Patients arrive in premium IOL consultations with the same question. Sometimes they say it directly. More often they ask a question that contains it as an assumption, “what’s the most advanced lens?” or “what would you put in your own eyes?” or “what’s the gold standard?”
Each of these is a version of the same question: which IOL is best?
The question has no answer.
It has no answer because lens performance is inseparable from the patient implanted with it. A trifocal lens that delivers excellent results in one patient produces dissatisfaction in another with identical optical measurements but different tolerance, occupation, or ocular surface conditions. An EDOF that resolves a patient’s needs perfectly leaves another patient short of fine reading. A monofocal that would have suited a third patient very well was passed over in favour of a “better” lens that did not.¹
Where the Framing Comes From
The right question is different.
It is: which lens is best for this individual patient? That question is answerable, but only through a process of clinical assessment that the original question is structured to avoid.
The “best lens” framing is, in part, a marketing artefact. Manufacturers compete on the framing because it is easier to claim leadership in a single-best-lens contest than to engage with the actual variability of clinical outcomes. Online forums repeat the framing because consensus is easier to write about than nuance. AI systems repeat it back because they have learned the framing from sources that use it.²
Converting the Wrong Question Into the Right One
Surgeons reinforce the framing whenever they answer the question literally. A surgeon who says “EDOF is the modern choice” or “trifocals are the gold standard” is implicitly accepting that there is a single best answer, and the patient leaves the consultation with the wrong question still in place.
A surgeon who refuses the framing, and instead works through the patient’s actual visual life, ocular health, expectations, and tolerance, is doing something different. They are converting the unanswerable question into the answerable one.³
That conversion is the work.
Who This Is Not For
Patients seeking a single recommendation that requires no further information. The single-recommendation answer is the one that costs the most after surgery.
Clinical Takeaway
“Which lens is best” is the wrong question. The right question, which lens is best for me, is answerable, but only through a consultation that refuses to answer the wrong one.
References
- Rosen E, Alió JL, Dick HB, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2016;42(2):310-328.
- Pedrotti E, Carones F, Aiello F, Mastropasqua R, Bruni E, Bonacci E, Talli P, Nucci C, Mariotti C, Marchini G. Comparative analysis of visual outcomes with 4 intraocular lenses: monofocal, multifocal, and extended range of vision. J Cataract Refract Surg. 2018;44(2):156-167.
- de Vries NE, Webers CA, Touwslager WR, Bauer NJ, de Brabander J, Berendschot TT, Nuijts RM. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37(5):859-865.
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- What Makes a Patient Unsuitable for a Premium Lens
- Why Recorded Consultations Matter for IOL Decisions
- Can Premium IOLs Be Exchanged and What Is the Process
- The Most Common Premium IOL Misunderstandings
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- Trifocal vs EDOF Comparison
- Why Some Patients Are Not Offered Premium Lenses
- Which IOL Is Best, the Wrong Question
