From game-changing IOLs to laser scleral therapy, this APAO 2025 session suggests presbyopia correction is getting personal.
The first day of the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOS), in New Delhi, featured a standout session on presbyopia.
Experts from around the world took the stage to spotlight breakthrough strategies, from true accommodation and extended depth of focus (EDOF) IOLs to laser-based scleral restoration and a novel live simulation tool. They covered not only what’s working now, but what’s coming next.
Presbyopia correction with EDOF IOLs
Dr. Naren Shetty (India) shared why he prefers refractive EDOF IOLs for presbyopia correction. “We are in a generation where 20/20 or 6/6 vision is not enough—patients want more.”
According to Dr. Shetty, monofocals still offer the best visual quality, but “you have very little presbyopic correction,” and multifocals, while effective at near vision, involve “a compromise in quality of vision.”
Refractive EDOFs, he argued, strike the right balance. “There is no splitting of light. That is how it’s able to maintain quality of vision—and in the new generation of refractive EDOFs, the halo profile is almost similar to a monofocal level, including dysphotopsia,” said Dr. Shetty.
The case for trifocal IOLs
On the other hand, Dr. Vaishali Vasavada (India) made a strong case for the use of refractive trifocal IOLs, emphasizing their ability to deliver both visual quality and independence.
“The number of patients whom I can implant a trifocal in is increasing,” she noted, echoing findings from recent meta-analyses showing that nine out of ten patients achieve spectacle independence, while only 3% to 5% report significant halos, glare or starbursts.
“I think the basic point we need to understand is that the newer generation trifocals have an excellent range of vision continuity, as well as [providing] best inline spectacle independence—and the whole discussion about dysphotopsia and the negative effects is really going down drastically,” added Dr. Vasavada.
Her patient cases—ranging from surgeons and lawyers to those with nystagmus or in monocular situations—show that today’s trifocals work well beyond textbook candidates. “It’s no longer about who qualifies; it’s about identifying the few who don’t.” Her take-home message was clear: The main barriers are not the lenses, but “a hesitant surgeon or an uninformed patient.”
Getting the best of both worlds
Dr. David Chang (USA) offered a fresh perspective with his mix-and-match approach, pairing different IOL types to give patients exactly what they’re after: the best of both worlds. Recognizing that too many options can lead to confusion, he referenced The Paradox of Choice, explaining how excess information often fuels indecision and anxiety in patients.
To simplify the process, Dr. Chang blends technologies—typically pairing Alcon’s Vivity EDOF in the dominant eye with a PanOptix trifocal in the non-dominant. “I tell my patients this is like surf and turf. They’re getting the best of both worlds, so they don’t feel like they’re having to give up something by not choosing the other,” he explained.
With this strategy, patients gain strong binocular distance and intermediate vision, functional near, and excellent night comfort.
Try before you buy: IOL edition
Dr. Helena Prior Filipe (Portugal) addressed a key challenge in refractive surgery: helping patients choose the right IOL. Her solution? Live simulation.
“Live simulation replicates what the patient would experience if the IOL were already implanted. It uses adaptive optics, real-time post-op optical modeling, virtual reality and wavefront-guided imaging to create an immersive preview, so the patient can ‘test drive’ their vision before surgery.”
Patients can simulate near, intermediate and distance vision and explore options such as multifocal, EDOF or mix-and-match combinations. “Unmet expectations are usually about dysphotopsias, contrast sensitivity and vision in different lighting—things hard to explain but easy to simulate,” she noted.
In a live demonstration on stage, Dr. Ronald Krueger (USA) tested the simulation tool himself using a mix-and-match setup: an EDOF lens in one eye and a trifocal in the other. After comparing them in real time, he selected the EDOF as the better option for his visual needs.
Dr. Filipe emphasized that this approach “enhances shared decision-making, reduces regret and may soon become standard in clinical practice.”
The rise of accommodating IOLs
Prof. Dr. Jorge Alió (Spain) took the stage with 18 years of research behind him and a bold message: accommodating IOLs are ready for primetime. At the center of his talk was the Lumina lens (AkkoLens)—a next-generation, dual-optic, sulcus-fixated IOL designed to mimic the natural eye.
The Lumina lens, designed around the Arradi principle, dynamically adjusts optical power in response to ciliary muscle activity without splitting light. In Phase III clinical trials, the results were promising: 81% of patients achieved uncorrected visual acuity (UCVA) of 0.7 or better, and 100% showed improved vision with correction. For distance vision, 91% maintained their UCVA at the one-year follow-up, and all patients achieved a corrected distance visual acuity (CDVA) of 0.8 or better.
The takeaway? Accommodating IOLs like Lumina may finally deliver what previous generations could not: functional vision across distances without compromising optical quality.
Laser scleral microporation: A non-lens fix
Dr. Robert Ang (Philippines) presented a novel, non-lens-based approach to presbyopia correction: laser scleral microporation (LSM) using an erbium YAG laser. The concept is rooted in physiology, targeting age-related scleral stiffening caused by advanced glycation end products. By softening the sclera, LSM aims to restore the natural biomechanics of the ciliary body–zonule–lens system without touching the cornea or lens.
In a study of 50 emmetropic presbyopes (mean age: 52), laser micropores were applied in four scleral quadrants. The results showed significant improvement in intermediate vision and modest gains in near vision (J2–J3) over 12–24 months.
“Our study showed that… we have a good intermediate and a modest amount of near vision. It reduced patients’ dependence on reading glasses. The most important feature is that we reserve the cornea and the lens for future use, and it improves their quality of life.”
Laser scleral therapy shows promise
Dr. Krueger later shared promising early results on laser scleral therapy (LST), a non-invasive presbyopia treatment targeting the real root of the problem—“a stiffening sclera”—not just the lens.
The procedure targets the posterior sclera using a 1.55 µm pulsed diode laser, a wavelength chosen for its safety, precision and deeper tissue penetration without denaturation. “The goal is to shrink and soften tissues… and increase compliance of the sclera,” Dr. Krueger explained. This allows the ciliary body to move more freely, restoring natural accommodation.
In a pilot study of 11 emmetropic subjects aged 44 to 63, all retained their distance vision and gained one to five lines of near vision. One standout case improved from 20/60 to 20/20.
“It was a simple treatment that just took one minute,” he said. While still in early testing, LST shows promise as a repeatable, accessible option in the future.
Presbyopia at a crossroads
If this APAO 2025 session made one thing clear, it’s this: the era of one-size-fits-all presbyopia solutions is over. From refractive EDOFs and diffractive trifocals to accommodating IOLs and scleral-based laser procedures, the field is moving rapidly toward personalization and physiological restoration. As Dr. Chang put it, “patients want the best of both worlds,” and now, surgeons have more tools than ever to deliver on that.
What unites these innovations is their shared goal: restoring function, preserving quality and putting the patient’s lifestyle at the center. Whether through simulation, lens design or scleral restoration, the focus is shifting from managing presbyopia to mastering it. As new technologies mature, the challenge won’t be finding options—it will be choosing the right one for each patient.
Editor’s Note: Reporting for this story took place during the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), being held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025) from 3-6 April in New Delhi, India.
