Objective:

The AAO 2026 case-based session presented a systematic approach to identifying causes of poor visual quality and dissatisfaction after cataract surgery, including in patients with good Snellen acuity.

Approach:

• Ocular surface: Assess dry eye, meibomian gland dysfunction, epithelial basement membrane dystrophy, tear-film instability, and corneal staining; stabilize surface disease before further refractive or surgical intervention.
• Refraction and expectations: Evaluate residual sphere or cylinder, refractive target miss, anisometropia, monovision intolerance, spectacle dependence, and differences between the achieved result and patient expectations.
• IOL-related causes: Assess dysphotopsia, unwanted photic phenomena, lens tilt or decentration, and capsular factors. Discuss surgical options only after considering whether they are likely to improve symptoms.

Key Findings:

• Good Snellen acuity does not rule out substantial dissatisfaction or symptoms such as glare, halos, fluctuating vision, reduced contrast, and dysphotopsia.
• The panel recommended identifying the dominant cause through a consistent evaluation of ocular-surface, corneal, refractive, optical, and IOL-related factors.
• Patient expectations, including anticipated spectacle independence or near vision, may contribute to dissatisfaction.

Interpretation:

The session focused on evaluating postoperative dissatisfaction beyond Snellen acuity by systematically considering ocular-surface, corneal, refractive, optical, and IOL-related causes, as well as patient expectations.

Limitations:

• The context describes a case-based educational session, not a clinical study; it provides no patient-level outcome data or comparative evidence for the approaches discussed.

Conclusion:

The panel recommended identifying the dominant cause of postoperative dissatisfaction before considering further refractive or surgical intervention.

Sources:

• Article context: Decoding Cataract Dissatisfaction