Beyond Cataracts
Viviana Cetola
Life News Today
For centuries, restoring vision lost to cataracts was the only goal. Today, medicine can aspire to much more. Advances in intraocular lenses, biometry, digital surgery and artificial intelligence make it possible not only to remove the clouded lens, but also to plan with increasing precision how a patient will see after surgery. This transformation has made cataract surgery one of the most advanced and personalized procedures in modern medicine.
To understand this change, it is important first to distinguish among some of the vision problems that appear with age. Many people approaching 40 begin to notice that reading up close becomes more difficult and that they need to hold a book, phone or other text farther away in order to focus on it. This condition, known as presbyopia, results from the progressive loss of the eye’s ability to focus on nearby objects and is part of the normal aging of vision. Astigmatism is different and can cause blurred or distorted vision at different distances, primarily because of irregularities in the curvature of the cornea or lens.
Cataracts, on the other hand, develop when the lens, which is normally transparent and helps focus light inside the eye, becomes progressively cloudy. With age, the proteins and fibers of the lens undergo changes that can cause them to clump together and alter its transparency, a process that also involves different cellular mechanisms and oxidative stress. A person may begin to experience cloudy vision, less vivid colors, difficulty driving at night, reduced contrast sensitivity or greater discomfort from glare. Because these changes often progress slowly, patients may become accustomed to them before realizing how much their vision has deteriorated.
Cataracts are one of the leading causes of blindness worldwide, but they are also a cause of vision loss that can be treated surgically with excellent results in many patients. In the United States, their prevalence increases considerably with age, and more than half of people over 80 either have cataracts or have already undergone surgery to correct them. This enormous number of patients has driven decades of research into how to remove the clouded lens while also improving the quality of vision after surgery. The result has been an extraordinary transformation. Modern surgery is no longer simply about removing what prevents a person from seeing, but also about determining what type of artificial lens can provide the most appropriate visual outcome for each eye.
The path toward this level of precision began long before modern medicine. Surgical techniques for treating cataracts date back to antiquity. In India, procedures were described in which the clouded lens was displaced away from the visual axis, a practice whose origins date back more than 2,000 years, although its exact date remains a subject of debate among medical historians. These procedures could allow a person with an advanced cataract to regain some degree of vision, but the results were very limited and complications could be serious. The major change came many centuries later, when medicine began searching not only for a way to remove the diseased lens, but also to replace its function.
One of the key figures in that transformation was British ophthalmologist Sir Harold Ridley, who developed the first modern intraocular lens after observing that small fragments of acrylic material could remain inside the eyes of pilots injured during World War II without causing the severe reaction expected from a foreign body. Based on those observations, he developed an artificial lens that could be implanted inside the eye after removing a lens affected by cataracts, and performed his first implants in the late 1940s. The first intraocular lenses were far removed from the options available today, but they changed cataract treatment forever. The monofocal lenses that later became the standard focus primarily at a single distance, generally far away, which means that many patients continue to need glasses for reading. When astigmatism is present, a lens specifically designed to correct it may also be necessary.
The evolution of intraocular lenses, known as IOLs, has made it possible to go far beyond that original objective. Monofocal lenses remain widely used and can provide excellent visual quality, but designs are now available that seek to expand the range of vision and reduce dependence on glasses. These include multifocal lenses and extended depth-of-focus lenses, known as EDOF lenses. This broader range of vision also requires consideration of possible unwanted effects, since some designs can produce halos, glare or reduced contrast sensitivity. For this reason, the most technologically advanced lens is not necessarily the best choice for everyone. A patient’s age, the characteristics of the eye, the presence of other diseases, daily activities and expectations all play a role in a decision that must be individualized.
One of the options recently introduced in the United States is TECNIS PureSee, an EDOF intraocular lens that received approval from the Food and Drug Administration in March 2026. Data evaluated by the FDA showed improved intermediate vision and greater depth of focus compared with a monofocal lens, while distance vision was comparable and contrast sensitivity was maintained. This type of technology seeks to expand the range of vision without some of the visual compromises associated with other lenses that provide multiple focal points. Even so, no lens necessarily eliminates the need for glasses in every situation, and the choice should be made after discussing both the benefits and limitations with an ophthalmologist. The ability to choose among different designs is precisely one of the reasons cataract surgery has become increasingly personalized.
Dr. Habeeb Ahmad, M.D., M.S., Global Medical Director of Cataract Surgery at Johnson & Johnson, has described this evolution as a convergence of different technologies. “Our goal is to provide every patient with consistent, high-quality visual outcomes,” Ahmad says in an article published by the company. This “technology convergence” combines advanced diagnostics, biometry, surgical planning, data analysis and new intraocular lenses. His perspective is also relevant because of its source, since Ahmad holds a medical position within one of the companies that develops and markets these technologies. Beyond any specific product, the principle changing the specialty is that two patients with similar cataracts do not necessarily have the same eyes, the same needs or the same visual expectations. “Every patient and every eye is different,” Ahmad says. “We are moving from a standardized model to precision surgery that allows us to achieve predictable and reproducible outcomes across patients.” Artificial intelligence is beginning to play a role in this process by making it possible to analyze large amounts of information and recognize relationships among characteristics of the eye that can be difficult to evaluate in isolation. These tools can contribute to calculating intraocular lens power, planning surgery and identifying certain risk factors. Their incorporation does not mean that an algorithm replaces the surgeon. In complex eyes because of disease, previous surgeries or particular anatomical characteristics, having more information available can help support better-informed decisions, but no technology by itself can guarantee a particular outcome.
The operating room itself is also changing. Digital systems can connect measurements taken before the operation with surgical planning and the equipment used during the procedure, reducing manual steps and the need to repeatedly enter the same data. A study published in 2024 in the Journal of Cataract & Refractive Surgery compared an integrated digital system with the existing workflow at two high-volume surgical centers. Researchers observed reductions of 25.3% in the time devoted to preoperative measurements, 55.1% in surgical planning and 22.6% in the surgical procedures studied. The findings are important because they demonstrate improved efficiency and reduced use of certain resources, although the study by itself does not demonstrate that digitalization produces better vision after surgery.
The next stage could further change what we understand cataract surgery to be. A review published in 2025 in the scientific journal Eye examines the development of artificial intelligence, automation and different robotic systems capable of participating in certain stages of surgery. New lenses that attempt to reproduce the eye’s natural accommodation through changes in shape or movement within the eye, including designs that use fluids, are also being studied. Another area of research is investigating substances capable of acting on the processes that cause the lens to become cloudy. However, there are currently no approved eye drops that eliminate cataracts or replace surgery, and experimental results obtained with different compounds do not yet support considering them an established clinical alternative.
The evolution of cataract surgery demonstrates how a procedure originally intended to restore severely impaired vision has become an intervention in which visual quality, different focusing distances and the individual needs of each patient can all be considered. This ability to personalize treatment also requires caution, because having more technology available does not mean that every option is appropriate for every eye. Intraocular lenses, digital systems and artificial intelligence expand the surgeon’s possibilities, but appropriate selection continues to depend on an individualized medical evaluation and realistic expectations. The true advance is not simply removing a cataract or eliminating the need for glasses. It is using each of these tools to achieve the best possible visual outcome safely.
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