ESCRS forms Functional Vision Working Group

Should enhanced monofocal intraocular lenses (IOLs) be the standard of care? Can IOLs be classified in such a way as to avoid mixing categories and prevent confusion for the user? A group of ESCRS members are working to answer these and similar questions and produce a functional classification that more directly correlates with the effect on patients’ quality of vision. 

The ESCRS Functional Vision Working Group, formed by ESCRS President Filomena Ribeiro and led by Research Committee Chair Joaquín Fernández, announced its intentions in a report in the August issue of the Journal of Cataract & Refractive Surgery, which is jointly published by ESCRS and its US counterpart, ASCRS.

“Classifying intraocular lens (IOL) technologies is not an easy task, primarily because of the various categories that can be integrated into a classification,” the working group stated. “Some of these categories represent different characteristics that may be inappropriately combined in an attempt to create a simplified taxonomy, which is not always feasible. Therefore, when defining an IOL, it is crucial to differentiate between various categories and avoid mixing them, to prevent confusion for the user.¹

The working group’s report listed categories, subcategories, and options used to classify IOLs, reviewed the optical technologies historically used to classify IOLs, discussed the four main categories of IOLs recognized by the International Organization for Standardization, and presented an evidence-based functional classification that incorporates the scientific method. The report concluded that shifting to a functional vision classification is important because it more directly correlates with the effect on patients’ quality of vision—but conceded additional functional outcomes (such as patient-reported outcomes) should be included in future analyses.

The working group also authored a guest editorial in the same issue of the JCRS titled “Should enhanced monofocal intraocular lenses be the standard of care? An evidence-based appraisal by the ESCRS Functional Vision Working Group.”² The editorial presented the results of a literature review to analyse the level of scientific evidence on enhanced monofocal IOLs. The working group concluded the literature review justified the use of enhanced monofocal IOLs as the standard of care in cataract surgery, but noted studies are still needed to demonstrate their cost effectiveness vis-à-vis conventional monofocal IOLs.

In addition, the working group met at the ESCRS Annual Congress in Barcelona. The meeting was designed to serve as a foundational session toward building a global consensus for adopting an evidence-based functional classification that integrates patient-reported outcomes. Building this consensus will require including scientific societies, standards organisations, and industry in discussions.

“With an evidence-based approach, the ESCRS Functional Vision Working Group aims to ensure that decisions in cataract surgery not only reflect the true visual needs of the patient, but also advance the field of ophthalmology and strengthen ESCRS’s role in shaping global standards of care,” Dr Fernández said.

1. Ribeiro F, Dick HB, Kohnen TM, Findl O, Nuijts R, Cochener B, and Fernandez J. “Evidence-based functional classification of simultaneous vision intraocular lenses: seeking a global consensus by the ESCRS Functional Vision Working Group,” Journal of Cataract & Refractive Surgery, 2024 Aug; 50(8): 794–798. doi: 10.1097/j.jcrs.0000000000001502

2. Ribeiro F, Pinero D, Dick HB, Findl O, Cochener B, and Kohnen TM. “Should enhanced monofocal intraocular lenses be the standard of care? An evidence-based appraisal by the ESCRS Functional Vision Working Group,” Journal of Cataract & Refractive Surgery, 2024 Aug; 50(8): 789–793. doi: 10.1097/j. jcrs.0000000000001479