Celebrating surgical innovation and spirited debate at the heart of anterior segment care.
The Sunday afternoon JCRS Symposium at ASCRS 2025 delivered a lively mix of celebration, science, and sharp clinical debate. Sponsored by the Journal of Cataract & Refractive Surgery (JCRS), the session opened with a tribute to excellence in ophthalmic research, honoring the recipients of this year’s JCRS article awards.
Recognizing a tradition of innovation, Dr. Howard Kimble was awarded Best Technique Article for his work on Haptic Tuck for Reverse Optic Capture of a Single Piece Acrylic Toric IOL, while Dr. Emma Freeling received the Best Full-Length Article Award for her national registry study on intracameral antibiotics and endophthalmitis prevention. Dr. Eric Broker was also recognized for his pioneering laboratory work using fluorescein-conjugated hyaluronic acid to visualize residual viscoelastic material.
With the accolades concluded, moderators Dr. William J. Dupps, Jr. (USA) and Dr. Sathish Srinivasan (UK) steered a high-energy program, tackling advances and debates across anterior segment subspecialties, from AI in surgical planning to the safest strategies for posterior polar cataracts.
Computational medicine steps into the surgical suite
Dr. Nambi Nallasamy (USA) showcased how machine learning is redefining intraocular lens (IOL) selection and surgical training. By directly predicting postoperative anterior chamber depth (ACD) rather than relying on historical “effective lens position” estimates, new models are improving refractive outcomes. He also introduced new evaluation metrics like MAPI and CIR to better assess AI-based IOL formulas in real-world settings.
“Right now, surgery is kind of a black box,” he said, highlighting the difficulty of objectively measuring surgical skill and case complexity. His team’s AI tools, ranging from instrument tracking to real-time pupil behavior analysis, are poised to offer smarter feedback for surgeons and trainees alike.
Charting the AI revolution in ophthalmology
Dr. Dimitri Azar (USA) provided a sweeping look at the role of artificial intelligence across medicine, tracing its roots back to the transformational Flexner Report of 1910.1,2 Today, AI represents a third revolution in healthcare, Dr. Azar argued, alongside molecular biology and genomics.
Generative AI promises major shifts in patient care, research and surgical education. He emphasized that while AI can supercharge diagnosis and planning—from corneal topography to keratoconus screening—real-world deployment must balance innovation with caution about bias, regulation and generalizability.
“And now with the convergence of microelectronics and AI, we have artificial intelligence as being the third revolution since the 1910 Flexner report,” he noted.
READ MORE: AI Tools in Ophthalmology: From Virtual Scribes to Surgical Planning at ASCRS 2025
Why Femto LASIK holds the crown
Bringing humor and clinical rigor to the stage, Dr. Michael Mimouni (Israel) made the case for femtosecond laser-assisted in situ keratomileusis (LASIK) as the gold standard for treating hyperopia up to 4 diopters.
“LASIK has decades of robust data. PLEX is promising and less invasive, but the long-term evidence, especially for hyperopia, is still evolving and its benefits remain theoretical for now when compared to the well-documented outcomes of femto LASIK,” he said.
Dr. Mimouni pointed to faster recovery, predictable centration and reduced regression compared to newer lenticule extraction techniques (such as kerato-refractive lenticule extraction or KLEx).3 With playful jabs at newer technologies and even a cheeky AI consultation to back his argument, he left little doubt where he cast his vote.
KLEx charts a new path for hyperopic correction
Dr. Sri Ganesh (India) offered a compelling defense of keratorefractive lenticule extraction (KLEx) for hyperopia, emphasizing the new generation of results from global multicenter trials.
In his experience, KLEx offers several advantages: more natural centration on the visual axis, larger effective optical zones, better quality of night vision and reduced regression compared to hyperopic LASIK. In his multicenter trial, he reported that 81% of eyes achieved a spherical equivalent refraction within ±0.5 diopters and 93% within ±1.0 diopters, outperforming earlier hyperopic SMILE and Flex studies.4
“This is a new baby,” Dr. Ganesh said, encouraging clinicians to monitor KLEx advances as technology and nomograms continue to improve. Despite a steeper learning curve and slower early recovery compared to LASIK, Dr. Ganesh concluded that KLEx represents a compelling evolution in hyperopia treatment.
READ MORE: Ray Tracing, AI and the Rise of Customized LASIK
The imaging debate over AS-OCT
In a spirited exchange, Dr. Namrata Sharma (India) advocated for the necessity of routine preoperative anterior segment optical coherence tomography (AS-OCT) in posterior polar cataracts.
Preoperative AS-OCT allows surgeons to discern posterior capsule integrity, customize surgical approaches and counsel patients more accurately about risks, she emphasized. “It helps surgeons to customize the technique and tools, and aids patient counseling,” she concluded.
However, Dr. Abhay R. Vasavada (India) offered a counterpoint, stressing the primacy of clinical judgment.
“It’s nice to have documentation. It’s nice to impress the audience. But really, what we are interested in is a basic, good clinical examination,” he emphasized. Dr. Vasavada warned that an overreliance on imaging risks eroding critical observational skills, a trend he sees across ophthalmology.
True posterior polar cataracts, he stressed, can often be diagnosed at the slit lamp through classic signs like a bull’s-eye appearance or fishtail defect. Even with perfect imaging, the fragile posterior capsule may still rupture during surgery due to underlying structural weaknesses. For Dr. Vasavada, mastering surgical technique outweighs any preoperative scan.
Standard phacoemulsification still stands strong
Dr. Soon Phaik Chee (Singapore) defended traditional phacoemulsification techniques in posterior polar cataract surgery, arguing that with meticulous technique, such as careful hydrodelamination and viscodissection, excellent outcomes can be achieved. Her data showed comparable outcomes between femtosecond-assisted and manual phaco, with intraoperative rupture rates of just 6.7% and 5.9% respectively.5
“If you don’t have a good technique, you will break the capsule anyhow,” she reminded the audience, sharing retrospective data showing comparable posterior capsule rupture rates between femto-assisted and manual phaco cases at her center.
Her takeaway was simple: mastering fundamentals ensures that even complex cataracts can be managed safely, without depending on advanced technology alone.
Femto phaco offers a gentler touch
Closing the debate, Dr. Dagny Zhu (USA) highlighted how optimized femtosecond laser settings (e.g., lower energy, greater spot separation) and the femtodelineation technique can reduce stress on the fragile posterior capsule.
READ MORE: The Age of Femtosecond Laser
“You want to avoid sudden rapid buildup of hydraulic pressure inside the capsular bag,” she stressed, regardless of preexisting capsule status. Dr. Zhu showed how precise, low-energy laser segmentation allows controlled nuclear removal with minimal pressure shifts. Published studies now show posterior capsule rupture rates as low as 4.4% with this technique.6
She concluded that with careful technique and modern femto refinements, posterior polar cataract surgery can become a more predictable, controlled and safer procedure.
Innovation, debate and shared wisdom
From lively debates on imaging and surgical techniques to big-picture visions of AI in the OR, the JCRS Symposium proved that anterior segment innovation is thriving.
READ MORE: Innovation and Imagination Collide on the Main Stage at ASCRS 2025
Whether embracing time-tested strategies or pushing the frontier with machine learning and lenticule extraction, ophthalmology’s future continues to be shaped by dialogue, data and a commitment to better patient outcomes.
Get the latest updates from ASCRS 2025 with our daily coverage here.
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.
References
- Flexner A. Medical Education in the United States and Canada. Washington, DC: Science and Health Publications, Inc.; 1910.
- Duffy TP. The Flexner Report–100 years later. Yale J Biol Med. 2011;84(3):269-276.
- Vanathi M. Kerato-lenticule Extraction (KLex) surgeries – Current perspectives. Indian J Ophthalmol. 2024;72(4):459-460.
- Reinstein DZ, Sekundo W, Archer TJ, et al. SMILE for Hyperopia With and Without Astigmatism: Results of a Prospective Multicenter 12-Month Study. J Refract Surg. 2022;38(12):760-769.
