Issuu

The Global Eye Care Issue December 2025 cakemagazine.org

The Value of Vision

The economic case for universal eye care p28

Letter to Readers

Blurred Lines and High Beams When aging eyes meet blinding headlights, night driving becomes the ultimate vision test…and not everyone’s passing with flying colors. Dear Readers,

'm so tired of driving at the moment. I spent last week in the UK. I flew to Manchester, picked up a hire car (the delightful Nissan Qashqai), picked up my son, and we drove to Glasgow to spend the week with his Scottish side of the family—and I did the reverse trip a week later. I came to the conclusion that most drivers in the UK must have glaucoma. The drivers appear to have no peripheral vision whatsoever. In fact, they also seem to be quite myopic. Time after time, drivers failed to notice they were closing in on a slower vehicle in front of them. Then, despite—as the law tells them they should—looking in their mirrors, they fail to see the cars about to pass them in the overtaking lane, forcing these cars to brake suddenly and leaving a tiny gap between the interloper and the person they've just cut up. Worse, these drivers seem to have an arm and finger spasm problem that's photosensitive. When flashing the headlights to signal “Hey! I am here, you know,” one of their arms rises and their middle digit raises for a few seconds. I jest, of course. This is just people driving around in a bubble of entitlement. But there's more to visual impairment and driving than you'd first think. Let's begin at night. Aging eyes and night driving are a match made in hell. We all know the higher-order aberrations that affect drivers with multifocal IOLs in their peepers, but have you considered those before surgery? The clouding that starts in people's twenties and develops into incipient cataract in their forties, until it's full-symptom time in their sixties, is a disaster for light scattering at night—especially with the high-powered, blue-rich “white” LED light used in most modern cars these days. Add to that a little moisture inside the windscreen, and it's instant un-fun time: between 2 and 5 in every 10 drivers aged between 59 and 96 in California reported giving up driving at night entirely. When you consider the high prevalence of other age-related ocular morbidities (AMD, glaucoma and even my incipient bugbear, presbyopia), you have to wonder if the other 5

CAKE MAGAZINE | December 2025

to 8 in every 10 should continue driving at night for too much longer either. But when the theme of this issue is that the benefits of bringing improved sight to people pay dividends, it's a little unsatisfactory that those with old eyes can't drive their Old('s)mobile. We all age, and we can all be economically active, and frankly, in most developed countries, a car can certainly help with that. What can be done? From your point of view, if you're a cataract surgeon, and if the patient wants a multifocal IOL, there are several IOLs that are coming to market or have recently arrived that should have a better HOA profile at night than previous generations. You can suggest some glare-reducing driving glasses. But really, this is an issue that both the government and society need to take to task. Despite the hype, self-driving cars just aren't good enough to safely drive us all around at night, and very few people have access to them, even today. Car headlights are getting smarter (my car switches off the “matrix” LEDs that would illuminate other cars and even highlights road signs as I approach them), but these are still very expensive, and the U.S. has only just made these headlamps legal—so it's going to be a long time (especially in the U.S.) until most cars have them. In the meantime, the best thing we can all do is drive a little more carefully and considerately, create a bit more space on the roads, and clean our windscreens well. And if you're weekend driving on the M6 or the M74 in the UK, drive a bit more defensively than usual, because you've been warned now that the standard of driving on display there is...appalling.

Cheers,

Mark Hillen, PhD

Director of Communications ELZA Institute, Zurich, Switzerland Editor-At-Large | CAKE

In This Issue...

Cataract

Anterior Segment

05 08 10 12 14

16 18 20

Finding the Eye’s Natural Balance Alcon Unveils Unity® VCS and Unity® CS in India Merging Cataract and Retina on One Stage Riding the Wave(front) of Innovation with SIFI IOLs Setting the Stage for Perfect Vision Welcome to Teleon’s IOL Buffet

One Orchestra, Two Coordinated Sections

Monocular trifocal in exacting emmetropes Elara 900 Brings the Slit Lamp Into the 21st Century Eye Banking Through the Ages

Progress, challenges and the road ahead

Stumped By Ocular Surface Disease?

European eye care practitioners might want to “Look at the Lids” for Demodex blepharitis

AI’s Blind Spots

Why biased algorithms could worsen eye care for millions

Cover Story

The Value of Vision

The economic case for universal eye care

Kudos

Enlightenment

Restoring Childhood

What does it take to give sight—and childhood—back to a generation?

Haag-Streit: A “Year of Innovation”

Lights, Camera, Incision

How video rewired surgical learning

The Gender Lens

Improving eye care access for women and girls

CAKE MAGAZINE | December 2025

Advisory Board Members

Matt Young CEO & Publisher Gloria D. Gamat Chief Editor

Dr. Harvey S. Uy

University of the Philippines; Peregrine Eye and Laser Institute, Manila, Philippines harveyuy@gmail.com

Dr. Francis Mah

Scripps Clinic Medical Group La Jolla, California, USA Mah.Francis@scrippshealth.org

Diana Truong Associate Editor Maricel Salvador Graphic Designer Writers April Ingram Chow Ee-Tan Elif Uslu Hazlin Hassan Kendra Bruning Tan Sher Lynn Contributors Andreas F. Borkenstein, MD Dr. Shilpa Ghosh

Dr. William B. Trattler

Center For Excellence In Eye Care Miami, Florida, USA wtrattler@gmail.com

Dr. Cathleen McCabe The Eye Associates Sarasota, Florida, USA

cmccabe13@hotmail.com

Matt Herman Head of Content Strategy

Hannah Nguyen COO Travis Plage CFO Ruchi Ranga Society Relations & Conference Manager

Prof. Burkhard Dick

University Eye Hospital Bochum Bochum, Germany burkhard.Dick@kk-bochum.de

Prof. Dr. Sorcha Ní Dhubhghaill Brussels University Hospital (UZ Brussel) Brussels, Belgium nidhubhs@gmail.com

International Business Development Brandon Winkeler Robert Anderson Sven Mehlitz

Published by

Media MICE Pte. Ltd.

6001 Beach Road, #09-09 Golden Mile Tower, Singapore 199589 Tel: +65 8186 7677 Email: enquiry@mediamice.com www.mediaMICE.com

CAKE MAGAZINE | December 2025

PHACOEMULSIFICATION

ataract

Finding The Eye’s Natural Balance Surgeons are starting to embrace near physiologic IOP during cataract surgery, and they’re finding calmer chambers, happier patients and smoother cataract cases… proof that sometimes, nature really does know best. Sponsored by Alcon

Image: Shutterstock AI/Shutterstock.com

ometimes, the eyes prefer the way nature made them. Thanks to advances in surgical equipment and devices, cataract surgeons can now operate at nearphysiological intraocular pressure (IOP) without sacrificing safety, efficiency or outcomes.1

glaucoma specialist break a sweat. “IOP can go as high as 80 to 90 mmHg during surgery,” said Dr. Vasavada. “In glaucoma, we are worried about 21 to 23 mmHg—and here we are operating at 60, 70 or 80 mmHg without any fear.”

for adopting physiological IOP. The study showed that using lower bottle heights and flow rates led to significantly better outcomes2, prompting the need to explore even lower settings with Alcon’s CENTURION (Alcon, Geneva, Switzerland).3

To understand why this approach is gaining momentum, we spoke with Dr. Shail Vasavada (India), a pioneer in low IOP cataract surgery and an advocate for bringing cataract procedures closer to the eye’s natural pressure.

“We realized that if we could go lower with INFINITI, we could go lower with CENTURION.4 That was the tipping point for us.”

What they discovered was compelling and prompted Dr. Vasavada to explore even lower settings with Alcon’s upgraded system. “We realized that if we could go lower with INFINITI, we could go lower with CENTURION.4 That was the tipping point for us,” he recalled.

Why surgeons are switching to physiological IOP During cataract surgery, IOP can spike to levels that would make a

Lower pressure prioritizes safety during surgery

- Dr. Shail Vasavada

Dr. Vasavada said that a study with Alcon’s INFINITI gravity-based fluid system was his turning point

Patient safety was the top concern when Dr. Vasavada first began experimenting with low IOPs. Would

CAKE MAGAZINE | December 2025

ataract

PHACOEMULSIFICATION

the chamber remain stable? Would the risk of posterior capsule rupture rise?

“You finish the surgeries much faster1 because you have fewer intraoperative issues, like iris flutter, pupil coming down during the surgery or anterior chamber fluctuations7, so, it’s more efficient timeand surgery-wise.”7 - Dr. Shail Vasavada

To get answers, Dr. Vasavada and his colleagues studied two groups: one operating at 20 mmHg and low flow rates, and another at 55 mmHg and high flow rates. Similar to other studies, they found that the low-IOP group had better occlusion break response, surge control and more stable pressures.2,5 In addition, a 2022 study demonstrated a significantly higher preservation of endothelial cell density at both day 4 and the 3-month follow-up when using near-physiologic IOP (20 mmHg) compared to high IOP (50 mmHg).6 Notably, this is a compelling finding because the phacoemulsification machine settings were nearly identical between the two [IOP] groups. “Although it may sound counterintuitive, low intraocular pressure may have benefits6— even for surge response and other issues,” he said. “You finish the surgeries much faster1 because you have fewer intraoperative issues, like iris flutter, pupil coming down during the surgery or anterior chamber fluctuations7,” he explained. “So, it’s more efficient time- and surgerywise.”7

Happier patients, fewer surprises Patients are simply more comfortable8, too. When cataract surgery is performed at 20 to 30 mmHg IOP instead of the traditional 50 to 60 mmHg, according to Dr.

Vasavada, more patients had corneal clarity (94.6% vs 69.0% in the high IOP group, p<0.01), more had mild edema resolving by week 1, patients reported significantly reduced perioperative pain (1.67 vs 3.19 on a 10-point scale, p<0.01)—all these directly can contribute to faster visual recovery and potentially fewer postoperative visits.1 Operating at lower IOPs also helps protect delicate intraocular structures. It demonstrated less retinal microvascular disturbance (i.e. posterior-segment circulation), found no increase in complications and reported less retinal changes.9 Another benefit Dr. Vasavada has noticed? The lack of disruption to anterior chamber structures as evidenced by less postoperative inflammation, less disruption to the corneal endothelium, and less corneal edema in the early postoperative period.10 “Having a few central Descemet’s folds was very common, particularly with denser cataracts and we would counsel patients that you'll have a longer recovery time—and now we no longer have to do that.”

Lower pressure, smoother surgeries A common misconception is that operating at lower IOPs have detrimental effects on the cornea and anterior segment. In reality? Cataract surgery at a nearphysiologic IOP showed a higher preservation of endothelial cell density versus high IOP (50 mmHg).6 Smoother surgeries with fewer complications also creates a better patient experience, which can enhance their overall perception of cataract surgery.

A valuable edge in challenging cases “[Physiological IOP]6 definitely gives us an edge in difficult case scenarios, especially in young patients with posterior polar cataracts,” said Dr. Vasavada. “You don’t want a high IOP intraoperatively because the posterior capsule is very fragile.”11 Patients with extremely high myopia also benefit from lower

CAKE MAGAZINE | December 2025

intraoperative IOPs.1,8 “They feel the stretch, they feel the pain and surgeons find it very difficult—even with low bottle heights—to actually reach the nucleus,” he continued. Operating at lower IOPs can make cataract surgery less painful and more comfortable for these patients.

Bringing physiological IOP into the OR Thinking about lowering intraoperative pressure to something closer to the eye’s natural state? Dr. Vasavada has some practical advice for putting the concept into practice.

Don’t get stuck on a #1 particular number.

“When we say physiological IOP, it doesn't always mean 20 mmHg for every eye. It may mean a range,” he noted. Dr. Vasavada’s sweet spot is typically 20 to 40 mmHg, but he’ll generally work between 20 to 30 mmHg. For example, when he’s chopping or dividing the nucleus, he operates at 20 mmHg. During fragment removal, he increases the IOP to about 30 mmHg. If you’re transitioning to a fluidicsbased system, he recommends starting around 50 mmHg, which is already equivalent to a 75-cm bottle height in traditional setups. “Once surgeons are comfortable with the machine, I would gradually start lowering IOP by 10 mmHg,” he said, “until they find their own ‘sweet spot’.”

Embrace technological #2 advances.

According to Dr. Vasavada, two Alcon innovations have made the lower IOP surgical approach practical: • CENTURION’s Active Fluidics keeps the chamber stable regardless of the parameters used.3 • The Active Sentry handpiece places a pressure sensor right at the phaco probe level, giving a faster response to surge mitigation.4 “The Active Fluidics and the Active Sentry handpiece combine5,13 to improve efficiency,” he said.

Although many surgeons worry about increased surge when operating at low IOPs and higher vacuum settings, Dr. Vasavada explained that complete occlusion is rare, and the balanced tip and cutting efficiency of the phaco probe make a difference.3

evolving, sometimes you get left behind.”

his surgical performance, patient comfort1,8 and his overall outcomes.3

“Keep an open mind,” he continued. “Try it out, and then decide whether it works for you, rather than having a fixed mindset of ‘this is how it is, and this is how it will be'."

“With the Active Sentry handpiece5-6, the pressure and surge response is so fast that even if I’m working at an IOP of 20 mmHg and a maximum vacuum of 700, I’m not worried about the posterior capsule or surge at all,” he noted.

He said that operating at near physiological intraocular pressures has definitely helped him improve

“I would urge everyone that it's time—we've been doing things far too long in the same way,” he concluded. “It's time that we refine it even further and take the next step. The willingness to evolve in the pursuit of better patient outcomes stands as both a privilege and an obligation for every surgeon.”

1. Sarossy A, Chakrabarti R. Physiological Intraocular Pressure in Cataract Surgery: A Comparative Consecutive Case Series Study. Clin Ophthalmol. 2025;19:2289-2294.

Make reductions in the transition. In the initial

transition period, when you’re lowering IOP, Dr. Vasavada advised to lower both the aspiration flow rate and vacuum. For example, if you use an aspiration flow rate of 40 to 45 cc per minute, reduce it to 30 to 35 cc per minute. “Once you get the hang of the chamber stability and how the chamber is deepening at an IOP of 30 or 20 mmHg, then you can step back on your vacuum and flow rate,” he said.

References

2. Vasavada V, Raj SM, Praveen MR, Vasavada AR, Henderson BA, Asnani PK. Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial. J Refract Surg. 2014;30(8):534-40. 3. Liu Y, Hong J, Chen X. Comparisons of the clinical outcomes of Centurion® active fluidics system with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density. Front Med (Lausanne). 2023;10:1294808. 4. Alcon data on file, 2017, REF-02559. 5. Vasavada V, Vasavada AR, Vasavada VA, Vasavada SA, Bhojwani D. Real-time dynamic changes in intraocular pressure after occlusion break: comparing 2 phacoemulsification systems. J Cataract Refract Surg. 2021;47(9):1205-1209. 6. Kokubun T, et al. Verification for the usefulness of normal tension cataract surgery. Presented at: The 126th Annual Meeting of the Japanese Ophthalmological Society (JOS); Apr 14-17, 2022; Osaka, Japan. 7. Vasavada V, Srivastava S, Vasavada V, et al. Impact of fluidic parameters during phacoemulsification on the anterior vitreous face behavior: Experimental study. Indian J Ophthalmol. 2019;67(10):1634-1637.

The future of physiological IOP in cataract surgery

8. Scarfone HA, Rodriguez EC, Rufiner MG, et al. Vitreous-lens interface changes after cataract surgery using active fluidics and active sentry with high and low infusion pressure settings. J Cataract Refract Surg. 2024;50(4):333-338.

Dr. Vasavada believes that operating at physiological IOP will soon be the norm in the next few years. Even though naysayers may suggest operating at lower IOP could take longer or compromise safety14, the evidence has found that operating near physiologic IOP resulted in less trauma to corneal physiology and maintained the stability of the anterior vitreous face (AVF).7 Dr. Vasavada says that “there are no downsides to operating at a low IOP—and there are some added benefits.”

9. Raimondi R, Sow K, Peto T, et al. The effect of intraocular pressure during phacoemulsification in patients with either diabetic retinopathy or glaucoma; a randomized controlled feasibility trial. Graefes Arch Clin Exp Ophthalmol. 2025;263(8):2277-2288.

For surgeons hesitant to change a system that’s already working, he offered a gentle nudge: “But that’s how medicine is—if you don’t keep

Alcon medical device(s) comply with the current legislation for medical devices. Please refer to relevant product’s instructions for use or operator manual for a complete list of indications, contraindications, warnings and serious incidents.

10.Rauen MP, Joiner H, Kohler RA, O'Connor S. Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology. J Cataract Refract Surg. 2024;50(8):822-827. 11.Sharif-Kashani P, Fanney D, Injev V. Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol. 2014;14:96. 12.Cyril D, Brahmani P, Prasad S, et al. Comparison of two phacoemulsification system handpieces: prospective randomized comparative study. J Cataract Refract Surg. 2022;48(3):328-333. 13.Machiele R, Motlagh M, Zeppieri M, et al. Intraocular Pressure. [Updated 2024 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK532237/ Accessed on August 25, 2025

This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.

CAKE MAGAZINE | December 2025

ataract

SURGICAL SYSTEMS

Alcon Unveils Unity VCS and Unity® CS in India, Merging Cataract and Retina on One Stage ®

Sponsored by Alcon

A blockbuster debut in India puts Alcon’s Unity® VCS and Unity® CS—a superior^ efficiency powerhouse—under the surgical spotlight.

largest cataract market in the world with about eight million cataracts performed annually here. And the workload for surgeons is immense, with only one ophthalmologist available for every 100,000 people.

Technical innovations that transform surgery This next-generation platform introduces several first-tomarket technologies that bring transformative advances to cataract and vitreoretinal surgery, including UNITY 4D Phaco, HYPERVIT® 30K and the sophisticated UNITY Intelligent Fluidics system. Senior Director of R&D at Alcon, Satish Yalamanchili, explained that it is offered in two configurations: VCS for combined vitreoretinal and cataract surgery, and CS for cataract only. Both run on the same platform for consistency and ease of use. "The goal was to be able to create a single platform with multiple configurations, so that it is not only efficient for you, but also for your staff," Mr. Yalamanchili noted. "It creates that level of ability to be able to operate this irrespective of which segment you're operating."

n a scene that felt less like a product launch and more like curtain-up at a Bollywood premiere, Alcon’s (Geneva, Switzerland) new Unity® Vitreoretinal Cataract System (VCS) and Unity® CS made its debut at the 37th annual meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2025) in Ahmedabad, India. The new, versatile platform offers two configurations, a combined console (VCS) which is now available, and a standalone cataract system (CS), which will be commercially available in the coming months. Rolling on stage on its own, the machine drew gasps from a packed house of eye care professionals. The choice of venue was no accident: India, with its immense cataract and vitrectomy caseloads, is both the world’s busiest ophthalmic theater and an ideal proving ground for what Alcon believes is a transformational leap in surgical technology.

A bold vision Alcon, during the launch in India, highlighted taking the company’s mission a little further by pushing its boundaries and challenging all odds. This launch, according to Alcon, is a testament of years of hard work, a collaboration of engineers, of surgeons, of visionaries who dared to ask one question, ‘Can we do it a little better?’. Alcon’s answer is Unity VCS: a single platform that merges cataract and vitreoretinal surgery capabilities, designed for precision, superior^ efficiency and, ultimately, excellent patient outcomes. Senior Vice President and President of Alcon International, Rajkumar Narayanan, underscored why India was the right place for such a launch. "We believe that India as a market is really appropriately suited for this piece of technology,” he said. “It is the

CAKE MAGAZINE | December 2025

The headline act, however, is Unity’s 4D Phaco, a major evolution beyond longitudinal and torsional ultrasound. "This 4D motion results in faster nucleus removal and less energy released into the eye†," he explained, while video footage demonstrated the technology's unique volumetric cutting pattern. Bench data suggested it is “twice as fast as [removing] luminal material†, which means that the amount of energy that you're imparting at the excision is also reduced by half," Mr. Yalamanchili said. Overall, the system delivers "41% less energy into the eye†," potentially leading to more^ efficient surgeries and excellent outcomes for patients. Another milestone is Intelligent Fluidics, which maintains intraocular pressure (IOP) with flow rather than pressure. "Previously with Centurion®, we were changing source pressure to maintain the IOP. But now in this system, for the very first time, we're going to be maintaining that IOP with flow, infusion flow," Mr.

Yalamanchili explained. "In other words, it's going to help you because even if you have an incisional leakage‡, it would not matter. It's going to maintain the desired IOP." The system also features enhanced surge mitigation technology, building on Alcon's ACTIVE SENTRY® technology to provide exceptional efficiency and even better chamber stability when compared with CENTURION with Active Sentry during simulated occlusion break testing§. For surgeons, Unity VCS and Unity CS bring several upgrades: • UNITY® HyperVit® 30K, the world’s fastest cutter at 30,000 cuts per minute, outpaces previous systems by 50%§§. • UNITY® 27+ DS perform with the stiffness of 25-gauge tools, optimizing surgical control and reach—without compromising efficiency. • UNITY® TetraSpot allows flexibility between one, two or four spots depending on cases. • UNITY® Illumination with variations in luminance and color contrast helps surgeons distinguish tissue planes excellently.

Unity VCS in the real world Dr. Hisaharu Suzuki from Japan shared results from roughly 205 Unity VCS surgeries since February 2025. “I perform approximately 1,500 cataract surgeries per year and UNITY VCS/CS has streamlined my surgical procedures while enabling

us to deliver exceptional patient outcomes,” said Dr. Suzuki. And through a series of case presentations, Dr. Suzuki showed Unity VCS performing smoothly across a spectrum of cataracts. “The UNITY 4D phaco technology in particular has been impressive, breaking up even large, dense cataracts efficiently, while maintaining more physiologic IOP throughout the surgery,” he shared. “Beyond the device performance, UNITY VCS/CS expedites my surgical workflow and introduces significant usability improvements—which my entire team greatly appreciates,” added Dr. Suzuki.

A new era for ophthalmic surgery in India The symbolism of launching Unity VCS in India was not lost on attendees. "India is a market where you have really talented surgeons, and I am for sure really excited and looking forward to what all of you can do with this technology, how you can push the boundaries even further," Mr. Narayanan said. “Alcon has a long legacy of advancing phaco and vitreoretinal technology for surgical ophthalmology. With UNITY VCS/CS, we are introducing more than a dozen innovations designed to deliver significant efficiencies for surgery centers across the globe,” said Amar Vyas, Country Head of Alcon India. “We are especially proud to bring these next-generation equipment solutions to India, a country with a rapidly growing demand for advanced eye care. By equipping ophthalmic surgeons with cutting-

UCMPMD Guidance • For the use only of registered Medical Practitioners or a Hospital, or a Laboratory. • Brand Name: Unity VCS,Unity CS Imported & Marketed by: Alcon Laboratories (India) Pvt. Ltd., 11th Floor, RMZ Azure, Bellary Road, Hebbal, Bengaluru - 560092 • Please refer to the relevant product DFU for detailed list of indications, warnings, precautions for use, contraindications, etc. Additional information is available on request. • Date/ last updated: <01-July 2024>

edge technology, we aim to better support healthcare professionals with enhanced stability and efficiency and elevate the standard of care for patients across India,” added Mr. Vyas. As the session closed with a celebratory cake-cutting, one thing was clear: Alcon isn’t simply adding another tool to the surgeon’s armamentarium. By combining cataract and vitreoretinal surgery on a single platform with superior efficiency, stabilizing the intraoperative environment in a new way, and introducing a cutting technique that quite literally thinks outside the box, Unity VCS feels more like a reset button for ophthalmic surgery.

^ based on bench testing. Compared to Constellation and centurion † Based on bench data. * Trademarks are the property of their respective owners. **Based on N=10 HPs, Artificial cataract lens IOP 55mmhg vacuum of 450 mmHg ‡ Mean fluctuation at flow vs. setpoint of 2.36 ± 2.13, 4.19 ± 1.97, 1.84 ± 2.82, and 2.13 ± 2.86 mmHg during phacoemulsification, irrigation/aspiration (IA), vitrectomy, and extrusion/fragmentation, respectively. †IOP setpoint as low as 16 mmHg (posterior) and 20 mmHg (anterior) without exceeding a mean fluctuation of 4.19 ± 1.97 mmHg. § Based on bench data. Reduction in surge is correlated to less change in anterior chamber depth. §§ Compared to HYPERVIT 20k

Editor’s Note The 37th annual meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2025) was held from 21-23 August in Ahmedabad, India. Reporting for this story took place during the event. This is only for reference of registered medical practitioner or a hospital or a laboratory. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions. A version of this article was first published on cakemagazine.org.

CAKE MAGAZINE | December 2025

ataract

IOLs

Giacomo Savini (Italy) highlighted the newly updated SIFI IOL Calculator, which employs the fifth-generation, AI-powered Hoffer QST formula for spherical equivalent and the Naeser/ Savini toric calculator for cylinder predictions, ensuring maximum accuracy.

Riding the Wave(front) of Innovation with SIFI IOLs Sponsored by SIFI

Mastering wavefront technology to unlock all the possibilities that stretching light has to offer—a studied and ideal balance between quality and quantity of vision

ntraocular lenses (IOLs) never fail to spark discussion among ophthalmologists—and at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025), experts gathered to discuss on the SIFI IOLs’ common DNA: the proprietary wavefront technology and its benefits: evidence based, seamless visual outcomes across all distances and uncompromised patient satisfaction.

Decoding SIFI IOL functionalities With so many IOLs on the market, the ESCRS IOL Functional Classification is an indispensable compass for clinicians searching for the “right” lens for their patients. Opening with How SIFI IOLs Fit into the Evolving Classification Landscape, Prof. Filomena Ribeiro (Portugal) walked through how SIFI’s lenses fit into this evidence-based system. She explained that the new functional classification of IOLs has been developed, based on standardsdefined end-points, particularly the range of focus (RoF) measured from monofocal defocus curves. Using cluster analysis, the system was

qualified as evidence-based and relies on two key metrics: RoF at 0 D defocus, using 0.2 or 0.3 logMAR cut-offs and ΔVA from intermediate to near when VA decline is nonmonotonic. Depending on data collection methods and biometric parameters, an IOL’s place in the classification can shift. Prof. Ribeiro noted that the SIFI EVOLUX® IOL lands in the “partial depth of field enhanced” category, while the Mini WELL® falls under “partial depth of field extended.” The WELL Fusion® System, meanwhile, is currently considered “full depth of field,” although she pointed out that more evidence is needed before this label can be assigned with high certainty. Unlike diffractive IOLs, SIFI’s presbyopia-correcting portfolio relies on wavefront technology to provide a smoother, more continuous range of vision with fewer side effects.

Accurate formulas for reliable predictions Formulas may not excite dinnerparty conversation, but in the clinic they make all the difference. Dr.

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The Hoffer QST formula has been shown to be one of the most accurate formulas for IOL power calculation, while the Næser/Savini calculator has been shown to be one of the most precise solutions for toric IOL calculation, proven by several recent published studies. “We did a short analysis of 36 patients implanted with EVOLUX® and measured with the IOLMaster 700 (ZEISS). Using the values available on the SIFI calculator, we got a mean prediction error of zero,” he said. “This means that the constant is correctly optimized so you don’t have a hyperopic or myopic bias.” Eighty-nine percent of eyes with a prediction error fell within 0.50 diopters, though Dr. Savini reminded colleagues to warn patients that about 10% of cases may still deliver a refractive surprise of +0.50 D or more. For toric IOL selection, he added a word of caution: always pay close attention to total corneal astigmatism.

WELL Fusion® for presbyopic cataract patients The WELL Fusion® System brings together two non-diffractive, true EDoF IOLs—Mini WELL® and Mini WELL PROXA®—and lets them play to their strengths. Prof. Ahmed Assaf (Egypt) explained that Mini WELL® has three optical zones, designed for continuous vision from distance, to optimal near at 40 cm, while Mini WELL PROXA® has five zones that lean more heavily toward near vision (at 35 cm). This unique optical system grants full range of vision while maintaining an excellent patient satisfaction and visual safety profile (minimal haloes and glare).

“The lenses are not mix-and-match, but rather complementary and work in synergy with each other,” he said. Typically, Mini WELL® is implanted in the dominant eye and Mini WELL PROXA® in the non-dominant one.

daily life, good contrast sensitivity, less dysphotopsias than diffractive extended depth of focus (EDoF) and other diffractive IOLs, minimum chair time and at a similar price as a monofocal.”

In his practice, the second-eye choice is guided by the patient’s feedback after the first surgery. “If the patient is happy with the Mini WELL® we implant the Mini WELL® in the other eye. If the patient expresses more need for reading, then we implant the Mini WELL PROXA® in the other eye.”

Transforming vision with EVOLUX®

Drawing on 100 patient cases, Prof. Assaf reported that distance visual acuity outcomes were similar whether bilateral Mini WELL® or the Fusion® System was used. However, the Fusion® System provided superior intermediate vision at 66 cm and stronger near performance at 35 cm. “We had good results with the Fusion® System,” he said. “[There’s] additional value with the Mini WELL Fusion® System in terms of near vision, whether uncorrected or corrected.”

Putting EVOLUX® to the test How does SIFI’s EVOLUX® IOL, with its enhanced range of vision and nondiffractive optical design, stack up against its peers? Prof. Cinzia Mazzini (Italy) presented results from a prospective study comparing EVOLUX® with the TECNIS Eyhance™ (Johnson & Johnson Vision). Fifty patients were enrolled, with 25 eyes implanted with each lens. At 12 months, the EVOLUX® group demonstrated better visual acuity (VA) across all distances, as well as reduced need for near and intermediate add. Both groups showed strong refractive and functional stability with no significant posterior capsule opacification, good contrast sensitivity, and no cases of glare or halos. Prof. Mazzini concluded that “EVOLUX® provides the same distance VA as a monofocal IOL, but with more intermediate vision to improve functional performance in

At Svjetlost Eye Clinic (Croatia), Dr. Krešimir Gabrić has overseen more than 600 EVOLUX® implantations. That number alone, he said, reflects confidence in the lens. “IOLs are becoming the new standard of care,” he explained. “They broaden clear vision—especially intermediate— without diffractive optics, so patients experience fewer disturbances.” A retrospective study of 116 eyes from 82 patients reinforced this view. The results included: • UDVA improved from 0.89±0.54 logMAR to 0.10±0.14 logMAR (p<0.001). • UNVA at 40 cm improved from 0.94±0.36 logMAR to 0.47±0.19 logMAR (p<0.001). • 85% of patients no longer needed spectacles for intermediate work. • 96% achieved UDVA of at least 20/40. • 76% landing within ±0.50 D of target refraction. The monocular defocus curve revealed functional vision of 0.2 logMAR or better across a 2.0 D range, with effective intermediate and near vision, as well as preserved contrast sensitivity and minimal dysphotopsia. Dr. Gabrić observed that EVOLUX® either matches or surpasses other enhanced monofocal IOLs, citing smooth visual transition, less pupil dependent performance and wavefront optimization as differentiators. Safety and stability were also clear strengths, with tolerance for minor tilt or decentration. “For cataract patients, EVOLUX® is ideal for excellent distance plus enhanced intermediate vision with

minimal photic phenomena,” he said. Refractive lens exchange (RLE) patients, he added, also benefit from reduced spectacle dependence. EVOLUX® has shown particular value for patients with comorbidities such as glaucoma, mild macular degeneration or epiretinal membrane—and for high-volume surgeons aiming to satisfy increasingly discerning patients.

From optics to outcomes Dr. Erik Mertens (Belgium) observed that “When talking about the range of vision provided by IOLs, EVOLUX is, in my opinion, even better than an enhanced monofocal, landing in the Increased Range of Vision segment, so mitigating presbyopia correction”, based on AECOS classification. A memorable case was presented: a 63-year-old taxi driver who works night shifts. His top priorities were crisp night vision, spectacle independence and the ability to see both his dashboard and his credit card reader without difficulty. Dr. Mertens implanted EVOLUX® with mini-monovision, emphasizing its advantages over other IOLs, including lower dysphotopsia, no dependence on pupil size, a wider depth of focus and a more efficient delivery system. The outcome ticked every box. The patient experienced no glare or halos under any light condition and reported he could drive, read his dashboard and use GPS without glasses. His verdict was simple: “It feels like when I was 35 to 40-yearsold, [I have the] same vision.”

CAKE MAGAZINE | December 2025

ataract

OCULAR SURFACE

Image created with assistance from Midjourney AI, ©Media MICE Pte Ltd, 2025.

Setting the Stage for Perfect Vision By Dr. Shilpa Ghosh

Before the curtain rises on cataract surgery, there’s one often-overlooked act that can make or break the show: getting the ocular surface performance-ready. Because when dry eye sneaks into the spotlight, even the best surgeon can’t save the scene.

hink of the eye as a grand theater. Cataract surgery is the headlining act, but even a world-class surgeon can’t deliver a show-stopping performance if the

stage is dusty, the floor uneven or the spotlight flickering. In ophthalmology, that “dust” is ocular surface disease (OSD)—particularly dry eye—and the “uneven floor” is an unstable tear film

CAKE MAGAZINE | December 2025

that can distort those all-important pre-op measurements guiding intraocular lens (IOL) selection. Cataract surgery planning lives and dies by precision: keratometry, topography, biometry, the works. But when the ocular surface is off, so are the numbers. That’s how you get refractive surprises, not standing ovations. Studies show that 30% to 80% of cataract patients have signs of OSD, yet fewer than 3% receive active management before surgery.* Take one 68-year-old woman with mild punctate keratitis. Her biometry bounced by 1.0 D between visits. Two weeks of preservative-free lubricants and lid hygiene later, her readings leveled out, and her refraction landed within 0.25 D of target…a short delay for a big payoff.

The pre-show prep

Checking the progress

The final rehearsal

Every cataract patient deserves an ocular surface “sound check.” Even mild disease can throw off your harmony.

“Feeling better” is nice, but we want numbers to back it up. Track improvements in SPEED (up by at least 4 points), NEI staining (3 or below), TBUT (above 10 seconds) and topography repeatability (within ± 0.25 D).

When the surface looks steady, recheck your keratometry and IOL power. Stability within ± 0.25 D means the eye is ready for the main event. Still fluctuating? Keep the curtain closed a little longer, and track, recheck, repeat.

For example, one 72-year-old diabetic went from SPEED 14 to 6, NEI 8 to 2, TBUT up to 12 seconds, and biometry variation dropped to under 0.20 D. Now that’s a well-rehearsed result.

A flawless cataract outcome doesn’t start in the OR. It starts weeks earlier, when the tear film glistens evenly and every detail aligns. Just like a conductor tuning the orchestra before the first note, a surgeon who perfects the ocular surface ensures visual harmony from the very first glance.

A quick SPEED (Standard Patient Evaluation of Eye Dryness) or OSDI (Ocular Surface Disease Index) questionnaire is an easy opener. SPEED scores above 8 usually mean symptoms are real. Then it’s slit lamp time: look for conjunctival hyperemia, irregular corneal reflexes, punctate erosions or meibomian gland inspissation. Confirm your findings with NEI (National Eye Institute) corneal staining and TBUT (tear break-up time). An NEI score above 3 indicates epithelial compromise, while a TBUT under 10 seconds confirms tear film instability. Together, SPEED and NEI form a handy diagnostic duet.

Timing the tune-up How long should you treat before retesting? It depends on the level of dysfunction. Mild cases often bounce back within one to two weeks, moderate OSD needs three to four, and severe disease can demand six to eight weeks (or more) for full reepithelialization. In other words: patience pays off. Remind your patients that “waiting is winning,” because a little time upfront leads to big-time precision later.

Smoothing the stage Start simple: preservative-free tears, lid hygiene, warm compresses. Once inflammation joins the cast, bring in low-potency steroids or immunomodulators. If meibomian gland dysfunction plays a starring role, LLLT (low-level laser therapy) or IPL (intense pulsed light) can boost gland output and tear stability. In tougher cases, cryopreserved amniotic membranes can restore the corneal surface fast. And for that supporting cast, new players like Miebo (perfluorohexyloctane), Xdemvy (lotilaner) and omega-3s help keep the tears rolling.

When the stage won’t settle Still seeing surface instability? Time for detective work. Revisit possible culprits, such as exposure, systemic meds or untreated inflammation. Then step up therapy with topical steroids, serum drops or another round of amniotic membrane therapy. And don’t rush the main event. It’s better to delay the premiere than open with poor acoustics.

Keeping the audience in the loop Communication is everything. Tell your patients the ocular surface is the “stage” where their new lens will shine. Phrases like, “We’ll treat the dryness first so your results hit the mark,” or “We’ll repeat your scans once the surface is stable. It’s worth the wait,” help set clear expectations. This kind of transparency not only builds trust, it positions you as both scientist and artist.

The new directors behind the curtain Technology is quietly transforming ocular surface optimization. LLLT boosts meibomian gland output and TBUT by up to 40%. Cryopreserved amniotic membranes heal epithelium in just five to seven days. And AIenhanced topography now spots tear film instability earlier than ever. Think of it as upgraded stage lighting revealing every detail in high definition.

So go ahead, give that surface the spotlight it deserves. Because when the stage is smooth, the show always shines.

* Gupta PK, Drinkwater OJ, VanDusen KW, Brissette AR, Starr CE. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44(9):1090-1096.

Contributor With a steady hand and a sharp eye for detail, Dr. Shilpa Ghosh is helping patients in Assam (India) see the world more clearly—literally. Based in Dibrugarh and practicing at Apeksha Hospital (Dibrugarh, Assam, India), she specializes in cataract, cornea and anterior segment surgery, and has further honed her skills with a fellowship in minimally invasive glaucoma surgery (MIGS). A proud graduate of Maulana Azad Medical College with an MS in Ophthalmology and a DNB, Dr. Ghosh combines deep clinical expertise with a warm, patientcentered approach. Her mission? To bring advanced eye care closer to home for the people of Northeast India. ophtha.shilpaghosh.2020@gmail.com

CAKE MAGAZINE | December 2025

ataract

CHOOSING IOLs

Welcome to Teleon’s IOL Buffet By Andreas F. Borkenstein, MD*

From enhanced range to full freedom, Teleon offers every flavor of premium vision.

t ESCRS 2025 in Copenhagen, the conversation around premium IOLs was served on a silver platter. Cataract surgery is no longer a one-size-fits-all proposition—it’s a menu full of options. Surgeons can now select from enhanced monofocals, extended depth of focus (EDOF), multifocals, toric corrections and more. The challenge isn’t whether options exist, but identifying which lens best fits a patient’s lifestyle. “We as physicians need to find a way through this jungle of IOLs,” Prof. Thomas Kohnen (Germany) said, capturing the dilemma neatly. “And that’s why we put together [this new] classification.” What he is referring to is a new classification system developed by the European Society of Cataract and Refractive Surgeon’s (ESCRS) functional vision working group, which groups lenses by range of focus (RoF) and ΔVA (change in VA) into partial (with enhanced and extended subgroups) and full range. For surgeons, it’s like stepping into a buffet line where everything looks appealing. But the real skill lies in pairing the right plate to the right appetite, and Teleon’s menu of IOLs has something for every optical taste.

Stepping into quantum vision Between traditional monofocals and EDOF lies a sweet spot, now codified under the ESCRS classification system. Teleon’s LENTIS® and

ACUNEX® Quantum lenses expand intermediate vision without sacrificing distance acuity. Their patented Q-zone aspheric design is more than a technical flourish. It ensures stable performance even when decentered or tilted. Clinical studies confirm excellent distance acuity, crisp intermediate function and only minimal halos. For patients seeking a little more flexibility without big trade-offs, Quantum gives patients a smooth introduction to premium IOLs. Surgeons, meanwhile, can operate with confidence knowing the optics will remain stable under real-world conditions.

Living in the comfort zone Some patients live their lives at arm’s length: working at computers, cooking, playing music or driving at dusk. For them, intermediate clarity matters most. Teleon’s LENTIS® Comfort MF15/20 lenses, along with the VISIOTIS Progress (IOL Expert, Berlin, Germany), extend the RoF to about 1.58 D to 2.3 D—right in the lifestyle comfort zone. Unlike diffractive optics, the Comfort platform seeks to minimize common dysphotopsia trade-offs. And toric versions correct up to 5.25 D of astigmatism, broadening access to patients who might otherwise be excluded from multifocal options. What does that mean in practice? Steady outcomes, reliable quality

CAKE MAGAZINE | December 2025

of life and confidence in functional, independence-enabling tasks like driving at night. For many patients, that reassurance is worth more than an extra line on the near chart.

All the way to near And when glasses are a deal-breaker, it’s time for the main course: Teleon’s full-range IOLs. The LENTIS® Mplus family (MF30, MplusX) and the ACUNEX® VarioMax serve up distance-to-near freedom with asymmetric, segmental optics. This design features fewer halos compared with classic ringed multifocals and provides smoother focus shifts from horizon to fine print. Combined with femtosecond laser precision, these lenses offer predictability on every plate. Adaptation (think of it as neurogastronomy for your visual cortex) may take three to six months. Once the brain catches up, patients enjoy the closest experience to full visual freedom on the Teleon menu of IOLs.

Vision takes a village Even the finest optics won’t succeed without context. Matching IOL design to lifestyle requires careful dialogue, realistic expectation-setting and team-based support. Prof. Kohnen notes that the classification is a guide, not a rule. “We may place a [LENTIS®] Comfort lens in the dominant eye and a higher-add in the fellow eye,” he said, as an example. “For that patient, it fills out the range of vision while keeping unwanted phenomena low.” I fully agree with Prof. Kohnen’s statement, having applied this blended vision principle in my practice throughout the years— combining lenses of different ranges to balance visual quality and adaptability. The long-term results have been consistently positive, with very high patient satisfaction and minimal visual disturbances. Dr. Patrick Versace (Australia) takes a practical approach with patient communication. “I use simple pictures,” he explained. “With a monofocal, you see the road but not the dashboard or phone. With an EDOF, the phone is still blurry. With

a full-range lens, everything comes into focus. Patients come in already overwhelmed, so easy visuals make all the difference.” Enhanced and extended range lenses generally allow smoother adjustment, while full range options may require patience before the brain fully adapts. Here, digital simulators can help patients preview different IOLs experiences in daily life. Equally important is the infrastructure around surgery: • Diagnostics such as OCT biometry, corneal topography and aberrometry ensure precision. • Patient counseling supported by trained staff, brochures and demo models improves consent quality. • Workflow integration makes premium care scalable, not just aspirational. Surgeons who invest in this process tend to see higher satisfaction, fewer surprises and stronger word-ofmouth referrals.

Blending the buffet I believe that one underappreciated advantage of the ESCRS framework is its flexibility. Surgeons aren’t limited to one category per patient. Instead, lenses can be applied using a blended vision strategy across eyes to balance vision zones. A LENTIS® Quantum in one eye and a LENTIS® Comfort in the other, for example, can produce a blended profile that enhances both distance stability and intermediate function. Pairing an extended lens with a full range option can maximize independence while softening adaptation challenges. The art lies in knowing the optics, setting expectations and treating every patient as an individual rather than a template.

The full spectrum under one roof Plenty of manufacturers offer one or two premium categories. Teleon stands apart by delivering the

complete range: enhanced, extended and full focus. That breadth means surgeons don’t have to compromise or switch platforms to meet different patient needs.

walk away seeing their world more clearly. And with Teleon, surgeons can approach the IOL buffet with confidence, knowing the result is likely a happy, satisfied patient.

Just as importantly, all Teleon lenses are built on a glistening-free hydrophobic platform, ensuring longterm clarity and stability. Whether it’s the segmental precision of the Mplus MF30, the balanced comfort of the MF15/20 or the forgiving performance of the Quantum, surgeons can rely on consistent handling and outcomes.

To conclude, the rapid evolution and innovation within the IOL sector is undoubtedly a major gain for us ophthalmic surgeons—and, above all, for our patients. Yet with this progress comes responsibility. It is essential to have a deep understanding of both the optical principles and the laboratory data behind each IOL design, as well as the clinical outcomes they produce.

The takeaway The goal of cataract surgery today isn't an imitation of spectacles, but tailoring vision that feels natural from morning to night. The ESCRS classification provides the framework. Teleon provides the ingredients. • LENTIS®and ACUNEX® Quantum = Enhanced range • LENTIS® Comfort MF15/20 + VISIOTIS Progress, [ACUNEX®] Vario = Extended range • [LENTIS®] (Mplus MF30, MplusX), [ACUNEX®] VarioMax = Full range

Only with this knowledge and with the highest level of preoperative precision can we select the optimal lens or lens combination for each individual case. Companies such as Teleon Surgical with their broad and well-structured portfolio, make it easier for us to be prepared for every situation and to deliver truly personalized visual outcomes. And with that—bon appétit at the IOL buffet!

*Andreas F. Borkenstein, MD is a specialist in ophthalmology and optometry based in Graz, Austria. The content represents the author’s own professional opinion. The author has not received any financial compensation for this contribution.

Together, they allow every surgeon to find the perfect match for every patient. Based on my experience, after also performing optical bench tests1-2 with these IOLs and using the blended vision strategy in applying these in my clinical practice for several years, long-term follow-up confirms very pleasing results. Patients often report high overall satisfaction and functional independence in daily life, even years after surgery. From my point of view, the strength of this portfolio lies not only in the optical design but in its versatility in realworld practice. Over the years, I have seen how this range empowers surgeons to deliver stable, satisfying outcomes across a broad spectrum of patients. At the end of the day, it’s the range of optical taste that Teleon caters to, and the satisfaction of patients who

References 1. Borkenstein AF, Borkenstein EM, Schmid R. Evaluating Optical Quality of a New Hydrophilic Enhanced Monofocal Intraocular Lens and Comparison to the Monofocal Counterpart: An Optical Bench Analysis. Ophthalmol Ther. 2022;11(6):2045-2056. 2. Borkenstein AF, Borkenstein EM, Schmid R. Analysis of a novel hydrophobic acrylic enhanced monofocal intraocular lens compared to its standard monofocal type on the optical bench. BMC Ophthalmol. 2022;22(1):356.

Editor’s Note A version of this article was first published on cakemagazine.org.

CAKE MAGAZINE | December 2025

nterior Segment

EMMETROPIC PRESBYOPIA

One Orchestra, Two Coordinated Sections Monocular trifocal in exacting emmetropes By Kendra Bruning

One eye holds the melody as the other adds the harmony. For motivated emmetropic presbyopes, one-eye trifocal implantation widens range without dulling distance when selection, targeting and coaching are precise.

he clinical puzzle is all too familiar: emmetropic, relatively young presbyopes who cherish their crisp distance vision but struggle with the creeping burden of near tasks. Rather than asking both eyes to share diffractive duties, Medellín refractive surgeon and founder of Black Mammoth Surgical, Dr. Kepa Balparda (Colombia), prefers to keep the dominant eye for distance and upgrades the fellow eye for near and intermediate vision. In his retrospective pilot study (n=13) using the pentafocal Intensity SL (Hanita Lenses; Shlomi, Israel) in the non-dominant eye, uncorrected near and intermediate vision improved in the operated eye, binocular distance was maintained, no exchanges were required, and 100% reported spectacle independence for daily tasks at three months.1 With careful dominance testing, precise biometry and conservative targeting, binocular vision behaves like an ensemble: distance carries the melody, the upgraded eye fills the harmony, and the brain conducts the blend.

Casting and score These are exacting patients: emmetropic presbyopes who take pride in their uncorrected distance visual acuity (UDVA) yet feel the growing drag of readers. Think of them as listeners who love a clear solo line but crave a fuller arrangement for everyday tasks.

Bilateral diffractive implantation can certainly widen the score, though some notice a subtle softening in perceived contrast when the whole orchestra plays through diffractive optics.2 Monovision LASIK offers another route, but comfort depends on how much anisometropia a person can live with and what their daily “set list” demands.3 A monocular trifocal aims to preserve distance clarity in the “first violin” while letting the fellow eye quietly add near and intermediate support— the phakic-pseudophakic duet that rounds out the sound. Still, the selection process is exacting. You want a quiet surface, regular topography, a healthy macula and nerve, minimal cylinder, normal pupils and goals that match reality. Yellow flags include irregular astigmatism, forme fruste keratoconus (FFK), large mesopic pupils with a history of glare, or low tolerance for any quality shift. As Dr. Balparda puts it, “premium lenses require premium eyes.” When planning and targeting, it’s important to confirm ocular dominance with history, sighting and real-world tasks, then reserve the dominant eye for distance. Centering and effective lens position prediction matter, so pay attention to chord mu, angle alpha and anterior corneal power so the implant sits where the music blends. Targets should stay conservative, since heavy monovision risks bending the main theme for distance-critical patients.3 In practice, Dr. Balparda observes that monocular contrast sensitivity in the implanted eye may dip slightly, which is expected with diffractive optics, while binocular contrast for distance generally holds steady because the dominant eye carries that line.

Reading the score First, the solo. In emmetropic presbyopes, a unilateral trifocal lifts near performance without flattening binocular distance in everyday use.4 A second unilateral cohort showed similar outcomes in patientreported function, with VF-14 scores above three across most tasks. The predictable trouble spots were small print and night driving, yet overall tolerance remained high.5

CAKE MAGAZINE | December 2025

Then the section work. Larger emmetropic comparisons confirmed the expected trade. When both eyes receive diffractive optics, peak binocular near and intermediate improve. Even so, a one-eye upgrade can satisfy patients who seek range for daily life but insist on keeping distance clarity as their anchor.6 For long-view context, blended bilateral strategies show how a “melody eye” and a “range eye” share duties over time. Across three years, pairing an enhanced monofocal for distance with either a trifocal or a trifocal-extended depth of focus (EDOF) in the fellow eye maintained excellent binocular distance and intermediate vision, favored near in the trifocal arm, kept halos and glare modest, and showed Nd:YAG rates within expectations—more often in the enhanced-monofocal eyes than in the diffractive ones.7 Within that backdrop, Dr. Balparda’s pilot adds a focused clinical datapoint. A pentafocal in the non-dominant eye widened the usable range, improved near and intermediate vision in the implanted eye, preserved binocular distance, required no exchanges, and produced complete spectacle independence at three months, with roughly 92% across his broader clinical experience.1

Contrast, night work and the rehearsal period Contrast is the dynamic range of the visual score. Diffractive optics can shave a little off the monocular peaks at higher spatial frequencies when judged in isolation, consistent with long-term studies.2 The good news is that the ensemble effect helps: binocular summation tends to restore the volume, so distance performance feels stable once both eyes are “playing” together. In unilateral cataract models, monofocal or accommodative lenses show higher high-frequency contrast than multifocals, yet within multifocal groups the binocular result reliably exceeds the monocular read— an important point for chairside expectations.2 Coaching sets the tempo. Early on, encourage good lighting, practice at typical working distances, and avoid direct A–B eye comparisons that may

make the parts sound mismatched before the brain blends them. As Dr. Balparda explains, patients should expect a period of neuroadaptation and clear preoperative conversations make those first weeks far smoother. He cuts straight to the core: “What you tell before surgery is information; what you tell afterwards is an explanation for a complication.” A practical follow-up rhythm through three to six months lets the “rehearsal” conclude, providing space to fine-tune comfort, refraction and habits along the way.

Where it sits in the repertoire Every clinic has more than one way to play the piece. For patients comfortable with anisometropia who spend less time on fine near work, monovision LASIK can still be a solid choice, but stereo and satisfaction depend on how much imbalance they can tolerate and what their days demand.3 The monocular trifocal approach aims to preserve stereo and binocular summation while adding useful range, which is why it resonates with distance-protective emmetropes. Against bilateral trifocals, it’s a trade in emphasis. Two diffractive

optics typically deliver stronger peak binocular near and intermediate vision, whereas the monocular route favors steadier distance dynamics in contrast-sensitive patients who value that clarity above all else.6 When ocular status or temperament suggests a different score, smallaperture IOLs are solid alternatives that can extend depth without diffractive artifacts.8

Keeping time and closing the gaps On the practical side, the short-term monocular cohorts here reported no exchanges, and follow-up works best when it keeps time with adaptation. Tidy the surface, check refraction, and look closely at the lens and capsule during the early adjustment period, then again as the ensemble settles. These milestones help patients stay on tempo while neuroadaptation finds its rhythm.1,4,5 For context on photic phenomena and capsulotomy needs when one diffractive eye shares duties with a distance-optimized fellow eye, the three-year blended-optic data offer a useful reference point.7 The score, however, is still being written. Many monocular series remain small, single-center,

References 1. Balparda K, Escobar-Giraldo M, LópezVelásquez M, et al. Early results after the monocular implantation of a continuous full range of focus intraocular lens (Intensity SL) in emmetropic, young, presbyopic patients. [Unpublished study]. Medellín, Colombia: Oftalmólogos El Tesoro; 2025. 2. Mesci C, Erbil HH, Olgun A, et al. Differences in contrast sensitivity between monofocal, multifocal and accommodating intraocular lenses: Long-term results. Clin Exp Ophthalmol. 2010;38(8):768-777. 3. Schallhorn SC, Teenan D, Venter JA, et al. Monovision LASIK versus presbyopiacorrecting IOLs: Comparison of clinical and patient-reported outcomes. J Refract Surg. 2017;33(11):749-758. 4. Levinger E, Titonelli A, Duker IS, et al. Unilateral refractive lens exchange with a multifocal intraocular lens in emmetropic presbyopic patients. Curr Eye Res. 2019;44(7):710-714. 5. Ozturkmen C, Kesim C, Sahin A. Evaluation of vision-related quality of life after unilateral implantation of a new trifocal intraocular lens. Beyoglu Eye J. 2022;7(3):167-172. 6. Fernández-García JL, Llovet-Rausell A, Ortega-Usobiaga J, et al. Comparison of

patients with emmetropia and presbyopia and different accommodation who undergo unilateral or bilateral implantation of a trifocal IOL. J Refract Surg. 2023;39(12):817-824. 7. Danzinger V, Lisy M, Schartmüller D, et al. 3-Year Comparison Of Two Mix-And-Match Strategies: Enhanced Monofocal And Trifocal Versus Enhanced Monofocal And Trifocal EDOF IOLs. J Cataract Refract Surg. 2025 Oct 17. [Epub ahead of print] 8. Hayashi K, Uno K, Hayashi S, et al. Comparison of visual function between phakic and pseudophakic eyes with smallaperture intraocular lenses. Am J Ophthalmol. 2025;223:53-59. 9. Hayashi K, Uno K, Hayashi S, Yoshida M. Age-related difference in the presbyopiacorrecting effect of trifocal and enhanced monofocal intraocular lenses. Jpn J Ophthalmol. 2025 Jul 9. [Epub ahead of print] 10. Cho JY, Won YK, Park J, et al. Visual outcomes and optical quality of accommodative, multifocal, extended depthof-focus, and monofocal IOLs in presbyopiacorrecting cataract surgery: A systematic review and Bayesian network meta-analysis. JAMA Ophthalmol. 2022;140(11):10451053.

and short in follow-up. The field would benefit from prospective studies stratified by age, glare testing, pupil behavior and centration analysis.2,6,9,10 Dr. Balparda’s series is early and under peer review; but the signal is encouraging and the disclosures transparent, with larger and longer cohorts needed to define durability and generalizability.1

Coda For the right emmetropic presbyope, one orchestra can carry two coordinated sections. Keep the dominant eye on the melody. Let the non-dominant add near and intermediate with a well-chosen diffractive profile. Select precisely, target conservatively, center meticulously and coach through rehearsal. Most patients will leave the concert hall humming, glasses-free for everyday routines and without dulling the distance line they prize.

Contributor Based in Medellín, Colombia, Dr. Kepa Balparda is a leading refractive surgeon and the visionary founder of Black Mammoth Surgical, a research and development company tackling some of the most exciting challenges in eye health. A global key opinion leader, researcher and consultant for several major pharmaceutical companies, Dr. Balparda’s curiosity and creativity fuel his work. His current research zeroes in on refining outcomes in both laserbased and intraocular lens-based refractive surgery, pushing the limits of precision and patient satisfaction. Equal parts clinician and innovator, Dr. Balparda blends science with ingenuity to improve how the world sees. Whether in the operating room, the lab or at international conferences, he continues to carve out a bold path for the future of vision correction. kb@kepabalparda.com

CAKE MAGAZINE | December 2025

nterior Segment

IMAGING

Examinations were slightly faster with Elara 900 with a mean exam length of 3.9 ± 1.12 minutes using Elara 900 versus 4.85 ± 0.96 minutes with a traditional slit lamp. Prof. Auffarth noted that, although exams can be completed quicker with the Elara 900, new users often spend more time exploring its different capabilities and taking videos. Both slit lamps have a comparable adjustment period, with Elara 900 having a slight edge.

Elara 900 Brings the Slit Lamp Into the 21st Century Can you improve slit lamp efficiency? Haag-Streit thinks so—and ophthalmologists agree. We took a deep dive into the benefits of the Elara 900 as shared by its first global users. Sponsored by Haag-Streit

escribed as THE “slit lamp for the 21st century,” HaagStreit’s Elara 900 builds on tradition with improved visualization, ergonomics, workflow, and documentation features. Recently, Haag-Streit tasked a panel of slit lamp experts to put Elara 900 to the test. This report reveals survey findings and key takeaways as shared in a panel discussion by Prof. Gerd Auffarth, Prof. Filomena Ribeiro, Dr. Sunil Mamtora, Prof. Maria Kugelberg, and Prof. David Goldblum.

Breaking the slit lamp mold A new slit lamp doesn’t come around often. As Prof. Gerd Auffarth (Germany) noted, “The slit lamp is an instrument that everybody takes for granted…you just never consider that it could get any better.” Now, the Elara 900 proves that slit lamps can improve, with key features

like superior clinical visualization, optimized ergonomics, and dualcamera documentation in 3D video or image capture in 4K. Further, Elara 900’s one-touch “presets”, coupled with motorized height and magnification, reduce manual steps which could streamline examinations. “You can have automated 'presets' that guide you through, for example, evaluation for a corneal procedure. If you have a DMEK [Descemet membrane endothelial keratoplasty] and do a follow-up, you have the right magnification and the illumination,” explained Prof. Auffarth. He then shared promising findings from his recent survey comparing the Elara 900 with a traditional slit lamp. Twenty residents and consultants at University Eye Clinic Heidelberg (Germany) who used the Elara 900 for at least one day were included.

CAKE MAGAZINE | December 2025

Comfort is another key factor—and 70% said that Elara 900 was more ergonomic. This left 30% undecided, while none (0%) said the traditional slit lamp was more comfortable. All respondents said Elara 900 had superior image quality. Prof. Auffarth explained that “the main reason for Elara 900’s overall superiority lies in the great detail it provides.” In his survey, 75% also voted for Elara 900 as having the better fundus visualization, with only 10% preferring the more familiar, traditional slit lamp. In addition, 100% would use Elara 900’s photo and video documentation in their daily work routine. Overall, 90% preferred Elara 900, while 5% were undecided and 5% preferred the traditional slit lamp. “We’re here to show that there can be change, advancement, and enhancement in a slit lamp—that you can put a slit lamp in the 21st century,” said Prof. Auffarth.

Leading with ergonomic design “When acquiring new technology, how often do we consider ergonomics?” asked ESCRS President, Prof. Filomena Ribeiro (Portugal). “It’s not something that comes to mind, but it’s very relevant.” “Many eye care professionals report pain from using a non-ergonomic device,” she continued, adding that 79% reported neck pain in the past 6 months.* The Elara 900 addresses ergonomic issues encountered in traditional slit lamps. One key feature that enables a fatigue-free working posture is Elara 900’s inclined eyepiece, which encourages a natural head and neck position. Prof. Ribeiro says Elara 900’s

ergonomics reduce strain, support long-term comfort, and were designed with the comfort of the patient, as well as the examiner, in mind.

temperature. With this, you can really fine tune. You can change the color temperature, you can change the white balance,” said Dr. Mamtora.

The optical path of the Elara 900 is decreased by 23% compared to traditional slit lamps. This brings the patient closer and reduces strain during exams. Additionally, it has a spacious headrest, creating a more comfortable experience for patients.

“The optical system has also been redesigned, so the optical pathway isn't extended,” he continued. “If you struggle with having to stretch your arm further in a slit lamp with a beam splitter, that's no longer a problem.”

To learn more about its ergonomic features, Prof. Ribeiro conducted a recent internal study with 10 users at her clinic comparing the Elara 900 with a traditional slit lamp. Elara 900 fared either significantly or somewhat better in all categories, including examination speed, workflow, posture, and patient positioning.

Offering unrivaled clarity, optics & illumination Dr. Sunil Mamtora (United Kingdom) admitted that he was initially skeptical about Elara 900’s new visualization features and optical redesign. In fact, he was convinced that Haag-Streit’s BQ 900 was the gold standard: “I didn’t think it could get any better,” he revealed.

Dr. Mamtora led a study comparing Elara 900 with the BQ 900 with 20 ophthalmologists from the Royal College of Ophthalmologists (RCO) during its Annual Congress. He said their results clearly favored Elara 900: 70% said there was improved visualization with Elara 900 and 30% reported there was no difference.

Evolving clinical practice Prof. Maria Kugelberg (Sweden) described her experience with Elara 900 as “a revolution.” “Nothing has happened in this field since 1911 when the slit lamp was invented,” said Prof. Kugelberg. “But now it's here.”

“But when I used Elara 900 for the first time, there was a ‘wow’ moment,” said Dr. Mamtora. “When you focus on that corneal slit, the resolution, the dynamic range, the effect that you see there…it's quite astonishing.”

In her clinical practice, she said that patient satisfaction, with good posture for both patients and doctors, are standout benefits of Elara 900. “The Elara 900’s patient headrest provides better neck posture and larger patients are more comfortable too,” she shared.

He explained that the definite, noticeable improvement in optical quality is a result of the Elara 900’s reduction in source aberrations, and its “P-Type” projector illumination and new optical design.

Elara 900 also better supports patient education and interaction. Prof. Kugelberg highlighted its documentation capabilities that allow doctors to take and review images in real-time.

“With the new “P-Type” projector illumination in the Elara 900, you shine the light directly onto the eye [rather than reflected from a mirror]. You reduce the source of aberrations, and unsurprisingly, you have a crisper image,” he said.

“You can show the patient the problem or if there was a complication. You can describe how you will fix it,” said Dr. Kugelberg. This improves communication and can be helpful when family members are present, a common scenario with cataract patients, she explained.

Elara 900 also has the capability to preset illumination parameters. “When we examine the cornea, we benefit from having a cooler color temperature. When we examine the retina and the fundus, we benefit from having a warmer color

Improving patient compliance Prof. David Goldblum (Switzerland) discussed how Elara 900’s images can be used to educate patients

and improve compliance. Recapping the slit lamp's numerous functions, Prof. Goldblum reminded us of its versatility: as a tool for examination, diagnostics, and imaging–even as a microscope for surgery. “The quality of Elara 900 is unsurpassed,” said Prof. Goldblum. “It has image quality that you see directly.” So, how can this improve compliance? Well, as Prof. Goldblum said, “a picture is worth a thousand words.” He then explained the picture superiority effect (PSE): the phenomenon in which pictures are more likely to be remembered than spoken or written information. Relaying PSE back to the Elara 900, he recalled a recent case: “When I showed pictures [from Elara 900] to the patient, he was absolutely keen on having a biopsy taken. Unfortunately, we were right and this was a melanoma. He's in treatment now,” he shared. “[The images were] a great help in treating and guiding the patient.” In the end, he said that “sharing photographs with our patients will enhance their understanding, and their confidence in us.”

* Wasserman JB, Bustos KM, Coombs SD, et al. Effect of slit lamp table design on neck position and the prevalence of neck pain in eye care professionals. Work. 2022;72(1):181-188.

Editor’s Note Reporting for this story took place at the 43rd Congress of the European Society of Cataract and Refractive Surgery (ESCRS 2025), held from 1216 September in Copenhagen, Denmark. A version of this article was first published on cakemagazine.org. “The Slit Lamp Exam. Reinvented” satellite symposium is now available on-demand. If you missed the symposium – or would like to revisit the discussions – the full recording, courtesy of MCI, is available now on YouTube.

CAKE MAGAZINE | December 2025

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EYE BANKING

Eye Banking Through the Ages Progress, challenges and the road ahead By April Ingram

From ice boxes to AI, eye banking has come a long way—but the global demand for donor tissue still outpaces supply. Can innovation, infrastructure and a little human generosity finally close the gap?

To better understand the current landscape, we turned to those at the heart of global eye banking. Dr. Hajirah Saeed (USA), associate professor of ophthalmology at the University of Illinois Chicago, captures the ongoing challenge, saying, “Despite major scientific advances in eye banking and corneal transplantation, the demand for corneal tissue continues to exceed supply in the majority of the world.” Corrina Patzer (USA), chief strategy officer at VisionGift—a nonprofit eye bank with operations in Oregon and Massachusetts—echoed this sentiment, “The need for corneal tissue far outweighs what’s currently available, leaving many patients around the world still waiting for the chance to see again.”

The pillars of progress Success in eye banking depends on a few key foundations: strong infrastructure and regulation, efficient logistics and sustained public awareness. Unfortunately, many countries lack the resources to develop the rigorous quality control, accreditation and training standards necessary to ensure safe and effective tissue handling.5 Image created with assistance from ChatGPT, ©Media MICE Pte Ltd, 2025.

t may be difficult to imagine, but over 100 years ago—when automobiles were still novelties and before any World Wars—physicians were already transplanting corneal tissue. The world’s first successful full thickness corneal transplant was performed by Dr. Eduard Zirm in 1905. Fast forward to the 1930s, when Dr. Vladimir Filatov recognized a key barrier to progress: tissue to be available when it was needed. He championed the use of human cadaver corneas and documented storage methods using ice boxes, laying the groundwork for modern eye banking.1 A decade later, in 1944, Dr. Richard Paton founded the first eye bank in New York City, the Eye-Bank for Sight Restoration.1 His vision was simple but transformative: preserve and distribute donated tissue so that every surgeon could have access when a patient needed sight restored.

Yet, despite these enormous advances, global eye banking today continues to grapple with familiar challenges. Donor shortages persist, access remains uneven and the demand for tissue far outstrips supply.2 The numbers tell a sobering story. An estimated 12.5 million people worldwide are waiting for a corneal transplant, but only about one in every seventy will receive one. And while regions such as North America and parts of Europe enjoy selfsufficiency (even exporting tissue), low- and middle-income countries face chronic shortages due to limited infrastructure, training and public awareness.3 The COVID-19 pandemic only deepened the divide. Eye banks around the world faced sharp declines in donations and surgeries. Although recovery is underway, some regions are still lagging slightly behind pre-pandemic levels.4

CAKE MAGAZINE | December 2025

Even when infrastructure exists, the logistics of procurement, processing and international distribution are complex. Cultural and religious misconceptions can also dampen voluntary donation rates.5 Some regions have tackled this challenge through Hospital Cornea Retrieval Programs (HCRPs), shifting away from purely voluntary systems toward hospital-based tissue collection.5

Innovation in action Dr. Saeed and colleagues recently presented an eye banking model for resource-limited settings at the Association for Research in Vision and Ophthalmology Annual Meeting (ARVO 2025), focusing on the creation of an eye bank in Gaza in 2022. Between August 2022 and October 2024, approximately 330 corneal transplantations were performed in the war-torn region. Ophthalmology residents were trained to procure

tissue from the morgue, achieving an average turnaround of three days from procurement to surgery—with no infections and only three cases of graft failure.6 This model demonstrates that even under challenging circumstances, strategic adaptation and training can deliver remarkable results.

A look ahead New technology continues to reshape the field. “Innovations such as extended preservation techniques, preloaded lamellar grafts and AIassisted donor screening are making corneal transplantation more efficient and accessible,” said Dr. Saeed. She added, “Regenerative therapies, ranging from cultured endothelial cell injections to mesenchymal stem cell therapies, promise to further reduce dependence on donor tissue.” Ms. Patzer also highlighted emerging technologies transforming care. “Traditional eye banking continues to play a vital role, but new technologies are opening doors we couldn’t imagine before,” she said. “For example, innovations like KeraNatural [VisionGift; Massachusetts, USA], a sterile corneal graft used in the corneal allogenic intrastromal ring segments (CAIRS) procedure, make it possible to restore sight to patients who might not have access to or be candidates for a full transplant.” She continued, “By creating consistent, sterile and reliable options, these advances reduce the strain on traditional donor tissue while expanding care to regions where corneal grafts are scarce.

Globally, this means eye banks and surgeons can serve more patients, more effectively.”

The road to equitable access Even with these breakthroughs, the need for donor tissue still exceeds supply. Researchers and manufacturers are exploring alternatives such as artificial corneas, corneal implants and advanced therapy medicinal products (ATMPs). These developments could help bridge the gap while reducing dependence on human tissue. Yet, as Dr. Saeed reminded us, “The world’s population itself holds the solution: there are more than enough potential donors to eliminate the shortage entirely.” She emphasized that real progress will depend not only on technology but also on addressing infrastructural, logistical and cultural constraints. “By strengthening eye bank networks, fostering public awareness and harmonizing policy frameworks, the field can transform these scientific breakthroughs into equitable, sustainable access to sight restoration worldwide,” she concluded. From ice boxes to AI, the evolution of eye banking has been a story of persistence, innovation and human generosity. The next century of progress may not rely solely on new technology but on something more powerful: the collective willingness to see that no one is left waiting in the dark.

References 1. Crawford AZ, Patel DV, McGhee CNJ. A brief history of corneal transplantation: From ancient to modern. Oman J Ophthalmol. 2013;6(Suppl 1):S12-S17. 2. Voss JH, Greenwald MF. Opportunities and Challenges in Global Eye Banking: A Review. Int Ophthalmol Clin. 2025;65(2):35-43. 3. Gain P, Jullienne R, He Z, et al. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2):167-173. 4. Mousavi M, Kahuam-Lopez N, Iovieno A, et al. Global impact of COVID-19 on corneal donor tissue harvesting and corneal transplantation. Front Med. 2023;10:1210293. 5. Anitha V, Tandon R, Shah SG, et al. Corneal blindness and eye banking: Current strategies and best practices. Indian J Ophthalmol. 2023;71(9):3142-3148. 6. Saeed HN, Almanassra M, Fathy C, et al. An eye banking model for resource-poor settings. IOVS. 2025;66(8):2036.

Contributors Dr. Hajirah Saeed is redefining what’s possible for the most complex eye conditions. An Associate Professor of Ophthalmology at the University of Illinois Chicago, she also co-directs the Ocular Regenerative Medicine and Advanced Pediatric Experience fellowships, training the next generation of innovators in vision science. Her clinical expertise lies in treating severe ocular surface disease and anterior segment dysgenesis in both adults and children, and she’s internationally recognized for her groundbreaking work on Stevens-Johnson syndrome (SJS), supported by NIH and DOD funding. Dr. Saeed’s research doesn’t stop there. Her team explores cutting-edge areas like machine learning for diagnostics, corneal crosslinking in pediatric patients, and sustainable eye banking solutions in the developing world. hnsaeed@uic.edu

Corrina Patzer has spent more than 20 years turning bold ideas into better vision for people around the world. As Chief Strategy Officer at VisionGift, a leading nonprofit eye bank with locations in Oregon and Massachusetts, she drives innovation at the intersection of science, strategy and sight restoration. Her leadership has fueled breakthroughs in global tissue distribution and product development, including KeraNatural, a sterile corneal allograft designed for CAIRS procedures, and the Coracle, a corneal viewing chamber that has reshaped how donated tissue is handled and prepared. A true bridge-builder between research and real-world impact, Corrina is passionate about ensuring that every scientific advance in eye banking finds its way to the patients who need it most. corrina@visiongift.org

CAKE MAGAZINE | December 2025

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CORNEAL SURFACE

hen patients keep coming back with dry, itchy, crusty, irritated lids, or blepharitis that just won’t quit—a quick eyelid check could be the solution. At a Tarsus-sponsored symposium on Day 3 of the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025) in Copenhagen, Denmark, ophthalmologists Erik Mertens and Radhika Rampat urged attendees to take a few extra seconds at the slit lamp to inspect the lids for indicative signs of Demodex blepharitis (DB). It’s a small change in examination technique that can make a big difference in spotting one of the most common yet overlooked contributors of ocular surface disease.

Underdiagnosed but highly prevalent

Stumped By Ocular Surface Disease? European Eye Care Practitioners Might Want to “Look at the Lids” for Demodex Blepharitis Sponsored by Tarsus Pharmaceuticals, Inc.

Diseases like dry eye and MGD can be enigmatic. Checking for collarettes and other signs of Demodex blepharitis could uncover the root cause in some cases.

CAKE MAGAZINE | December 2025

Demodex blepharitis (DB) is a big diagnostic blind spot. Although studies suggest1 it affects about 54% of patients presenting to EU eye care clinics,2 this mite-induced condition remains widely underrecognized across European practices. Dr. Mertens (Belgium) and Dr. Rampat (UK) presented data showing that 69% of blepharitis patients are playing host to Demodex mites.3 Yet the vast majority continue to receive symptomatic treatments for dry eye, MGD or "non-specific" blepharitis without addressing the root cause. "Despite this high prevalence, DB is often missed due to its nonspecific symptoms. Many clinicians don’t routinely examine for collarettes waxy, cylindrical debris at the base of the lash - a key diagnostic marker,” said Dr. Rampat. “But as awareness of DB grows, incorporating targeted examination techniques is critical to improving detection and management of this commonly overlooked disease,” said Dr. Rampat. The implications extend far beyond diagnostic accuracy. Dr. Mertens believes this diagnostic delay contributes to progressive meibomian gland dysfunction,

Integrating this into routine eyelid examinations is a simple yet powerful step in improving detection of Demodex blepharitis.

“When DB is mistaken for other OSDs, this leads to repeated use of therapies that don’t match the underlying cause.” - Dr. Erik Mertens

persistent ocular surface inflammation, and a frustrating cycle of symptoms for patients, all of which might be avoided with a timely mite check. “When DB is mistaken for OSDs, this leads to repeated use of therapies that don’t match the underlying cause,” said Dr. Mertens. “When this happens, this not only delays resolution of the condition, but may actually further exacerbate ocular surface damage and contribute to patient frustration,” he explained. These issues can also extend beyond the clinic to the cataract and refractive operating theater. “In surgical settings, undiagnosed DB can cause fluctuating vision which may compromise preoperative ocular surface optimization, increasing the risk of suboptimal outcomes after cataract or refractive procedures. Thus, early identification and targeted treatment are needed to break the cycle of mismanagement and improve long-term ocular health,” shared Dr. Mertens.

A quick test to flip the DB script Just a few extra seconds at the slit lamp could make all the difference in detecting DB and managing the lid, lash and ocular surface issues it may cause. The key isn’t complicated testing or expensive tools, but a small

shift in technique. Collarettes are cylindrical, waxy debris of mite waste products and eggs found at the base of the eyelashes and can be identified during a routine slit lamp exam. Research shows that 100% of patients with collarettes are found to have Demodex mites, making this an easy and reliable diagnostic marker.4 So how do ophthalmologists get the jump on collarettes? Dr. Rampat said to simply have patients look down during slit lamp exam.5 This offers a clear view of the upper lash line, where collarettes often hide. According to Dr. Rampat, the technique takes almost no extra time and can help you avoid missing an important diagnosis.

“By methodically looking for debris, lifting the lashes, pushing on the lid margin and pulling lashes to reveal mites or debris, clinicians can uncover early indicators of DB that are easily missed during standard slit lamp exams. Asking your patient to look down is quick, non-invasive and requires no additional equipment—making it a practical step that improves diagnostic accuracy and supports more targeted treatment planning in everyday clinical settings,” said Dr. Rampat. Dr. Mertens added that this simple step has helped him catch more cases and approach stubborn ocular surface symptoms with more confidence. “As a result, it provided us clinical clarity,” shared Dr. Mertens. According to Dr. Mertens, routinely diagnosing DB in his practice has not only enhanced clinical confidence but also increased patient trust that their doctor is providing a complete assessment and will do everything they can do to address the issue with the tools available to them now.

The hidden cost of diagnostic inertia A routine collarette check might be quick, but those are just a few

"Despite this high prevalence, DB is often missed due to its nonspecific symptoms. Many clinicians don’t routinely examine for collarettes - waxy, cylindrical debris at the base of the lash - a key diagnostic marker." - Dr. Radhika Rampat

CAKE MAGAZINE | December 2025

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CORNEAL SURFACE

And these patients aren’t avoiding the clinic—33% had seen a doctor more than twice.6 The takeaway? A quick lid check could make a lasting difference for a large group of overlooked patients. “As diagnostic techniques become routine and as more clinicians routinely screen for collarettes, DB is shifting from an overlooked to a recognizable, impactful disease for our patients,” concluded Dr. Mertens.

seconds you and your patients can’t afford to miss.

What’s next for Europe and DB

The clinical consequences of a missed diagnosis are one thing, but the human toll is just as substantial. According to the ATLAS study that surveyed 311 patients with DB, 80% of patients reported disruptions to daily life. Nearly half struggle with night driving, and about a third need more time for daily hygiene routines.6

Dr. Mertens (Belgium) and Dr. Rampat (UK) see the “Look at the Lids” initiative as more than a diagnostic reminder, it’s a shift toward proactive, targeted care for eyelid health.

“Around the issue of Demodex blepharitis, one of the most surprising clinical insights is just how big an impact it has on a patient's daily life. Many suffer for years, misdiagnosed or dismissed, leading to frustration and even anxiety around their eye health,” said Dr. Mertens. And for European practitioners seeing younger patients, the contact lens intolerance data has proven striking as well. A study in 62 users of contact lenses showed that 93% of those with contact lens intolerance have Demodex mites, suggesting that many of these cases—often chalked up to dry eye or general sensitivity—might actually stem from a sneaky mite problem.4 “Today, clinicians are increasingly recognizing that acknowledging DB can result in better comfort, confidence and emotional wellbeing of these patients—once more highlighting the importance of looking beyond the slit lamp and listening to the patients’ experiences,” emphasized Dr. Mertens.

“The future of DB management lies in proactive diagnosis, standardized screening and targeted therapies. But most importantly, it starts with the first step of recognizing DB and to increase awareness to better address it. DB should no longer be a disease that should be tolerated or mismanaged," noted Dr. Rampat. As the understanding of eyelid health advances, accurate diagnosis is no longer a nice-to-have. It’s essential. The ATLAS study underscores the urgency: 51% of patients with DB had symptoms for four years or more before diagnosis, and 58% had never been diagnosed with blepharitis at all.6

Because we now recognize the true impact of Demodex blepharitis, overlooking it isn’t optional—it must be identified and addressed. Learn more at lookatthelids.eu. Disclosure: Dr. Mertens and Dr. Rampat are paid consultants for Tarsus Pharmaceuticals, Inc. GL--2500109

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Editor’s Note The 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025) was held from 12-16 September in Copenhagen, Denmark. Reporting for this story took place during the event. A version of this article was first published on cakemagazine.org.

References 1. Tarsus Data on File - Evaluation of the Real-World Burden of Demodex Blepharitis: A UK MultiCentre Study 2. Tarsus Data on File - Demodex blepharitis Patient Screening Study Brief Summary 3. Trattler W, Karpecki P, Rapoport Y, et al. The Prevalence of Demodex Blepharitis in US Eye Care Clinic Patients as Determined by Collarettes: A Pathognomonic Sign. Clin Ophthalmol. 2022;16:1153-1164. 4. Rhee MK, Yeu E, Barnett M, et al. Demodex Blepharitis: A Comprehensive Review of the Disease, Current Management, and Emerging Therapies. Eye Contact Lens. 2023;49(8):311-318. 5. Starr CE, Gupta PK, Farid M, et al; ASCRS Cornea Clinical Committee. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684. 6. O'Dell L, Dierker DS, Devries DK, et al Psychosocial Impact of Demodex Blepharitis. Clin Ophthalmol. 2022;16:2979-2987.

CAKE MAGAZINE | December 2025

Industry Update

Contact Lenses Outshine Spectacles for Kids with Primary Congenital Glaucoma, Study Finds Sharper, steadier, smoother. RGPCLs outfocus spectacles in kids after PCG surgery. Fresh data is shedding new clarity on why rigid gaspermeable contact lenses (RGPCLs) may trump spectacles after primary congenital glaucoma (PCG) surgery. The Contact Lens for Vision Rehabilitation in PCG Children (CLEVR-PCG) trial, conducted at Zhongshan Ophthalmic Center (Guangzhou, China), found that young patients wearing RGPCLs enjoyed greater gains in visual acuity, contrast sensitivity and stereoacuity than those who stuck with glasses.* “RGPCLs provided superior visual acuity and contrast sensitivity improvement versus continued spectacle wear for children after PCG surgery,” the study authors reported.

Inside the study The randomized clinical trial enrolled 56 children aged four to 15 years with surgically managed PCG who had shown poor response to spectacles. Participants were randomly assigned to either the RGPCL group (29 children) or the continued spectacle group (27 children) for 12 months. Both groups received standardized amblyopia patching when indicated.* Of these, 48 participants completed at least one followup and were included in the primary analysis. By the end of the study, 22 children (76%) in the RGPCL group and 19 (70.4%) in the spectacle group made it to the 12-month finish line.*

The results After a year, the RGPCL group achieved significantly greater improvement in best-corrected visual acuity (BCVA) in their worse-seeing eye. Mean improvement reached 0.31 logMAR for RGPCL wearers versus 0.12 logMAR for the spectacle group—a clinically meaningful edge of roughly 10 letters or two lines on a vision chart.* A closer look revealed that 62.5% of children in the RGPCL group gained two or more lines of BCVA improvement, compared to 37.5% in the spectacles group.* Other standout results included:* • Greater improvement in contrast sensitivity (0.40 vs. 0.13 log units)

• Better near stereoacuity, with 50% of RGPCL wearers achieving 60 arcseconds or better versus 25% among spectacle users Importantly, no serious adverse events occurred during the study, underscoring the safety of RGPCL use in this population.*

Why it matters PCG remains a leading cause of childhood blindness worldwide. Even when surgery successfully manages intraocular pressure, kids may still struggle with vision due to corneal irregularities, refractive errors or amblyopia. The authors suggest that RGPCLs offer a visual edge by creating “a smoother refractive surface and reducing higher-order aberrations” that can interfere with vision in these young patients.* “These findings support using RGPCLs for children undergoing PCG surgery, including those with worse baseline visual acuity or poor spectacle response,” the researchers concluded.

Room for more clarity As with any single-center study, there were a few caveats. The modest sample size, 12-month duration and partial blinding due to the visible nature of the interventions could introduce bias.* The researchers recommend future multicenter studies with longer follow-up to confirm their findings and to further explore the long-term safety, developmental outcomes and quality-of-life impact of RGPCLs in children with PCG.*

Bottom line: In the battle of lenses versus glasses, RGPCLs appear to give young PCG patients a clearer view of the world—and perhaps, a brighter outlook on life.

* Jiang J, Hu Y, Zhu Y, et al. Visual outcomes of children with primary congenital glaucoma receiving different refractive corrections: The CLEVR-PCG randomized clinical trial [Preprint]. JAMA Ophthalmol. November 6, 2025.

Editor’s Note: A version of this article was first published on cakemagazine.org.

CAKE MAGAZINE | December 2025

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AI IN OPHTHALMOLOGY

algorithms can be used to improve ophthalmic diagnosis or treatment, but you can imagine that if this kind of algorithm is biased or unfair, it could magnify and perpetuate the inequities in ophthalmic care, such that minorities end up receiving even worse care.”

A problem older than AI yet much bigger Ophthalmology has long struggled with unequal access, uneven disease burdens, and patchy utilization across geography and race. “We know that there are already disparities in ophthalmic care,” Dr. Wang said, pointing to striking variations in blindness rates across U.S. states and persistent gaps in care between communities. Add AI on top of that uneven landscape, she warned, and the technology could accelerate inequity rather than solve it.

Image: Shutterstock AI/Shutterstock.com

AI’s Blind Spots Why biased algorithms could worsen eye care for millions By Hazlin Hassan

Dr. Wang noted a number of highprofile cases in which algorithms used to recommend patients for extra care “were systematically favoring white patients,” as well as another widely-used algorithm that misjudged kidney function, among others. Meanwhile, AI systems across healthcare continue to be trained on data that reflects who gets care, not who needs it.

AI might have 20/20 vision for pathology—but not for people. Behind the promise of smarter algorithms lurks a familiar problem: bias that could blur the future of equitable care.

Ophthalmology faces the same issue. “Globally…the number of clinical trials evaluating AI is very uneven,” Dr. Wang said.

Even within the United States, “the patient cohorts used for training clinical machine learning algorithms is heavily skewed” toward certain regions, rarely reflecting the nation’s racial, ethnic and socioeconomic diversity.

rtificial intelligence (AI) is rapidly becoming the newest member of the ophthalmology care team, screening scans, flagging risks and even predicting who might lose vision before symptoms begin. But at the American Academy of Ophthalmology 2025 annual meeting (AAO 2025), one speaker delivered a sharp reminder: AI may be powerful, but it is not automatically fair, objective or equitable.* In fact, if designed carelessly, it can view the world through the same

distorted lens that has shaped decades of healthcare inequality. The message came courtesy of Dr. Sophia Wang (USA), a Stanford glaucoma specialist and AI researcher who has spent the past several years elbows-deep in training datasets and real-world patient records. “I have been privileged to be on the front lines of witnessing the explosion in AI in ophthalmology, and AI in healthcare in general,” she began. “There is a lot of hope that AI

CAKE MAGAZINE | December 2025

She outlined several key frameworks for assessing AI ethics: • Anti-classification: Exclude protected attributes (like race) as inputs. • Parity: Ensure accuracy is similar across demographic groups.

• Equalized odds: Match both truepositive and false-positive rates for each group. • Calibration fairness: If a model predicts an 80% risk, it should mean 80% across all subgroups.

Fairness: Easier said than defined “We have to think very carefully about what we mean by fairness,” Dr. Wang said. Fairness, she explained, is not a single measure quantity, and it can’t be achieved by simply removing race from the equation. This is because in predictive glaucoma models, the underlying distribution might differ by race, she noted. Excluding race and ethnicity does not necessarily make a model fairer; sometimes it blinds the algorithm to clinically meaningful patterns. “It is tricky,” she admitted.

Finding bias in the wild

false-positive rates are equal across groups. The results? “We definitely found evidence of bias in our models,” Dr. Wang said. It wasn’t glaring, but subtle enough that “we had to look for it pretty carefully to appreciate it.” And the definition of fairness itself shifted by site. Results differed depending on if they were evaluating the Black-predominant center or the Asian-Hispanic one. “Generalizability of the fairness of the model is not guaranteed,” she emphasized. “There is no easy, one size fits all, simple solution.”

Better data, smarter math Dr. Wang outlined a series of approaches to tackle bias throughout AI development—before, during and after training: • Build larger, more representative datasets.

To move from theory to practice, Dr. Wang walked the audience through her team’s work on a real glaucoma prediction model. The algorithm was trained on the Sight Outcomes Research Collaborative (SOURCE), a sprawling, multi-institutional registry spanning 23 sites across the United States.

• Leverage national efforts like the National Institute of Health’s All of Us Research Program, which intentionally oversamples underrepresented communities.

Her team had previously developed a model to predict which glaucoma patients would progress to requiring incisional surgery. But as more sites joined SOURCE, they revisited the model with the question: is the model biased?

• Re-evaluate models regularly after deployment.

The seven-site dataset included around 40,000 glaucoma patients with dramatic variation in demographics. While 60% were White, one external validation site was a “Black-predominant site with very few White patients.” Another had “more White patients but also a sizable Asian and Hispanic population.” The diversity made it ideal for stress-testing fairness. Her group evaluated three “sensitive attributes,” namely race, ethnicity and sex. Fairness was measured using equalized odds, a method that checks whether true-positive and

• Apply techniques such as reweighting, resampling or data augmentation.

Her takeaway? “Fairness valuation for AI models is a must, and we, as users, have to demand these types of valuations in order to feel that models can be trustworthy.” Her pro tip? “The best techniques are the ones that build fairness into the training process from the beginning. These work better than fixing the data going in or tweaking the predictions going out.” “We really have to build these considerations into our approach as we are making the models, and ideally at every stage of development, multiple stakeholders should be involved,” Dr. Wang added. She added that bias correction often feels like a game of whack-a-mole.

“You could fix the bias, but then maybe overall performance gets worse,” she said, half in jest.

The bigger picture Ultimately, Dr. Wang said, “Fairness is more than just the mathematical definitions. We get to decide, as a society, what is far and how do we get to equity in ophthalmology, and what role does AI play in that process?”

“Fairness is more than just the mathematical definitions. We get to decide, as a society, what is far and how do we get to equity in ophthalmology, and what role does AI play in that process?” - Dr. Sophia Wang

AI may be transforming ophthalmology, but whether it narrows or widens the gap in care will depend on the choices made now, while the technology is still being shaped. For a field defined by vision, the goal couldn’t be clearer: teach AI to see everyone, equally.

* Wang S. AI and Health Disparities: Investigating Bias and Ensuring Fairness in AI Algorithms for Glaucoma. Lecture at AAO 2025. Orlando, Florida, United States. October 19, 2025.

Editor’s Note The American Academy of Ophthalmology Annual Meeting 2025 (AAO 2025) was held October 17-20, 2025, in Orlando, Florida. Reporting for this story took place during the event.

CAKE MAGAZINE | December 2025

Cover Story

The Value of Vision

The economic case for universal eye care By Tan Sher Lynn

Turns out, clear vision isn’t just good for patients. It’s good for progress too. At the UN, leaders and advocates made the case that when the world sees better, it works better too.

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hey say hindsight is 20/20—but foresight, it seems, is even more valuable. Nearly one billion people in low- and middleincome countries live with avoidable sight loss, a figure set to climb as populations age and screen time soars.1 The ripple effects touch nearly every corner of life: unemployment, poor educational outcomes, social isolation, mental health struggles, injury risk and economic losses. The message is clear. Investing in eye health doesn’t just restore vision; it powers prosperity.

Delivering on these six priorities, the report says, could generate $28 in economic benefits for every $1 invested, putting eye health on par with nutrition as one of the smartest investments in sustainable development. A $7.1 billion investment by 2030 could yield $199 billion in returns; sustained action could ultimately unlock $447 billion annually—the equivalent of 13 million additional years of schooling, 22 million more people employed, and 304 million caregivers, mostly women, freed from unpaid work.

At a high-level meeting during the “The findings are striking,” Mr. 80th United Nations (UN) General Holland said. “By prioritizing these Assembly2, the International Agency six accelerator interventions we can for the Prevention of Blindness achieve rapid results within one to (IAPB) and the United Nations three years. The report shows that Friends of Vision Group launched investing in eye health is one of the The Value of Vision report3, a smartest investments a country can landmark call urging governments, make.” non-governmental organizations Seeing beyond (NGOs) and global “Over a billion health agencies to place people are eye health at the Opening the session, living with sight heart of sustainable Ambassador Walton development. Webson, permanent loss because representative they don’t have “Over a billion of Antigua and access to the eye Barbuda to the UN, people are living care they need.” with sight loss reminded delegates because they don’t that vision is far - Peter Holland have access to the more than a medical IAPB Chief Executive Officer eye care they need,” metric. “Vision,” he said IAPB Chief said, “is not just Executive Officer a health issue. It Peter Holland. “We now have clear is about human potential, equity evidence of both the urgency and the and progress. If we are serious return on investing in eye health. The about achieving the Sustainable Value of Vision report is built on solid Development Goals, we must evidence. It combines ambition with recognize that the ability to see is achievability to show how tackling fundamental.” sight loss transforms societies and economies.” He called for collective momentum, adding, “Progress is not only The report sets out a bold goal: reach possible. When we act together, it is one billion people with avoidable probable.” sight loss and unlock $447 billion each year for the global economy. Founded by Antigua and Barbuda, It maps a practical path forward Bangladesh and Ireland, the Friends through six priority interventions: of Vision Group now includes early detection via community nearly one-third of UN member screenings, quick access to reading states. Ambassador Webson glasses, expansion of the eye health emphasized that no single nation workforce, greater surgical capacity, can end avoidable blindness alone. removal of barriers like cost and “Through partnership, innovation and distance, and improved cataract solidarity, we can ensure that sight— outcomes through better training, and opportunities—are created for biometry and postoperative care. all,” he said.

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Cover Story

The economic argument was underscored by Antigua and Barbuda’s Prime Minister Gaston Browne, who announced that his country will host the first-ever Global Summit on Eye Health in 2026.

for Bangladesh, described how her country has woven eye care into its national health system.

small nations can lead by example in integrating eye care into broader development strategies.

“Eye health is not a vertical program,” Ms. Begum said, “but a smart, system-wide investment in human and social capital.” Bangladesh has established more than 330 community eye centers digitally linked to base hospitals serving up to 300,000 people each, with plans to add 250 more centers, upgrade 30 district units and enhance 17 base hospitals.

Eye health as a smart global investment

Five years after the UN adopted the “Vision for Everyone” resolution— its first commitment to ensure eye care for all by 2030—PM Browne acknowledged that progress has lagged. “Millions of children still sit in classrooms unable to see the blackboard. Workers are leaving their jobs because their vision no longer allows them to perform safely. “Our aim is simple,” she explained. The elderly are too often sidelined “Earlier detection, reliable referral, because of higher surgical impaired sight,” numbers and he said. good visual “Vision impairment She affects over two billion outcomes.” Calling vision loss urged stronger people worldwide. “both a human partnerships to tragedy and an scale affordable At least one billion economic one,” cataract of those cases are PM Browne cited surgery, lowpreventable or data from IAPB, cost spectacles Sightsavers and and AI-powered untreated, yet eye The Fred Hollows diagnostics health receives less Foundation for diabetic showing that retinopathy, than 0.06% of global investing in vision noting that policy, health funding. care for one billion investment Behind these figures people could and technology generate $447 must work are stalled lives: a billion in annual hand in hand child who cannot returns, 22 million for maximum learn, a farmer who new jobs and 13 impact. million additional cannot work, an elder school years. Prime Minister losing connection of St. Kitts and with their community.” Nevis Terrance “For small states like Antigua and Drew—a - Rabab Fatima, Under Secretary-General Barbuda,” he physician and High Representative for the Least Developed Countries (LDCs), Landlocked said, “investing in himself—framed Developing Countries (LLDCs) and Small eye health is not eye health as Island Developing States (SIDS) charity. It is smart a cornerstone economics. The of national choice before us development. is stark: either we allow vision loss He shared that his government has to continue robbing the world of resumed post-COVID eye surgeries, talent and human dignity, or we act cleared a backlog of more than 500 decisively and reap the social and cataract and glaucoma cases, and economic dividends that are right in continues to offer free eye care via front of us.” telemedicine and visiting specialists.

Building the framework for visionary policy Money matters, but policy makes it last. Nuran Begum, health advisor

“Good vision enables children to learn, adults to work and older persons to live with dignity,” he said, pledging full participation in the 2026 Global Summit and reaffirming that

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Under Secretary-General Rabab Fatima, a founding member and former co-chair of the Friends of Vision, offered a global perspective on the crisis. “Vision impairment affects over two billion people worldwide. At least one billion cases are preventable or untreated. Yet, eye health receives less than 0.06% of global health funding, and we face a $14.3 billion funding gap,” she said. “Behind these figures are stalled lives: a child who cannot learn, a farmer who cannot work, an elder losing connection with their community.” Ms. Fatima underscored that solutions are simple and proven. “Every $1 invested yields $36 in benefits—among the highest returns in public health. From eyeglasses to cataract surgery, the interventions are known; the impact is transformative.” Her roadmap outlined five key priorities: closing the funding gap, integrating eye care into national plans, strengthening partnerships, improving data collection and maintaining high-level advocacy. She reaffirmed the UN’s commitment to supporting 92 vulnerable countries and urged urgent, convictiondriven investment in eye health as a pathway to equality and opportunity. Dr. Yusuf Tanko Sununu, representing Nigeria’s president, reinforced this message, highlighting Nigeria’s 20242028 National Eye Health Strategic Development Plan focused on primary care integration, workforce expansion, and new national screening guidelines for diabetic retinopathy and glaucoma. “Investing in eye care is not only a moral imperative, but an economic necessity,” he said, emphasizing that good eye health boosts productivity, reduces healthcare costs and strengthens national growth.

Echoing this, WHO Regional Director for the Americas Dr. Jarbas Barbosa urged evidence-based integration of eye care into primary healthcare, training of frontline providers, expanding access to glasses and cataract surgery, and building robust data systems. “Every dollar spent on eye care generates a significant return for individuals and communities,” he said, stressing accountability and regional roadmaps ahead of the 2026 Global Summit.

Sharpening focus on the marginalized A major theme was equity, ensuring that women and children are not left behind in the global vision movement. George Laryea-Adjei, UNICEF Regional Director for West and Central Africa, noted that vision is fundamental to every child’s right to learn, participate and thrive. “Yet, globally, at least 450 million children have a sight condition that needs treatment and some 90 million children are living with some form of sight loss,” he said. He emphasized that unaddressed vision problems limit learning and participation, adding, “That is why at UNICEF, we've committed to assisting these 90 million children to be screened and for them to access all the support that they need including the provision of assistive technology.” UNICEF’s commitment reflects a growing global movement. Guyana’s

school vision program has screened 73,000 children, improving reading speed and accuracy by 20% within months. India has screened more than 60 million students and distributed 10 million free spectacles, while Zimbabwe and Romania have expanded school-based and assistive vision services. Dr. A.H. Kabir, senior UN adviser on Gender Equality & Disability Inclusion, reminded the audience that “vision impairment is both a cause and consequence of gender inequality.” Women and girls make up 55% of people with vision loss and are significantly more likely to experience blindness or severe impairment. He urged countries to collect sex-disaggregated data, remove barriers and invest in women’s eye health as part of inclusive economic growth.

A clear vision for the future As the meeting concluded, one truth came into sharp focus: vision is a human right and an engine for progress. When a child can finally see the board, an adult can return to work, and an elder can live with independence, societies thrive. The 2026 Global Summit in Antigua and Barbuda will mark a pivotal moment to turn political will into realworld change. When global leaders join forces to make preventable blindness a relic of the past, the future of vision—and humanity—will look clearer than ever.

Vision as a Driver of Growth Good vision is the cornerstone of economic growth and social inclusion. When people see well, they learn better, work more productively and participate fully in society. Clear sight leads to healthier workforces, improved school performance, fewer injuries and reduced reliance on healthcare and welfare systems. • Reaching the one billion people with preventable vision loss could generate a staggering annual impact: • $447 billion added to the global economy • 22 million more people in employment • 13 million additional school years achieved • 1.2 million fewer road crash injuries • 320,000 extra years of life lived • 304 million people—mostly women—freed from avoidable sight loss • 1.12 million people relieved from depression

Editor’s Note

References 1. Blindness and vision impairment. World Health Organization. August 10, 2023. Available at: https:// www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment. Accessed on October 31, 2025. 2. Browne G. The Value of Vision: The Case for Investment. UNGA80. New York City, United States. September 25, 2025. Available at: https://youtu.be/yhT0RVu8h_A. Accessed on October 31, 2025. 3. The Value of Vision: The case for investing in eye health. IAPB. September 25, 2025. Available at: https://visionatlas.iapb.org/global-investment-case/. Accessed on October 31, 2025.

The United Nation’s General Assembly briefing on “The Value of Vision: The Case for Investing in Eye Health” was held (and webcasted) on September 25, 2025. Reporting for this story took place during the event. Media MICE is a member of the International Agency for the Prevention of Blindness (IAPB).

CAKE MAGAZINE | December 2025

udos

WOMEN IN OPHTHALMOLOGY

Restoring Childhood By Chow Ee-Tan

What does it take to give sight—and childhood—back to a generation? For Dr. Amina Hassan Wali, it’s part science, part heart and a lifetime of refusing to look away.

hen four-year-old Muhammad’s vision began to fade, no one noticed at first. The little boy who once ran joyfully through the schoolyard started to slow his steps, feeling for walls and edges. He told his grandmother that the letters in his coloring books were “moving,” grew hesitant at playtime, and became a quiet spectator at football matches.

sentence Dr. Hassan Wali has heard many times, yet never tires of.

“He couldn’t see or understand things,” his grandmother Halima recalled. “He became afraid to go outside, and I was worried about what would happen to him next.”

A path lit early

The diagnosis—bilateral cataracts— came as a shock. How could a child have what many called an “old person’s disease”? Even if surgery could restore his vision, the family feared they could never afford it. But Muhammad was fortunate. Through a child eye health initiative by Sightsavers, he was referred to the National Eye Centre in Kaduna (Nigeria), where Dr. Amina Hassan Wali, consultant ophthalmologist and chief medical director, took charge of his care. The morning after surgery, Muhammad could see his father clearly for the first time in months.

“I think of how long a child would live with vision impairment if they didn’t get help early,” she said. “Saving a child’s sight means returning decades of life, dignity, independence and hope.” For more than three decades, that belief has been her compass.

Dr. Hassan Wali’s calling began at home with small but powerful acts of encouragement. Her mother, though not medically trained, had a strong instinct for preventive health. When an eye clinic was established in Kaduna, she urged family, friends and neighbors to go. “Ophthalmology was always there in the background,” Dr. Hassan Wali recalled. “I saw how much difference eye care made in ordinary people’s lives.” As a medical student, she first leaned toward pediatrics. But during her ophthalmology rotation, something shifted. Restoring sight felt immediate, tangible and profoundly life-changing.

Two years later, when Sightsavers visited again, Dr. Hassan Wali was delighted to hear he was back to running, playing, watching TV and confidently answering questions in class.

“I saw people who couldn’t see the day before, smiling after surgery,” she said. “Patients and families truly appreciate our support, and it is rewarding to help people regain their sight.”

“This surgery gave him back his childhood,” his grandmother said—a

“I also enjoy the interactive nature of ophthalmology,” she added. “When

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we go into the community and see patients, it feels deeply human and meaningful.” After completing her MBBS, Dr. Hassan Wali joined the National Eye Centre in 1995. She grew within its walls—from resident to consultant, and now chief medical director— leading Nigeria’s only national tertiary eye hospital, a referral hub serving a population of over 200 million. When the Centre began encouraging subspecialization in 2010, she took a bold step into pediatric ophthalmology and trained in Tanzania. “I saw so many children waiting for cataract surgery,” she recalled. “I thought of the number of years a child would live with vision impairment if they did not have support early on in their life. That made me realize the value of this career choice. I never looked back.”

Reaching the unreached Under Dr. Hassan Wali’s leadership, the National Eye Centre has strengthened its pediatric services, recruited a second pediatric consultant, trained perioperative nurses, and improved counselling for families facing complex conditions such as retinoblastoma. She also championed school-based vision screening, empowering teachers and

conversation, while trained health workers serve as local advocates, identifying and referring cases that might otherwise go unnoticed.

A woman leading by example Dr. Hassan Wali’s leadership blends quiet strength with empathy. She invests in staff development, believes deeply in mentorship and encourages young clinicians to explore subspecialties. “Leadership isn’t just managing systems. It is inspiring confidence, uplifting staff, and ensuring patients feel safe and cared for,” she said.

Photo courtesy of Sightsavers

community health workers to spot early warning signs. “Our child eye health project with Sightsavers aims to improve access to child eye health services and advocate for increased commitment to the integration of eye health services at state and local government levels,” she explained. The program collaborates with ministries of health, education boards and primary health care agencies. It even has international support from Speckles for Kids, an Australian children’s eyewear brand that donates products such as eye patches and sunglasses. “Sightsavers’ partnership has helped us reach more children with vision impairment,” noted Dr. Hassan Wali. “Due to the case finding element of the project, more children are being identified in communities and schools, and parents are more aware of vision screening for schoolchildren and that cataract surgery is available for children.” Awareness efforts go beyond hospitals. Radio programs, jingles and community outreach help bring eye health into everyday

Balancing these responsibilities with family life was no small feat. Together with her husband, she raised four children while advancing through surgery, leadership and national advisory roles. She admitted that gendered expectations persist, and women leaders often feel they must prove themselves twice. “I want young women to see they do not have to choose. They can lead, care for their families and serve with excellence,” she noted. “Passion and resilience are our strengths. Seek mentors. Build networks. Keep learning. And be gentle with yourself. Balance is possible.”

Vision and a legacy of light For Dr. Hassan Wali, the future of eye care in Nigeria begins with its children. “It is vital that cataracts in children are diagnosed early on, as they can cause the eye to stop developing,” she said. “Delayed treatment might mean that sight cannot be fully restored.” She advocates for compulsory school vision screening nationwide, stronger funding for pediatric specialists, and greater deployment of eye-care workers to underserved regions. “Good eye health also supports the overall wellbeing of children, child development, social engagement in their communities, and future opportunities,” she added. “It can help tackle inequality by allowing

children to learn, supporting independence and, later in life, open up opportunities to earn.” Awareness is growing, she noted. More children are being identified and treated, but there is still a long way to go. “We must not be complacent,” she stressed. Her dream is simple yet luminous: a Nigeria where no child is left behind because they could not see. “I would like my legacy to be an impactful leadership with dedication to patient care and welfare of the hospital’s staff,” she said. “I hope there will be a system that continues to strengthen long after me: children in school, families empowered, staff uplifted and standards raised.” For the countless children who now see the world anew, thanks to Dr. Hassan Wali, that legacy has already begun.

Contributor For more than three decades, Dr. Amina Hassan Wali has been a guiding light in Nigerian eye care. Now Chief Medical Director of the National Eye Centre in Kaduna, she began her journey there as a resident after earning her MBBS… and never looked back. A specialist in pediatric ophthalmology, Dr. Hassan Wali has combined clinical excellence with an unwavering commitment to community service. Her outreach work has taken her to nearly every state in Nigeria, where she’s helped deliver essential eye care to underserved populations. As Chief Medical Director, she oversees the Centre’s operations and strategic vision while nurturing the next generation of healthcare professionals. From launching staff development programs and rural nurse refraction courses to leading microsurgery training for theatre nurses, Dr. Hassan Wali continues to shape both policy and practice, showing that great leadership, like great vision, starts with seeing the bigger picture. amina.hassan@eyecenter.gov.ng

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udos

OPHTHALMIC TOOLS

company built its reputation on craftsmanship, optical precision, and collaboration with ophthalmologists and trusted business partners. Mr. Lenzen sees innovation as the natural evolution of that legacy. “We’re building on our heritage of 165 years of a great brand and innovation,” he said. “We’re continually partnering with ophthalmologists to create products. That’s where we come from, and we’ll use that tradition, and add innovation and new technology to create solutions to achieve the best possible outcome for patients worldwide.”

Haag-Streit A “Year of Innovation”

By Diana Truong

Heritage this old shouldn’t feel this fresh. But Haag-Streit’s 2025 lineup—three launches, one new CEO and a digital vision rooted in trust—shows that even after 165 years, Swiss precision still knows how to reinvent itself.

hen Haag-Streit (Bern, Switzerland) calls 2025 a “year of innovation,” they’re not just polishing the optics. The Swiss powerhouse—known for its slit lamps and surgical microscopes— has spent the past year reframing what innovation means in eye care. And, true to form, they’ve done it without losing sight of their greatest strength: trust. From three major product launches to a new CEO steering the ship, it’s been a transformative year for Haag-Streit. At ESCRS 2025 and AAO 2025, the company globally launched a trifecta of new products: the METIS 900 surgical microscope, the Refractor 900 refraction solution, and the Elara 900 slit lamp. Together, these mark not just technological leaps but a statement about HaagStreit’s direction: digital, connected and resolutely clinician-centric.

A confluence of innovation For Thomas Lenzen, Haag-Streit’s new CEO, the timing couldn’t be better. He joined the company on

September 1st after decades in the medical device industry. “For me it’s a great time to be at Haag-Streit,” Mr. Lenzen said. “Precisely because we have all those products that we’re globally launching at this point in time.” He explained that this “year of innovation” isn't a coincidence. It’s the result of nearly a decade of R&D work reaching maturity simultaneously. “We have innovated in the past a lot,” Mr. Lenzen said. “But we’ve worked very hard for the last almost ten years on those product categories. It’s great that they’re coming out all together at this time.” And Haag-Streit isn’t slowing down. “We’re going to use that momentum and maintain it for the future—and shorten our cycles of innovation,” Mr. Lenzen added.

Building on 165 years of precision Haag-Streit’s legacy is hard to overstate. Founded in 1858, the

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A key part of that future is integration: connecting Haag-Streit’s devices with digital software to improve workflow and clinical decision-making. “More than ever, time is money, and we’re making sure there is an exchange between our products and the software of the practices,” Mr. Lenzen explained. “We want to make ophthalmologists more efficient and to support them in achieving the best outcomes for patients.”

The slit lamp of the 21st century At the heart of Haag-Streit’s innovation story is the Elara 900, the company’s most talked-about release of the year. To mark its significance, Haag-Streit confidently lays claim to Elara 900 as “the slit lamp of the 21st century.” Theo Reininger, Senior Global Product Manager, led its launch. “We’re really launching a new product that’s revolutionary,” he said. “The company hasn’t seen something like this in the product portfolio before.” Mr. Reininger described the Elara 900 as a bridge between Haag-Streit’s legendary optics and the digital tools shaping ophthalmology’s future. “It merges what Haag-Streit is well known for—optics—with software,” he explained. “It bridges the gap between being a device that has been analog over the last decades, and we’re including software to increase its value.” That value comes from continuous software upgrades. “We have a software release cycle that’s twice a year,” he said. “We’re adding new features based on user feedback.

And yes, one day, we’ll add artificial intelligence to it.” But for Mr. Reininger, the goal isn’t to rush artificial intelligence; it’s to do it correctly. “We will bring it to the market when we believe it reflects Haag-Streit’s quality standards,” he said. “We’re in the business of trust.”

Guiding clinicians into the digital era Mr. Lenzen acknowledged that ophthalmology can be a risk-adverse industry, where routines—such as slit lamp examinations—have been established over decades. Subsequently, any changes had to be approached with pragmatism and empathy. That’s why, with Elara 900, clinicians will find features they know and trust—the precision optics, for example. These are combined with new digital features that speed up examinations, such as its digital “presets” and motorized controls. Combined, they make the new technology feel natural. “Innovation must fit into everyday life to work for eye care professionals,” Mr. Lenzen clarified. “As trusted partners, we bring value to customers through digital solutions.” Mr. Reininger added that even with new digital features, clinicians have adapted to the Elara 900 quickly. “We were pleased to see how fast the adaptation is,” he said. “You might need a few minutes to get used to it, but it becomes second nature.”

it. People trust it.” One clinician even described the new joystick controls as “going from manual to automatic. I'd never go back.”

Innovation shaped by feedback Haag-Streit’s innovation philosophy hinges on collaboration. As Mr. Reininger described, every software release and product refinement is shaped by close communication with clinicians. “In our release cycle, we start testing with select users,” he said. “We take their feedback, implement it and make sure every release has been tested prior to launch.” Before the Elara’s global premiere at ESCRS, Haag-Streit conducted a soft launch in Germany and Switzerland to gather insights from real-world users. “We wanted to make sure everything was set in place,” said Mr. Reininger. “At the same time, we worked with key opinion leaders who installed the Elara 900 in their practice and used it over a longer period of time.” “We tried to have a diverse group: different ages, genders and levels of experience,” he said. “The feedback was invaluable.”

balance—defining what the slit lamp of the 21st century is,” he said. For Haag-Streit, that meant being bold enough to innovate while staying grounded in what users love. “We are a premium brand,” Mr. Reininger explained. “We wanted to create something that could one day replace our current top-of-the-line BQ 900, but we had to make sure users could continue doing what they do in a better way.” Mr. Lenzen summed it up best, saying, “The biggest challenge was bringing all the ideas, all the client demands, all the fears of being too radical…into one device. Not just evolution, but still kind of a revolution.”

A vision built on trust If there’s one theme running through Haag-Streit’s” year of innovation,” it’s trust. From precision optics to digital integration, every step reflects the same meticulous care that has defined the company for over a century and a half. “Our ophthalmologists and distributors work with us because they trust us,” Mr. Lenzen noted. “With the Elara 900, we’re combining heritage with the next step, and we’re doing it the Haag-Streit way.” And that, more than anything, is what makes this year not just a “year of innovation” but a milestone in a legacy still unfolding.

Moments of realization Mr. Reininger said one of the most satisfying parts of the Elara 900’s rollout has been hearing reactions from ophthalmologists. “When users started switching between their traditional slit lamp and the new Elara, they had this revealing moment,” he said. “They realized how much manual effort they needed to put in before. Then they came back to the Elara and saw how easy, how efficient and how ergonomic it really is.” Feedback, he added, has been overwhelmingly positive. “People love

Editor’s Note

Reinventing without losing the soul Mr. Reininger was candid about the biggest challenge in developing the Elara 900. “Finding the right

CAKE MAGAZINE | December 2025

nlightenment

SURGERY VIDEOS

Lights, Camera, Incision How video rewired surgical learning By Elif Uslu

Before VR headsets and YouTube tutorials, there was one surgeon with a VHS camcorder and a vision. In this year’s ESCRS Heritage Lecture, Dr. Robert Osher took the audience on a cinematic journey through five decades of surgical teaching, complete with smuggled devices, honest blunders and the birth of the world’s first video journal in medicine.

n Day 3 of ESCRS 2025 in Copenhagen, the packed Bella Center hushed as ESCRS President Prof. Filomena Ribeiro (Portugal) stepped forward to present one of the society’s highest honors: the Heritage Medal. This year, the award went to a man synonymous with surgical teaching, humility and storytelling: Dr. Robert Osher (USA). His lecture, titled Video – Couldn’t Live Without It!, promised less of a technical masterclass and more of a love letter to the art of teaching through moving images.

A career in frames Dr. Osher opened with disarming honesty. “I’m not sure you’re going to be clapping at the end of this lecture. There’s not much education in this lecture, but I will tell you that I’m so honored to be here.”

For him, this was not a session in the traditional sense but a personal narrative spanning fifty years of ophthalmic surgery—and fifty years of video.

realized the lens of a camera could reach where textbooks could not

He traced his fascination back to 1973, while working with neuroophthalmologist Dr. Lawton Smith (1929-2011) at Bascom Palmer Eye Institute (Florida, USA). Even then, he sensed there had to be “a better way to learn than by listening about internuclear ophthalmoplegia or by studying photographs in a book.

One of the lecture’s recurring themes was Dr. Osher’s fearless embrace of imperfection. In 1981, when he introduced the first video symposium at AAO, he did the unthinkable: he showed his complications.

The better way would come soon enough: the VHS machine. Purchased originally to show Peter Pan to his children, it transformed his teaching. “Video. Wow. It was a completely new way to communicate,” he recalled. From patient education videos to early surgeon tutorials, Dr. Osher quickly

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Teaching through mistakes

“I dared to show my complications, of which I had many,” he said with a wry smile. It wasn’t a strategy for popularity—“I wasn’t invited back for 10 years,” he admitted—but it was a turning point for the culture of surgical teaching. Surgeons could finally learn from what went wrong, not just polished highlights.

“The audience loved to watch me suffer,” he joked. But in truth, they loved to learn.

The birth of a video journal Out of this realization grew one of Dr. Osher’s greatest legacies: the Video Journal of Cataract, Refractive, and Glaucoma Surgery (VJCRGS). Founded in the early 1980s, it was the first video journal in medicine “The first video journal in medicine where I could invite surgeons to record and send a video which I would edit and publish showing new techniques and technologies,” he said. The idea was deceptively simple: surgeons could watch with “beer and pretzels in the comfort of his or her living room.” Distribution was no small task in the VHS era. Dr. Osher credited partnerships with companies like Alcon and AMO for hand-carrying tapes “around the planet as more and more countries acquired video players.” And in those videos, he pushed boundaries: combining phaco with astigmatic keratotomy in 1985 (“the very first refractive cataract surgery,” as Dr. Richard Lindstrom later described), or clear lensectomy for hyperopia—radical, controversial, but captured forever on tape.

Innovator, storyteller (and smuggler?) Dr. Osher shared tales that balanced gravity with humor. He confessed to “smuggling” capsular tension rings and prosthetic irides into the United States after seeing them in Europe. He spoke of dragging giant 3/4-inch tape machines across the globe, only to land in Peru where “they didn’t have a single 3/4-inch player in the entire country.” He celebrated colleagues who pushed the field forward on film: Dr. Charles Kelman’s (1930-2004) phacoemulsification, Dr. Kunihiro Nagahara’s (Japan) Phaco Chop technique, Dr. Howard Gimbel’s (Canada) optic capture, Prof. Graham

Barrett’s (Australia) single-piece IOL, Dr. Robert Cionni’s (USA) modified capsular tension rings (CTR). Through video, their breakthroughs became immortalized, accessible and endlessly replayable.

Lessons from illness The lecture turned poignant when Dr. Osher shared a personal health scare: the discovery of a malignant kidney tumor. “An MRI for some mild unrelated lumbar symptoms shook up my universe,” he said. From that ordeal, his perspective crystallized. “Hug your kids and your spouse. Tell them often how much you love them, because there are no guarantees that you’ll be able to tomorrow.” It was a reminder that behind the lights, cameras and surgical milestones, the real legacy is family and connection.

A global impact For over 40 years, Dr. Osher has edited the VJCRGS, giving it away free of charge, without advertisements, to cataract societies worldwide. “Because of video, we are all better, more knowledgeable and more skilled ophthalmic surgeons,” he reflected. The lecture became a sweeping tribute not only to video but to the global community it built—a community that laughs together, learns together and improves together.

Looking ahead: virtual reality As the lecture wound down, Dr. Osher teased the next frontier. “After video comes virtual reality,” he said with a grin. For the past six months, he has been working with a startup called VirtuaLens, creating immersive tools for patient education. Imagine slipping on goggles to “see every different lens in six different settings: kitchen, golf course, driving.”

If video transformed how surgeons learned, VR may transform how patients choose.

Closing applause By the end, there was no doubt about applause. The audience rose, honoring a surgeon, teacher and pioneer who turned VHS tapes into a universal language.

“From one small idea and thousands of videos later, it’s been so satisfying to teach and to learn from each of my dear friends at ESCRS.” - Dr. Robert Osher

“From one small idea and thousands of videos later, it’s been so satisfying to teach and to learn from each of my dear friends at ESCRS,” Dr. Osher concluded. “Because of video, we are all better…and I’m glad to have played a small role in this wonderful journey.” This was not just a medal ceremony. It was a living chronicle of how one man, armed with a camera, changed the face of surgical education forever.

CAKE MAGAZINE | December 2025

nlightenment

EQUALITY IN EYE CARE

In Bangladesh, for instance, seeking treatment often requires navigating the layers of permission and By Diana Truong sacrifice. "You need to get permission to leave your Women make up over half of the world’s visionfamily's household impaired population. Not because their eyes are to go and get your weaker, but because the system is. From social eyes treated. You taboos to travel barriers, this is a clear-eyed look at also need a male why access still skews male, and how the eye care chaperone," Ms. community can balance the view. Gannon explained. "Technically, that n eye care, the biggest obstacles means you've got two people losing aren’t always clinical—they’re a day's wage to go and travel to the cultural. Like Taylor Swift concert city, which could be 50 km away... tickets that somehow always land So it's really an economic issue. It's in the hands of the privileged few, prohibitive, but also the cultural eye care services often remain barriers—that you need permission frustratingly out of reach for those to leave your community, and you who need them most, especially need the male decision maker to women and girls. agree for you to go and get your eye care needs treated." The numbers paint a clear (and concerning) picture. Fifty-five percent And that’s just the start. Beyond of people with vision impairment logistics, women often3: worldwide are women and girls. That’s 112 million more women and • Lack access to household finances girls with avoidable sight loss than • Prioritize family members' health men and boys.1 This isn’t just a over their own statistical blip; it’s a glaring inequity • Have limited awareness about that the eye care community can no treatment options longer overlook. • Face literacy challenges • Encounter myths and "For every dollar that's invested in misconceptions about eye surgery eye care, there's a $36 return. There's a $36 benefit for the community, for In Malawi, Dr. Moira Chinthambi saw the family," explained Kate Gannon, firsthand how distance and cost head of Program Funding at Orbis kept women from cataract surgery. International, during her lecture at Her team’s solution was refreshingly ESCRS 2025.2 "So no matter how simple and effective."The team now small the interventions are, when sends vehicles to the remotest of you invest in eye care, the ripple areas to look for women and girls effect is huge throughout the family, and make sure they're included,” throughout the communities where she shared in a Community Eye we're working." Health article. “Sometimes people would have to walk to go and look The takeaway? Investing in women’s for patients, pick them up and bring vision isn’t just good medicine. It’s them to the nearest health facility."4 smart economics. When women can see, families and communities Women-led vision centers flourish. Yet despite the obvious benefits, women and girls still One of the most promising ways to face disproportionate barriers to break down barriers? Women-led accessing the care they need. Green Vision Centers, pioneered by Orbis International in Bangladesh. Planted within communities, these Understanding the centers cut travel hurdles and, barriers staffed mostly by women, create a A woman’s journey to eye care can space where female patients feel safe be full of hurdles, especially in rural and comfortable seeking care. settings where economic, cultural and social barriers intertwine. "We've seen a 19% increase in

The

ender Lens

Improving eye care access for women and girls

CAKE MAGAZINE | December 2025

patients, and this is when we compare the women-led centers with the usual vision centers, where you will see men who are at the forefront," Gannon reported. "A bit more significantly, there's a 21% increase in female patients coming. So female patients are much more comfortable to come when the center is in their community. They don't have to travel, may not need a chaperone and are treated by a woman." The ripple effect doesn’t stop there. "And then when the mothers come, their children come. So you see an 18% increase in the number of children visiting the centers," she added. According to Ms. Gannon, these centers are more than just accessible. They’re smart, sustainable and innovative: • Solar power keeps the lights on, no matter what • Teleophthalmology connects patients to specialists at partner hospitals • Artificial intelligence (AI) tools help diagnose conditions like diabetic retinopathy • A social enterprise model that becomes self-sustaining within two to three years

Practical strategies for ECPs Here are proven, practical steps for making eye care more accessible to women and girls.

1. Listen first

Engage directly with women in the community to understand the barriers they face. Whenever possible, hold women-only discussions, because "women may feel scared or unwilling to discuss sensitive issues when male community members are present."4

2. Adapt services

Small tweaks can make a big difference4: • Allow women to bring children to appointments • Create separate waiting lines for women during outreach programs • Offer women-only clinic days with female practitioners • Coordinate eye care services with other women’s health services

In Sierra Leone, for example, "some women refused to be treated by male professionals due to their religious beliefs and because they did not feel comfortable around men. Setting up specific clinics for women, with women eye care practitioners, helped them to feel comfortable to seek care."4

3. Spread the word

Education matters, for both communities and health workers. In Ethiopia, one program tackled the tendency for women to put family eye care before their own by creating posters encouraging women to prioritize their own eye health.4

4. Recruit the menfolk

Men can be powerful allies. In Tanzania, a Sightsavers and UK Aidfunded program worked directly with men to challenge norms and support their spouses.4 Program manager Edwin Maleko explained: "Around 56% of the people who benefited from the program are women, but in terms of cataract surgery, the number in our previous project was just 36%. Why? Because if a woman accepts cataract surgery, she may need around two weeks to recover. Who will take care of the children? That is the challenge."4 The team crafted messages encouraging men to support their wives’ healthcare and partnered with religious leaders to reinforce them. "While there is still work to do in this area, it was encouraging to see that during the program, the number of women who accepted cataract surgery is now 46%."4

5. Go digitally (but thoughtfully) Technology can bridge gaps, if used wisely5:

women. It’s a reminder that tech is powerful, but only when paired with social and cultural solutions.5

The long view Lasting progress depends on integration. Eye care for women and girls must be embedded into the wider health ecosystem. A 2025 study in Frontiers in Public Health found that outreach and teleophthalmology were particularly effective in improving screening attendance and referrals for women and rural residents.6 But there’s a catch. The study noted that "health financing to enhance cataract surgery acceptance and actual surgical rates reported effectiveness for rural residents but showed only modest improvements" overall, emphasizing that money alone isn’t the magic solution.6 The most promising approaches are the ones that combine multiple strategies6: • Outreach screening paired with teleophthalmology • Health financing covering both surgery and transportation • Digital reminders alongside AI-supported diagnosis • Community education and engagement Access to eye care shouldn’t be like trying to score front-row tickets— dependent on privilege, connections or gender. Every woman and girl deserves the chance to see clearly, to read, to work, to care for her family and to fully participate in her community.

• Teleophthalmology connects remote areas to specialists • SMS reminders keep appointments on track • AI-supported screening delivers instant results

As eye care professionals, we’re not just witnesses to this inequality, we’re the ones best equipped to change it. By building gender-sensitive systems, adapting our services and leveraging technology, we can ensure modern eye care truly reaches everyone.

A study in Rwanda found that immediate AI-interpreted retinal imaging improved referral uptake for rural residents, older patients and men—though interestingly, not for

Because in the grand concert of sight, there should be no VIP section, just open doors, clear vision and an audience where everyone gets to see the show.

Editor’s Note Kate Gannon's insights in this article are based on her Day 4 presentation at ESCRS 2025 Copenhagen's Orbis Symposium titled "The Gender Lens: Improving Access to Ophthalmic Services for Women and Girls".

References 1. GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9(2):e130-e143. 2. Gannon K. The Gender Lens: Improving Access to Ophthalmic Services for Women and Girls. Lecture at ESCRS 2025. Copenhagen, Denmark. September 15, 2025. 3. Dhingra P. Barriers preventing women and girls from accessing the eye care they need. Community Eye Health. 2025;38(126):4. [Epub 2025 Mar 7] 4. Lawless F, Gondoe T, Sarr A. Improving access to eye care for women and girls: practical steps. Community Eye Health. 2025;38(126):10-12. [Epub 2025 Mar 7] 5. Mathenge W, Whitestone N, Nkurikiye J, et al. Impact of Artificial Intelligence Assessment of Diabetic Retinopathy on Referral Service Uptake in a LowResource Setting: The RAIDERS Randomized Trial. Ophthalmol Sci. 2022;2(4):100168. 6. Cardona M, Alwenya K, Rehman AU, et al. Eye care interventions that reduce access inequities for women, rural residents and older people in lowmiddle-income countries: a scoping review. Front Public Health. 2025;13:1578848.

Contributor Kate Gannon has spent her career turning big ideas into global impact. As head of Program Funding at Orbis International since 2016, she leads a dynamic team securing multimillion-dollar grants that help bring quality eye care to communities around the world. Before stepping into this role, Gannon helped drive Orbis projects in Nepal, India and Bangladesh—initiatives that made real strides in reducing avoidable blindness. Her passion for purposeful work runs deep. At Plan International UK, she managed a major DFIDfunded program to improve education for adolescent girls across seven countries. Earlier, at Deaf Child Worldwide, she built a South Asia program from the ground up, and at Y Care International, she helped secure vital support for youth development across Asia and the Middle East. Armed with a Master’s in Development Economics and a Postgraduate Certificate in Peace Studies, Kate blends strategic thinking with heart, making a clear vision for change her life’s work.

CAKE MAGAZINE | December 2025

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