Future-Proofing Ophthalmology: Meeting Tomorrow's Challenges Today at ESCRS 2025

Boomers, backlogs and bilateral battles…ophthalmology’s future needs more than just AI wizardry.

Future-proofing ophthalmology isn’t just about slick gadgets and AI algorithms. It’s about bracing for tidal waves of patients, rising costs and, yes, even climate change.

On Day 4 of the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025), the symposium panelists looked straight into the crystal ball and asked: what will it take to keep ophthalmology standing tall in the decades ahead?

From demographic hexagons to carbon conscious phaco, and AI triage to VR training, it’s clear that tomorrow’s challenges demand today’s creativity.

The baby boomer impact

Prof. Mats Lundstrom (Sweden) kicked things off with a demographic reality check: the post-war generation (born 1946–1964) is now between 61 and 79 years old. Fast forward a decade, and they’ll be 71 to 89.

“The number of people aged 80 will be a lot compared with today,” Prof. Lundstrom said, noting Eurostat’s population data that shows Europe’s classic pyramid is morphing into…well, a hexagon.¹ “It’s not a population pyramid any longer.”

That hexagonal future spells a steep climb in cataracts, macular degeneration and glaucoma cases. And as Prof. Lundstrom pointed out, research progress—especially in dry AMD—will only increase the number of patients seeking care.

So what’s the game plan? More staff in every role (from ophthalmologists to optometrists), stronger ties with primary care, revamped organizational models and a heavier dose of telemedicine.

Sweden has already stress-tested some of these solutions by leaning on the private sector. “In 2023, for instance, more than 50% of the surgeries were performed by private [providers],” Prof. Lundstrom said. “This is one example of changing the organization. If you have the old-fashioned way with only community-based clinics, you can think of establishing more private clinics.”

Sustainable practices in ophthalmology

Dr. David Chang (United States) set the stage with a wake-up call: healthcare’s environmental footprint is no longer a side note, it’s center stage.

“Multiple organizations from The Lancet to the WHO have identified climate change as the biggest threat to global public health,” Dr. Chang said. “Paradoxically, it is the healthcare sector which is one of the biggest contributors to CO₂ emissions worldwide.”

He spotlighted the Aravind Eye Care System in India as a case study in doing more with less. “The carbon footprint of one phaco at Aravind is one-twentieth of that of one phaco in the UK,” he explained. The culprit? The West’s obsession with single-use pharmaceuticals and supplies, binned after every cataract surgery.

Dr. Chang didn’t shy away from questioning long-held infection control dogma either. Registry data showed that reusing some supposedly “single-use” items at Aravind didn’t raise endophthalmitis rates. In fact, their rate of one per 10,000 cases came in lower than the U.S. IRIS registry.²

“That’s the paradox in the United States,” he said. “We are wasting and spending 20 times more in order to be safer. And are we safer? Well, clearly not by spending and throwing out 20 times more.”

To put numbers to the argument, Dr. Chang showed that reusable phaco systems could slash carbon emissions from the equivalent of driving 2,800 km down to just 140 km for every thousand cataract cases.

Technology integration and AI

Prof. Bruce Allan (United Kingdom) laid out how artificial intelligence (AI) and digital transformation could help tackle the growing patient backlog, without sacrificing quality of care.

“There are three pillars to this,” Prof. Allan explained. “Moving from expensive treatments to intercepting diseases early, moving from expensive care in hospitals to relatively inexpensive care in the community, and transforming from analog to digital.”

But the tech isn’t magic on its own. Prof. Allan stressed the need for two essential building blocks: interoperability standards (think SNOMED CT, FHIR and DICOM) to get systems talking to each other, and protocol-driven care to capture data in a consistent, usable way.

Using keratoconus as his demo case, he showed how AI models can predict disease progression with impressive accuracy, helping clinicians sort patients into different risk categories. His team’s AI model hit over 90% accuracy in predicting progression after just two visits.

“After…the first clinic visit, we can say that over half our patients are safe to go to the community for annual scanning,” Prof. Allan explained. “If we go to two visits, eight out of ten of them we can put in the low-risk box.”

The result? At Moorfields, the number of patients needing regular hospital follow-up could shrink from 8,000 to just 1,000, all while ensuring those most at risk stay firmly in the spotlight.

Training the next generation

Assoc. Prof. Ann Sofia Thomsen (Denmark) tackled the issue head-on, pointing to a looming workforce crunch. “By 2050, global blindness is expected to triple,” she warned. “The question is if we’re training enough skilled ophthalmologists to meet this challenge.”

Her solution? Simulation, simulation, simulation. She presented evidence showing that virtual reality training slashes complication rates, with trainees using simulators far less likely to cause posterior capsule ruptures.³

But don’t think that dropping a simulator in the corner of the skills lab will solve everything. Assoc. Prof. Thomsen stressed that training has to be structured, procedure-specific and competency-based—not just about logging hours.

“Self-directed training is not effective,” she said, citing data showing how wildly trainees’ practice time varies when left to their own devices. “Training programs should be procedure specific for the procedure of interest.”

Competency-based assessment, she argued, is the only way to ensure real proficiency. Trainees must meet a benchmark skill level before advancing, not just clock in their time.

To drive the point home, she left the audience with a sharp comparison: “I think that we all should ask ourselves the question whether we would board a flight with a pilot who had trained a fixed amount of hours in a simulator without being tested, or rather with a pilot who had passed a competency-based test. And I think our patients would answer the same as you.”

High-volume surgical efficiency

Dr. Neto Rosatelli (Brazil) has performed more than 300,000 cataract surgeries in his career, and he was quick to point out that efficiency isn’t about chasing big numbers for their own sake. “Numbers are a consequence of the effort towards quality and excellence,” he reminded the audience.

For him, the secret isn’t the surgeon at all. It’s the team. “The key person for team success is the coordinator. And it shouldn’t be the surgeon,” he said. “The coordinator is the person responsible for selecting, training, supervising…the team as a whole.”

That means cross-training staff across roles, tightening up communication and streamlining patient flow. The result? A system that keeps safety front and center, even at staggering volumes. In fact, Dr. Rosatelli reported zero cases of endophthalmitis across 150,000 surgeries over eight years.

Navigating payment systems

Dr. Steve Arshinoff (Canada) wrapped up the symposium with a candid look at navigating payment systems, using immediately sequential bilateral cataract surgery (ISBCS) as his case in point.

According to Dr. Arshinoff, the math is clear: ISBCS cuts costs by about 30% compared with doing two separate procedures. The problem? Payment policies often work against it. “If anyone tells me that the difference is anything other than money, I don’t believe it,” Dr. Arshinoff said, pointing out how Canadian provinces’ bilateral rates map neatly onto their reimbursement schemes.

It all comes down to perspective. “Payers want to shift all the financial risk from the payer to the provider,” he explained. Surgeons, on the other hand, see it differently: “Look, I don’t give the guy his disease. We just try to fix them.”

Still, the global trend is unmistakable. “ISBCS is increasing globally and will continue to accelerate because money costs will keep going up and it saves money. And the patients like it, the doctors like it, everybody likes it,” he said.

His advice was simple but firm: “We must try hard to convince the payers and the other groups we work with and cooperate with them as much as we can… We should be the leaders. We shouldn’t wait to be told to go do bilateral surgeries of government and state funding.”

Looking ahead

If there was one takeaway from this future-forward session, it’s that ophthalmology can’t simply coast on its past successes. The field will need sharper strategies, greener practices, smarter tech and a next generation of surgeons trained for anything. Oh, and maybe a little extra patience when negotiating with payers.

The road to a future-proof specialty may not be smooth, but as the experts in Copenhagen reminded us, it’s better to start paving it now than to trip over it later.

Editor’s Note: The 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025) was held from 12-16 September in Copenhagen, Denmark. Reporting for this story took place during the event. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.

References

Population projections in the EU. Eurostat. March 2023. Available at: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_projections_in_the_EU. Accessed on September 15, 2025.
Morris DS, Wright T, Somner JEA, Connor A. The carbon footprint of cataract surgery. Eye (Lond). 2013;27(4):495-501.
Yang L, Al-Ani A, Bondok MS, Gooi P, Chung H. The impact of extended reality simulators on ophthalmic surgical training and performance: A systematic review and meta-analysis of 17,623 eyes. Eye. 2025;39:1700-1709.