5 Key Takeaways

• 1

  At the AAO 2026 Meeting, a case-based panel presented a systematic approach to evaluating patients dissatisfied with vision after cataract surgery despite good Snellen acuity.

• 2

  The panel recommended assessing ocular surface disease first because dry eye, meibomian gland dysfunction, and other surface abnormalities can degrade vision and affect biometry.

• 3

  Subtle corneal abnormalities, including irregular astigmatism, ectasia, and Fuchs dystrophy, may require topography, tomography, or higher-order aberration assessment to identify.

• 4

  Residual refractive error, anisometropia, monovision intolerance, and unmet expectations for spectacle independence can contribute to dissatisfaction.

• 5

  IOL-related causes include dysphotopsia, tilt, decentration, and capsular factors; surgical options discussed included optic capture, lens exchange, and piggyback strategies.