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6 | 2022 ASCRS CLINICAL SURVEY HIGHLIGHTS FROM THE 2022 ASCRS CLINICAL SURVEY PRESBYOPIA CORRECTION Eighty percent of the respondents said they implanted multifocal or extended depth of focus (EDOF) IOLs, and of these, 43% reported that they thought deviation as low as ≥0.25 to ≤0.5 D from spherical target could have an impact on visual quality and patient satisfaction; 45% put their threshold for expecting a visually significant effect when off target between >0.5 D and ≤0.75 D. "True" monovision with a 1 D difference or greater between eyes was not very common among respondents who used presbyopia-correcting IOLs. Only 9% of respondents, on average, performed "true" monovision, while the majority (44%) said it accounted for less than 5% of their cases. Mini-monovision with a less than 1.0 D difference between eyes, however, was slightly more common, with 13% of respondents, on average. For some respondents, it still accounted for less than 5% of cases (32%), while others reported using this technique in 5–15% of cases (32%) and 16–25% (15%) of cases. I found this year's ASCRS Clinical Survey to be especially meaningful because it was the largest assessment of clinical practice of its kind performed since the COVID-19 pandemic. Interestingly, it appears that the use of presbyopia-correcting IOLs has increased to approximately 17%, when it was consistently between 8–10% pre-COVID-19 (2019–2020). More surgeons are also implanting trifocals (42%) as compared to EDOF IOLs (40%). One may have assumed the EDOF lenses would have a more conservative side effect profile, whereas the trifocals deliver more range of vision, but it appears that more surgeons are emphasizing delivering range of vision with the presbyopia-correcting lenses. I also found it interesting that the use of monovision was a little lower than previously assessed at 9% for "true" monovision and 13% for mini-monovision for a total of 22%, as compared to 27% in prior years. Perhaps some of this evolution has occurred as certain doctors may have switched from monovision to trifocals and EDOF lenses as their confidence in the technology has increased. It also appears that doctors are accepting less and less residual refractive error in their patients. We are fortunate that continued improvements in technology have helped us to improve our refractive accuracy, while at the same time we have learned that refractive accuracy is one of the primary factors that reduces dysphotopsias associated with premium lens technology. Overall, presbyopia-correcting technology has continued to expand in ophthalmology as more and better options become available in the marketplace. —Kendall Donaldson, MD Member, ASCRS Cataract Clinical Committee Based on those currently performing presbyopia-correcting IOLs (80%) n=753 What percentage of all cataract cases do you plan for mini-monovision, instead of performing a presbyopia IOL procedure? (with less than a 1.0 D difference between eyes aer surgery)? None <5% 5–15% 16–25% 26–50% >50% 15% 9% 3% 32% 9% 32% average cataract cases planned for mini-monovision with a <1.0 D difference 13% Average % of cataract cases planned for mini-monovision by segment 2022 Practice location U.S. 13% International 12% Years in practice Early stage (0–5years) 13% Mid stage (6–10 years) 13% Last stage (11+ years) 12% Perform majority of surgeries in Hospital outpatient department (HOPD) 13% Office 12% Gender Male 12% Female 15%

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