have difficult personalities. I have been surprised how relieved patients are when you level set expectations with them and discuss the realities and complexity of their particular scenario. 

This EyeWorld issue focuses on going “beyond the routine.” We do this by personalizing treatments, taking extra time to understand each patient’s lifestyle, concerns, and visual needs. This might mean adapting surgical plans to optimize not just vision but also quality of life, such as considering a patient’s hobbies, work demands, or caregiving responsibilities. Additionally, following up personally after procedures, checking on recovery, and addressing anxieties shows compassion beyond the exam room. Staying up to date on the latest evidence-based treatments ensures patients benefit from innovations early. These small but meaningful actions foster trust, improve outcomes, and demonstrate a deep commitment to whole-patient well-being, not just eye health.

Our editorial team has put together another great set of educational articles highlighting our issue’s theme of going beyond the routine.   

• Adapt contemporary secondary IOL techniques: Learn best practices for secondary IOL fixation via intrascleral haptic fixation (i.e., Yamane fixation) and indications for piggyback IOLs. Explore the role of the Light Adjustable Lens (RxSight) for both techniques.  
• Individualize surface optimization: Rather than applying blanket protocols, distinguish between visually significant and non-visually significant dry eye cases. Focus optimization efforts on patients who truly need it while avoiding unnecessary delays for those ready for surgery. Consider repeat measurements and cross-validation between devices to ensure reliability and repeatability.
• Embrace advanced diagnostic tools: Move beyond standard autorefractors and incorporate topography and wavefront diagnostics to get accurate starting points for routine and complex cases. Use “old school” techniques like retinoscopy when appropriate, as these can provide valuable insights that automated systems miss.
• Consider innovative solutions: Explore techniques like pinhole pupilloplasty for patients with irregular astigmatism who can’t be helped by traditional methods. This can reduce the need for corneal transplants and provide immediate visual improvement.
• Early intervention philosophy: Intervene earlier with laser treatments, MIGS, or other therapies before glaucomatous diseases progress and tissue damage becomes irreversible, maximizing the potential for positive outcomes.

Other important topics include the impact of emerging antibody drug conjugates (ADCs) on ocular health, the basics of pigment dispersion syndrome and pigmentary glaucoma, and updates from the ASCRS Foundation and ASCRS Government Relations. 

On the topic of government relations, we are facing another proposed cut to cataract reimbursements. As you know, cataract surgery reimbursements have steadily declined in recent years, creating financial pressures for ophthalmologists and surgical centers. Medicare and private insurers have reduced payments, citing efficiency gains, improved technology, and budget constraints. While surgical volume has increased, revenue per case has dropped, forcing practices to optimize workflow, reduce overhead, and adopt cost-saving measures. In 2026, CMS is proposing reducing the Medicare reimbursement for CPT 66984 (routine cataract removal with IOL) from $521.75 in 2025 to $466.87 in 2026, an approximate 11% cut. This marks a substantial reduction, adding to the long-term trend of declining payments for cataract-related procedures. This poses yet another headwind for us as we continue to face decreasing reimbursements. Certainly, embracing premium IOLs and elective surgical upgrades can offset losses, but the continued downward trend of insurance reimbursement for cataract surgery is extremely concerning. Your active participation in government relations activity is needed! Please continue to support our ASCRS eyePAC, write letters to your local government officials, participate in advocacy sessions, and consider attending the annual Legislative Fly-In in Washington, D.C.

I hope you enjoy reading this issue of EyeWorld. As always, if you have any suggestions for topics, improvements, etc., please feel free to reach out to me at gargs@uci.edu.