Consensus-based recommendation for presbyopia-correcting intraocular lens use and patient selection: a Delphi study

We conducted a Delphi study to establish expert consensus on the benefits, limitations, and patient selection of current presbyopia-correcting intraocular lenses (IOLs), including trifocal and extended depth of focus (EDOF) IOLs, with particular focus on their clinical and economic value and barriers to adoption. An expert panel of 22 cataract surgeons in Japan completed two rounds of anonymous electronic questionnaires to achieve consensus on key topics. Questionnaires collected demographic information, qualitative items rated on a 5-point Likert scale, quantitative items, and open-ended responses to elicit additional practice-related insights. Consensus was predefined a priori as ≥ 80% agreement. Panelists had a mean of 30.1 years (range: 12–47 years) of cataract surgery experience. Consensus was reached for 33 of 34 statements. The panel agreed that, when used in appropriately selected cataract patients, presbyopia-correcting IOLs substantially improve patient satisfaction and vision-related quality of life. Compared with monofocal IOLs, trifocal IOLs were preferred for patients prioritizing strong intermediate vision and greater spectacle independence, whereas EDOF IOLs were viewed as providing a broader continuous range of clear vision and better contrast sensitivity. Optimal outcomes were considered highly dependent on careful patient selection and counseling on the incremental value and trade-offs of presbyopia-correcting IOLs. The panel identified key barriers to broader adoption, including out-of-pocket costs, limited familiarity with payment models, and the need for stronger comparative clinical evidence. These findings provide guidance for more successful integration of presbyopia-correcting IOLs into cataract practice. Personalized IOL selection, supported by patient education and clear discussions about costs, can help surgeons align treatment with patient goals, improve satisfaction, and overcome barriers to presbyopia-correcting IOL adoption in Japan and worldwide.