At ASCRS 2025’s Saturday Main Stage session, leaders in cataract, refractive, cornea and glaucoma care explored the philosophy behind innovation—and mapped out where ophthalmology is heading next.
The Main Stage at the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2025) in Los Angeles offered more than a front-row seat to surgical innovation—it offered a glimpse into the mindset that fuels it.
Continuing one of the most beloved traditions at ASCRS, the Charles D. Kelman, MD, Innovator’s Lecture anchored the day’s program. But this year’s event offered even more.
Before Professor Damien Gatinel (France) took the stage, attendees were treated to a dynamic conversation about the philosophy, the challenges and the real-world impact of pushing the limits across cataract, cornea, refractive and glaucoma care.
READ MORE: Cataracts vs Glaucoma: What You Need to Know
Moderator Dr. Manjool Shah (USA) set the tone early, describing innovation not just as a luxury but as the heartbeat of ophthalmic progress. The morning’s speakers challenged attendees to think beyond the evidence, beyond the present moment and beyond the obvious.
The philosophy of innovation and the art of seeing differently
The morning opened with reflections from Dr. Reay Brown (USA), former Kelman Lecturer and lifelong champion of medical innovation. In a presentation that was both personal and provocative, Dr. Brown made the case for what he calls “deluded optimism,” framing innovation not as a linear process, but as an act of stubborn, irrational belief in unseen possibilities.
“Innovation often requires two deluded steps,” Dr. Brown explained. “First, identifying an unmet need that others have missed. Second, thinking that you are the one who can fix it.”
He illustrated the point with the story of Alexander Graham Bell’s telephone, once dismissed by Western Union as a “scheme” with no future. The real barrier, Dr. Brown argued, is not technical; it’s belief.
His own career in glaucoma surgery proved the point. From the early development of trabecular bypass procedures to watching his ideas resurrected decades later under new names, Dr. Brown showed that persistence, more than perfection, often determines success.
Dr. Brown’s reflections struck a chord with many in the room, urging ophthalmologists not just to follow data, but to dream a few steps ahead of it. “Most innovations don’t begin with evidence,” he said. “They begin with belief.”
It was a fitting philosophy to set the stage for the innovations to come.
READ MORE: 12 Notable Ophthalmic Innovations, Methods or Needs in Ophthalmology
Breaking new ground across subspecialties
The panel discussion that followed showcased how “deluded optimism” is already reshaping ophthalmic practice. Dr. Dagny Zhu (USA) highlighted the accelerating adoption of premium intraocular lenses (IOLs), including extended-depth-of-focus (EDOF) and trifocal designs.
“Despite the amazing advances over the past two decades, the adoption of premium IOLs has really stayed limited,” she said. “But if you look at even the last two to three years, the jump has been really enormous.” With improved technologies and rising patient expectations, she urged surgeons to embrace these tools now more than ever.
Dr. Zhu also spotlighted the rise of office-based cataract surgery (OBS) with oral sedation—a shift that puts patient experience first. “It’s bringing the attention back onto what provides the best patient experience,” she said, noting that patients move less, anesthesia risks are reduced and surgeons gain greater autonomy outside of hospital systems.
Dr. Nicole Fram (USA) humorously described moving away from intravenous sedation and added with a smile, “It’s almost like someone saying that Santa Claus isn’t real.” Changing traditional models may feel unsettling, but for many practices, OBS represents a leap forward in safety, efficiency and control.
Turning to glaucoma, Dr. Manjool Shah, the session’s moderator, spoke candidly about the overdue shift in glaucoma care from a model of endurance to one of proactive intervention.
“For so long, in the glaucoma world, we really didn’t have that option… we had to kind of say, ‘Yeah, got to suck it up and take these drops, which are going to beat you up, or have the surgery, which might make you lose vision.’ But that just doesn’t fly anymore.”
Today, interventional glaucoma is gaining momentum, led by early procedures like selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgeries (MIGS). But Dr. Shah emphasized that the next big need is to develop safer, reliable operations for patients whose disease demands more than MIGS can deliver.
READ MORE: A New Interventional Glaucoma Consensus Protocol Has Arrived
Meanwhile, Dr. Marjan Farid (USA) shared her excitement for regenerative breakthroughs in corneal surgery, particularly injectable endothelial cell therapies that could transform the treatment of corneal edema and Fuchs’ dystrophy.
“We’re looking at a future where one donor could help multiple patients,” she said, calling it a potential revolution for parts of the world where corneal blindness remains a major unmet need. As she noted, merging the worlds of corneal and refractive surgery isn’t just possible, it’s becoming the new expectation.
Redefining innovation with orthogonal thinking
When Professor Damien Gatinel took the stage for the 2025 Kelman Innovator’s Lecture, he embodied the spirit of orthogonal thinking, seeking breakthroughs at the intersection of unexpected fields.
In a talk titled At Wide Angle to Convention: Orthogonality and the Art of Breakthrough, he traced how crossing boundaries between mathematics, optics and clinical practice led to innovations like the FineVision trifocal IOL and a new classification system for ocular aberrations.
“We must combine different modes of thought to tackle challenges more effectively,” Dr. Gatinel said, pointing to examples from aviation to wavefront analysis.
Beyond his technical achievements—ranging from the development of the FineVision trifocal IOL to novel classification systems for higher-order aberrations—he celebrated the power of collaboration.
“Your candle does not lose its light by lighting another,” he said. “The more candles there are, the more we shine collectively and light up things.”
In a lecture rich with data, humor and heartfelt reflections, Dr. Gatinel reminded us that creativity, curiosity and collaboration are just as vital to ophthalmology’s future as surgical precision.
Emerging technologies and systemic shifts
Throughout the morning, speakers spotlighted emerging advances poised to reshape ophthalmology, from ray tracing-guided laser systems offering unprecedented visual outcomes, to artificial intelligence (AI) tools that may help match patients to their ideal IOLs, to robotics-assisted cataract surgery aiming to boost precision and expand access.
New approaches to keratoconus management, including corneal tissue addition techniques like corneal allograft ring segments (CARS), are also offering hope to patients once limited to contact lenses or full transplants.
READ MORE: AI Tools in Ophthalmology: From Virtual Scribes to Surgical Planning at ASCRS 2025
Beyond the technology itself, the focus is shifting toward efficiency, patient-centered care and accessibility. Office-based surgery, streamlined diagnostics and better workflow integration are all working together toward making cutting-edge ophthalmology available to more patients, without compromising on outcomes or experience.
Lighting the way forward
Saturday’s Main Stage session was a reminder that innovation in ophthalmology is not just about new technologies, it is about cultivating the courage to ask different questions, take calculated risks and challenge assumptions. From premium IOLs and ray tracing lasers to office-based cataract surgery and interventional glaucoma care, the landscape of vision care is evolving faster than ever.
For the next generation of innovators, the call is to stay curious, stay bold and when necessary, stay a little “deluded.”
Editor’s Note: Reporting for this story took place during the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2025) being held from 25-28 April in Los Angeles, California, United States.
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