George Waring IV, MD, of the Waring Vision Institute, spoke with Ophthalmology 360 at the 2026 ASCRS Annual Meeting about a new feature and design element of presbyopia-correcting intraocular lenses (IOLs): tolerance to refractive error.
George Waring IV, MD:
Hi, my name is George Waring IV, MD, from the Waring Vision Institute in Mount Pleasant, South Carolina. We’re here at the American Society of Cataract and Refractive Surgery and had the wonderful opportunity to give a lecture yesterday on an emerging concept around tolerance to refractive error in new-generation presbyopia-correcting IOLs. This falls in the rubric of simultaneous vision IOLs, which have been subdivided into full and partial depth-of-field lenses. This is an ongoing work and collaboration with the Global Functional Vision Working Group that has attempted to categorize IOLs with functional data.
One of the unique aspects that we’ve observed in contemporary presbyopia-creating IOLs is the tolerance to refractive error. Historically, lenses have evolved by correcting for spherical aberration, correcting for chromatic aberration, but one of the new features and design elements of presbyopia-correcting IOLs are that of tolerance to refractive error.
How does this happen? This is really sort of a combination of a depth-of-focus phenomenon but, perhaps more importantly, contrast sensitivity function that’s being redistributed in areas that are out of focus. That is to say, if an eye has a healing phenomenon outside of the prescribed endpoint, there’s still some tolerance because the contrast has increased around the intended focal points.
We’ve set out to study this with Dr. Karolinne Rocha and others and have cataloged the performance of different IOLs and IOL categories. What we’ve observed and what we reported on yesterday was some of this published data and some of the data that is currently in work. That is to say, the enhanced monofocal groups that we studied exhibit tremendous tolerance to refractive error. Some of the full depth-of-field lenses that we studied also provide tolerance to refractive error, and some of the emerging partial depth-of-field lenses also appear to be displaying this characteristic also.
This is really an emerging concept in the rubric of quality of vision, range of vision, symptoms, QRST. T for tolerance. This is sort of an emerging framework that we as, again, the Functional Vision Working Group, are starting to talk about more and more. It helps us better understand how these lenses perform, but the tolerance is really one of the most recent and most exciting aspects of new-generation presbyopia-correcting IOLs.
Thanks so much.
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