I am thankful to the engineers who continually improve our surgical products through technical advances. These engineers are usually smarter … More
Category: IOL related
1179: how to properly insert an AC IOL
One day you will certainly need to know how to insert an AC IOL. Note that these types of IOLs … More
1178: AC IOL orientation & calculations
Anterior chamber IOLs (AC IOLs) are not often used, but there will be a time where just about every cataract … More
1174: picking the right IOL for each eye
We are fortunate to have a wide range of different IOLs to offer our patients. We have bifocal IOLs, trifocal … More
1172: anterior capsular tear in phaco
The lens capsular bag is fragile and very thin, with an anterior measurement of about 14 microns and a posterior … More
1152: upside down IOL with bent haptic
You are performing cataract surgery on this patient and the case is going beautifully. You made a perfect 5 mm … More
1147: white cataract & damaged IOL
This intumescent white cataract case becomes even more challenging when the IOL was misloaded by the surgical tech and the … More
1135: IOL cutting for IOL exchange
Our guest surgeon is Jeff Whitman MD from Dallas, Texas, USA who shows us his technique for IOL exchange. While … More
1129: exposed and eroding IOL sutures
The best placement of an iOL is in the capsular bag. That is the end of the story. There are … More
1126: the IOL is stuck in the incision
When we move to smaller phaco incisions such as 2.2 mm or 2.4 mm wide, we accept that we will … More
1120: make sure the IOL is centered
We want the IOL optic and the capsulorhexis to both be centered. This is especially important for multifocal IOLs and … More
1118: Playlist: IOL Loading
Loading the IOL into the injector cartridge is a skill that every cataract surgeon must master. In my private practice … More
1107: IOL exchange of very unusual IOLs
Master surgeon Dr. Val Apostolov from Amsterdams shares with us some unusual cases. These are both IOL exchange surgeries for … More
1085: Zero power IOL for ultra myopia
Welcome to my operating room at our Beverly Hills surgery center. In this video we will discuss cataract surgery in … More
1078: Cataract Quiz – you see this post-op
You did surgery for this patient yesterday and she is so happy with 20/30 vision today. She started with a … More
1075: Can I use EDOF with eye disease?
I am frequently asked if the new class of EDOF (extended depth of focus) IOLs can be used in eyes … More
1062: Playlist: Refractive Issues
The most powerful refractive surgery that we have is cataract surgery. We can address +10 diopters or more of hyperopia, … More
1058: Quiz: Why did the IOL decenter?
Time for a Cataract Quiz and it features a case sent to us by Dr. Valentin Bachet from Lille, France. … More
1056: Let’s talk about my OR cases
Recently, on my usual Beverly Hills cataract surgery day, I had a line-up of a bunch of interesting cases and … More
1051: Fixing the Upside Down IOL
When we inject an IOL, we must ensure that it goes into the eye (either in the capsular bag or … More
1050: complete case: Toric EDOF IOL
This patient is a young man, in his 40s, with a history of cataract development over the last few years. … More
1011: Opacified IOL Exchange
While it is rare, some IOLs can become opacified with time. This has been reported primarily with hydrophilic acrylic materials … More
1003: Why did the patient go elsewhere?
This video shows two complete surgeries, both presented at high speed. The original cataract surgery was performed by me and … More
iris claw lens to address aphakia
Another excellent video from our colleague Dr. Val Apostolov from Amsterdam. In this case there is a patient with a … More
highly myopic cataract surgery
These are some of the most rewarding cataract surgeries to perform since we can correct the cataract as well as … More
Recovering from misloaded IOLs
We count on our surgical techs and assistants to help with certain parts of the cataract surgery. One of these … More
Extended Depth of Focus: Alcon Vivity
We all want to be young again, at least when it comes to vision: visual quality, range of vision, and … More
IOL design differences
We have many different IOL designs available for use in cataract surgery and even within the most popular category (single-piece, … More
Fixing IOL-induced UGH Syndrome
UGH syndrome is the triad of uveitis, glaucoma, and hyphema which all can be induced as a complication from sulcus … More
Twist and Out to Explant IOLs
I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10 … More
How to dissect the IOL out of the bag
When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of the … More
Cataract Quiz: What happened here?
Our quiz features a video from Gustavo Hüning, MD, MBA from Brazil and it shows an unusual situation that happens … More
Angle Alpha and Angle Kappa with IOLs
If an IOL has zero power, such as in an extremely myopic patient, where we place it in the eye … More
compilation video: IOL exchange
Every cataract surgeon needs to learn how to perform an IOL exchange because, although it is rare, we sometimes need … More
compilation video: suture-fixated IOLs
This video features all sorts of suture-fixation techniques for securing IOLs in cases where there is limited or no capsular … More
Equanimity under Duress
When Sir William Osler left the University of Pennsylvania’s Medical School (the first one in the USA, started in 1765) … More
Review: Yellow versus Clear Optics
There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a … More
Cataract Quiz: What’s wrong with the IOL?
Time for a Cataract Quiz, featuring guest surgeon Dr. Sourabh D. Patwardhan from India, featuring a complication with an IOL. … More
Fixing severe capsular phimosis
In a small number of patients, capsular phimosis can happen after cataract surgery. This can lead to severe distortion of … More
Lessons Learned with 3-piece IOLs
Most cataract surgeons now use single-piece acrylic IOLs for the majority of their cases, with three-piece IOLs reserved for unusual … More
Cataract Quiz: IOL with capsule tear
Cataract Quiz time: you have removed the lens nucleus and the cortex and you see that the anterior capsular rim … More
Should you use a trifocal IOL in Fuchs’?
This is an unusual case: the patient has Fuchs’ Corneal Dystrophy and yet we are implanting a trifocal IOL. Usually, … More
Review: Small Eye with high power IOL
Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10 … More
IOL cartridges – which one?
There are many different IOL injector systems from multiple different IOL manufacturers. It is the surgeon’s job to know the … More
Cataract Surgery with Asteroid Hyalosis
Asteroid hyalosis is a rare condition where patients have calcifications throughout the vitreous jelly. It occurs in about 1-2% of … More
Scleral-sutured IOL with GoreTex
This is an unusual case of prior trauma. A 13 year old boy was playing with fireworks and sustained a … More
IOL delivery technique
While it seems relatively easy to insert the IOL with an injector system, there are subtleties in the technique which … More
Mastering IOL Flange Techniques
In cases of insufficient zonular support, using a flange technique has become popular after Dr Shin Yamane shared his technique … More
Cataract Quiz: Optic-Iris Capture
Happy New Year! It’s Quiz Time: how do you approach this case with optic-iris capture and a dense fibrotic membrane? … More
Cataract Quiz: What is the problem here?
Time for another Cataract Quiz. Look carefully at the photo — the IOL has just been implanted and now it … More
The surgeon will struggle to finish. Why?
In this resident surgeon case, the anterior chamber flattens and there is loss of viscoelastic upon attempted manipulation of the … More
Cataract Quiz: Why is there a capsular wrinkle?
This surgery seemed quite routine. A nice capsulorhexis, easy nucleus removal, and complete cortex clean-up. The three-piece IOL was placed … More
Three-piece IOL: B versus C cartridge
There are two options for injecting an Alcon three-piece IOL using the Monarch injector: the B cartridge is bigger and … More
Why implant a zero power IOL?
This patient is ultra-myopic with an axial length of more than 31 mm. Using the free calculator at IOLcalc.com we … More
Cataract Quiz: Why is this cortex so adherent?
This seemed like a completely normal case… until it came time for removal of the last bit of cortex, which … More
Cataract Quiz: What complication will happen next?
Cataract Quiz: look carefully at the IOL in the injector cartridge. Now it’s time to implant the IOL into the … More
Guest Surgeon PanOptix Tips & Tricks
In the USA, we often get access to new technologies later than other countries due to the hurdles required to … More
Clear Optic versus Yellow-Tinted
There has been much debate about the light transmission properties of various IOL optic designs. While most IOLs have a … More
Initial Review of the Alcon PanOptix IOL
The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How … More
Review: Understanding Purkinje Images
Intra-ocular lens implants which are well-centered can provide better quality of vision for our cataract surgery patients. In the ideal … More
Quiz: What is happening in this eye?
Look carefully at this photo taken at the slit-lamp microscope. What is happening in this eye? Describe what you see … More
Learning Surgical Pearls from Colleagues
There are all sorts of surgical pearls that we can learn from our colleagues. Different techniques and methods of making … More
Review: How to Handle IOL Haptic Twist
When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL … More
Quiz: What is going on with this IOL haptic?
The surgery has gone very smoothly and the senior resident is doing a great job. The incisions are good, the … More
Resident surgeons must learn to load the IOL
The surgeon must know how to do every single part of the surgery, including setting up the phaco machine and … More
Alcon PanOptix Trifocal IOL Performance
In the USA, the FDA has recently approved the Alcon PanOptix IOL for use in cataract surgery. This is a … More
Cataract Surgery with High Power IOL placement
Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10 … More
Cataract surgery & Phakic IOL removal
Posterior chamber phakic lens implants can effectively treat a large degree of myopia while retaining the accommodation of a youthful … More
Capsular Tension Rings in Cataract Surgery
Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to … More
Which viscoelastic for the IOL injector?
We know that a dispersive viscoelastic will protect the corneal endothelium better during phacoemulsification of the lens nucleus. And a … More
Does age make a difference in IOL surgical planning?
We have some amazing surgical technology now with IOLs that give a wide range of vision and can even help … More
Take Pride in your Cataract Surgery Signature
Many ophthalmologists will perform tens of thousands of cataract surgeries during their careers and each of these procedures can improve … More
Review: How to load and inject a single-piece IOL
Let’s review a routine case, this time with a toric IOL. All surgeons in training must know how to properly … More
Quiz: What is the Problem that you see here?
This video has been sent to us by an anonymous resident surgeon in training. During this case there was a … More
Options for IOL Explant: Twist or Cut
In rare cases, we may need to explant the IOL and replace it with a different IOL for a different … More
Switching from a Toric IOL to a spherical sulcus IOL
We recently featured a four-part series of a single, complicated cataract case in which the phaco probe punctured the posterior … More
Posterior Capsule Break with a Toric IOL in the bag
The posterior capsule sustained a break during phaco which was near the capsular bag equator and not immediately noticeable to … More
IOL Calcs: PLUS Precision Ladas Universal Superalgorithm
The future of IOL calculations is with methods that can evolve. A static formula is a time-limited method which will … More
Basics: How to Load and Inject a Three-Piece IOL
In the USA, the most commonly used IOL in routine cataract surgery is a single-piece acrylic IOL. These IOLs work … More
Quiz: What is the problem here? Look Carefully!
This case seemed like a routine cataract surgery. Everything went smoothly. A good incision, a nice round capsulorhexis, easy removal … More
The IOL is stuck in the incision! What should we do?
This valuable teaching video was submitted by an anonymous resident who is still in training. In this surgery, a smaller … More
We must Align and Center a Toric Diffractive IOL
With new technology IOLs, we have the ability to address corneal astigmatism as well as provide a wide range of … More
LensGen Juvene IOL presentation from 2019 ASCRS meeting
For those of you who missed the 2019 ASCRS Meeting (American Society of Cataract & Refractive Surgery) meeting in San … More
Quiz: Why won’t this IOL stay centered?
This case seemed 100% normal. Reasonable dilation, good zonular support, 5-mm round capsulorhexis, phaco chop, and a normal capsular bag. … More
Old IOL explanted, then new IOL sutured to the Iris
This patient had a prior cataract surgery with a single-piece acrylic IOL precariously placed into a compromised capsular bag. This … More
Why Lens Geometry is important for IOL Calcs
The geometry of the IOL is important for IOL calculations and it must be taken into consideration. Yet, we learn … More
Quiz: Which ACIOL is in the correct orientation?
An anterior chamber IOL (ACIOL) is rarely used, but in cases with no capsular support, it can be very helpful … More
Dual Optic, Curvature Changing, Full Range Presbyopic IOL
Imagine an IOL for cataract surgery that mimics the human lens with the ability to give a wide range of … More
Why implant an IOL if the power is Zero?
Sometimes, in a very myopic eye, the desired IOL power will calculate to zero diopters. An IOL of zero diopters … More
Would you implant a CTR: Capsular Tension Ring?
This challenging cataract case has loose zonular architecture globally, not focally. There is no prior trauma and there is not … More
Quiz: Why does the IOL optic look cloudy?
This patient had cataract surgery with the same IOL about 18 years ago and she did very well for many … More
Misloaded IOL rips open the posterior capsule
An anonymous surgeon submitted a video of a complication that happened with a misloaded IOL injector. We are thankful for … More
Twist Technique to Easily Explant the IOL
There are times when we need to explant an IOL from the eye. This can be at the time of … More
What is the 7L rule for haptic orientation?
You must know instantly if the IOL is being implanted in the eye correctly. We have explained how the IOL … More
Inject more OVD before manipulating the IOL
When we insert the IOL, sometimes viscoelastic will be lost via the main incision. This can happen if we gape … More
Technique to suture an IOL to the iris
Sometimes, the IOL can dislocate after surgery and in the case of a three-piece IOL, we can easily suture the … More
Controlled IOL delivery during Cataract Surgery
In the past few days we have shown cases where the IOL delivery was less than ideal. This resulted in … More
Misloaded IOL leads to fractures of the optic
In this case, an ophthalmologist in training is performing this surgery during his residency program. The case looks great, but … More
Misloaded IOL shoots out of the injector
The new scrub technician was working with us for the first time. She had previously assisted with ophthalmology surgeries in … More
Mystery Case: What are these linear marks?
You’re doing a routine case and it is progressing beautifully. A good incision, a centered 5-mm capsulorhexis, efficient nucleus removal, … More
Which direction do you rotate the IOL?
Which way should you rotate the IOL, clockwise or counter-clockwise? The answer is… it depends. If the IOL haptics are … More
Important Lesson from a Misloaded IOL
I had a case recently, where the surgical assistant told me that he was having difficulty loading the IOL into … More
Why did the IOL Haptic get stuck to the Optic?
We use thin IOLs which are then placed into injectors which roll, fold, or compress the them so that … More
How to inject a 3-piece IOL when the haptics twist
When we inject a three-piece acrylic IOL into the eye, we must be very careful to ensure that the IOL … More
Tips & Tricks for High-Power IOL Delivery
A high-power IOL is not the same as an IOL with an average power, primarily because the increased power of … More
Phaco Chop with Surgeon-Loaded Toric IOL
Yesterday’s video was a complete toric IOL case from marking to alignment, however the IOL was loaded by the technician … More
How to deal with a Mis-loaded IOL
There are occasions when we will be handed an IOL which has been loaded incorrectly into the injector system. It … More
Using Purkinje Images for IOL Centration
Intra-ocular lens implants which are well-centered can provide better quality of vision for our cataract surgery patients. In the ideal … More
Wound-Assist Technique for IOL Delivery
The switch from large-incision manual extracap cataract surgery to smaller-incision phacoemulsification was helped tremendously by the advent of foldable IOLs. … More
Can we prevent negative dysphotopsia?
Jack Holladay, MD, MSEE was instrumental in describing the causes of negative dysphotopsias with his enigmatic penumbra explanation. Sam Masket … More
Cataract Surgery with Traumatic Zonular Loss
Are you ready for a challenge? This patient is a relatively young construction worker who sustained a blunt traumatic ocular … More
Misloaded IOL in a Floppy Iris Cataract Case
Even the best surgical technicians can have a case where the IOL is misloaded into the injector. It is up … More
Routine Toric Case with Surgeon-Loaded IOL
Again, time to learn from a routine case — this is the type of case that is your “bread … More
Comparison of Night Vision with Different IOLs
Patients often ask me if any of the new lens designs will give them youthful vision. The truth is that … More
Should you do a Primary Piggyback IOL?
In highly hyperopic eyes and nanophthalmic eyes the required IOL power can be very high, sometimes in excess of +40 … More
Single-Piece Acrylic IOL Injector Loading
All beginning cataract surgeons must know how to load the IOL into the injector for cataract surgery. While this seems … More