Intraocular lens selection in US cataract surgery: a prospective survey informing an expert-derived clinical decision tool

Background: Advanced-technology intraocular lenses (IOLs) can provide greater spectacle independence compared with monofocal IOLs, without significantly compromising visual quality. However, usage rates are variable and lower than those of monofocal lenses. Research, design, and methods: This prospective survey study investigated practice patterns and perspectives on IOL selection among a representative sample of US cataract surgeons (‘surgeons’; N = 127) and in those with recognized expertise in advanced-technology IOLs (‘experts’; N = 7). Using survey findings, an expert panel identified knowledge/confidence gaps.Results: Optical biometry was considered essential by 87.4% of surgeons and 100% of experts. Confidence in IOL selection was high (78.8% vs 100%), while 53.5% vs 100% offered advanced-technology IOLs to all qualifying patients. Confidence in post-operative management of advanced-technology IOLs was lower among surgeons (42.5%) than experts (100%). Experts reported a 30% lower threshold for treating astigmatism with toric IOLs than surgeons (0.71 D vs 1.01 D) and showed more consistent decision-making patterns driven by patient factors.Conclusions: Findings indicated variability in IOL-selection confidence and decision-making patterns, pre-operative assessment rigor, and comfort with postoperative management, highlighting opportunities for targeted education and standardization. An IOL selection decision-making tool was outlined to support IOL-selection standardization based on objective clinical criteria and subjective patient factors.