First the Patient, Then the IOL

To achieve patient satisfaction in refractive and cataract surgery, even a perfect surgical performance is sometimes not enough—effective communication plays an important role, according to Andrea Janeková MD, PhD.

This disconnect becomes clear in practice: despite all the perfect biometrics, refractive outcomes, and measurements, patients can still be unhappy after a surgery. The same surgeon with identical precision and skill set can implant the same type of IOL in two different patients and deliver different final outcomes.

“The difference is the expectation from the surgery,” Dr Janeková said. “When I start my consult with patients who want to be spectacle independent, I start with their lifestyle, not with the type of IOL, to better select the best options to solve their problems.”

Simple and direct communication, she stressed, can enhance the establishment of a good relationship between ophthalmologists and their patients, which helps in making the right IOL choice. Discussing complicated and technical optics with older patients is not useful in cataract surgery. Another effective strategy is to honestly reframe patient concerns about glare and halos as a brain adaptation to new optics rather than a problem, so they understand halos and glare are not necessarily postoperative complications.

Full transparency about costs and outcomes to manage patient expectations is fundamental. Key considerations about the economics of presbyopia vary for different patient groups, like moderate myopes, early presbyopic patients, or those who underwent corneal refractive surgery. These considerations can pose challenges that can limit the surgeon’s choice of technology, even though the motivation to get rid of the glasses is high. Dr Janeková suggested written documentation as a useful and dependable tool to protect the bond of trust between surgeon and patient.

Overwhelming patients with too many options and promising absolute spectacle independence are counterproductive, according to Dr Janeková. A surgeon must be clear and honest about every risk and issue surrounding the surgery, as not all presbyopic patients are the same.

Age matters in the evaluation of the expectations and tolerance for trade-offs. Younger patients are more likely to be active, have lower tolerance for visual effects, and want to get rid of glasses as soon as possible. The best strategy to take with this demographic is to share the decision-making process and manage their expectations. Conversely, older patients will want to improve their visual outcomes and will be more accepting of visual effects, focusing more on procedure safety. They do require clarity, reassurance, and simple communication strategies. Yet, as Dr Janeková emphasised, personalisation according to the patient’s case and lifestyle—and not age alone—drives final satisfaction.

The long-term value of the surgery and the shared decision making between patients and doctors are invaluable in the process leading to successful ophthalmic surgery, she stressed. Bearing this in mind can greatly help patients to change their life for the better.

“We are not just implanting lenses, we are implanting expectations, and clear communication before surgery helps us make our patients happy after the procedure,” she concluded.

Dr Janeková spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Andrea Janeková MD, PhD, FEBO, FEBOS-CR is Head Physician of Cataract, Refractive, and Vitreoretinal Surgery, Prague Eye Centre, Czech Republic. janekovaandrea@gmail.com