Dr Cathleen McCabe (far left) receiving the Barrett/Wolfe trophy from Professor Graham Barrett AM while Dr Andrea Ang and Dr Jacqueline Beltz look on.
Twin Waters on Queensland’s Sunshine Coast played host to this year’s Australasian Society of Cataract and Refractive Surgeons (AUSCRS) conference, themed, ‘The Sound of AUSCRS’.
Record numbers attended the event – over 500 delegates, including doctors, trainees, support staff, partners, and sponsors from around the world took the opportunity to share knowledge, learn more, and enjoy the quirks of this much-loved annual event.
Alan Saks was there for mivision and shares highlights from a program that included over 80 plenary lectures for doctors, alongside an extensive support staff program.
AUSCRS plenary sessions began with the Barrett/Wolfe Gold Medal Lecture, titled ‘The future of ophthalmology: AI and robotics’, presented by Dr Cathleen McCabe (USA).
Computer-controlled ablation and eye tracking have been used since the 1990s. Outside ophthalmology, more than 20 million da Vinci robotic surgeries over the past 20 years have likewise kept surgeons involved. The world’s first robotic-assisted cataract surgery (surgeon-guided with automated steps, under general anaesthesia) took place in October 2025, followed in April 2026 by the world’s first fully robot-assisted cataract surgery, under local anaesthesia. These were momentous steps.
Dr McCabe invited delegates to ponder the future: When will robotic cataract surgery become as common as excimer laser refractive surgery? Will the surgeon’s role remain essential, shift, or simply disappear?
There will never be enough human hands, Dr McCabe said. More than 600 million people need cataract surgery but only 30 million cataract surgeries are performed annually, by roughly 115,000 operating surgeons. More cataract surgery is needed. Robotics might help. Regardless, Dr McCabe said, the surgeon still owns candidacy, the target, and the call to stop. It’s a matter of judgment, not dexterity.
More than 600 million people need cataract surgery but only 30 million cataract surgeries are performed annually, by roughly 115,000 operating surgeons.
Complicated Cataracts and IOLs
Professor Gerard Sutton (Sydney), dressed in a nun’s habit, delivered ‘IOL calcification in complicated cases: An under-reported incidence?’ He explained how intraocular lens (IOL) materials differ in their opacification profiles, with hydrophilic lenses more prone to opacification and posterior capsule opacification (PCO).
Because opacification is a major reason for IOL explantation, he urged surgeons to plan for multiple scenarios, including scaffold techniques, add-on IOL removal, inflammation, zonular weakness, and the possible need for sulcus, scleral or iris-clip fixation.
Presenting incognito behind a smiley-face mask, Dr Joaquín Fernández Pérez (Spain) spoke about the evidence-based functional classification of IOLs. He outlined the global consensus work behind clinically relevant IOL categories, supported by visual acuity and defocus data, and contrasted this postmarket framework with the International Organisation for Standardisation (ISO) pre-market focus. He said the aim is clearer decision making for surgeons, patients, and payers, with future consideration likely to include contrast sensitivity and dysphotopsia.
In her presentation, ‘Hitting plano: The role of refractive targeting in patient satisfaction’, Associate Professor Julie Schallhorn (USA) noted that the ultimate measure of success in cataract surgery is patient perception of the outcome. She highlighted the importance of refractive accuracy; missing the target by as little as 0.25 D – whether hyperopic, myopic or astigmatic – significantly affects satisfaction, particularly with multifocal IOLs.
Her message was clear: if a patient wants plano, target plano, and treat the cylinder. Every line of acuity gained increases the likelihood of satisfaction by around 20%. Dry eye emerged as the most significant modifiable cause of dissatisfaction: it must be identified during work-up, discussed with patients, and treated aggressively.
Further insights into patient-centred care came from Professor Banu Cosar (Türkiye) in ‘Beyond biometry: Integrating expectations, visual behaviour, and personality into IOL selection’. One patient may spend six hours a day reading, while another spends the same time playing golf. Understanding these differences in visual behaviour allows surgeons to personalise IOL selection beyond anatomical measurements. Patients demonstrating higher levels of agreeableness, openness, and extraversion tend to be better candidates for premium IOLs. Those with high conscientiousness combined with neuroticism are more likely to be dissatisfied. Perfectionismwas identified as a hidden risk factor.
Such factors influence neuroadaptation, the central biological mechanism linking optics, psychology, and visual satisfaction. “The future of personalised cataract surgery lies not only in measuring the eye more accurately, but also in understanding the patient more completely,” she said.
Setting Expectations
Dr Blake Williamson (USA) captivated delegates with ‘Getting to happy: The art and psychology of the patient conversation and refractive cataract surgery’.
Postoperative patient satisfaction begins long before the operating room. The foundations are patient selection, education, and expectation management. As the saying goes, “Expectations are premeditated resentments”.
Marketing messages should align with clinical reality. Statements such as, “there are technologies that can reduce your need for glasses” are appropriate, whereas promises to “throw away your glasses” create unrealistic expectations.
He encouraged delegates to sit in their own waiting rooms, review patient flow, and closely observe staff interactions. Dramatically undersell so you can dramatically overdeliver. “It’s not what you tell patients, it’s what they remember,” he said.
… reflection is what separates good surgeons from great ones. “How could I do better next time?”
Innovation and Excellence
AUSCRS president Dr Jacqueline Beltz (Melbourne) followed with ‘New techniques and technology’, highlighting the continuous innovation reshaping cataract surgery and the need to adapt rapidly. Adopting proven innovations improves patient care, but surgical excellence comes through mastering new techniques and embracing advances thoughtfully.
Dr Beltz emphasised the importance of peer and industry collaboration. The annual GenEye surgical training days, which she pioneered, exemplify this collaborative approach.
Like others, she advocates meticulous preparation, pre-planning surgical lists, mentally rehearsing procedures, allocating additional time, briefing teams, and personally verifying instrumentation. She encouraged surgeons to anticipate complications, develop contingency plans, and undertake detailed case reviews to drive continuous improvement. Every case is both a clinical event and a learning opportunity.
Ultimately, she said, reflection is what separates good surgeons from great ones. “How could I do better next time?”
Refractive Lens Exchange
In a session titled, ‘Reimagining the dysfunctional lens syndrome’, Dr George Waring IV (USA) shared his staged approach to deciding on corneal or refractive lens exchange for particular patients. In early presbyopia, he goes for a corneal procedure.
In patients with symptomatic or measurable higher order aberrations and early opacities, it’s time to switch up to an IOL, to avoid affecting activities of daily living. Corneal procedures are less invasive/expensive, while an IOL addresses the source of the problem, improves visual quality, and can be therapeutic in reducing intraocular pressure (IOP). Dr Waring discussed presbyopia in the context of emmetropia, and latent hyperopia manifesting over time, as well as Scheimpflug densitometry and diagnostic tests for aberrations. He surmised that the treatment algorithm has shifted to earlier intervention with refractive lens exchange (RLE).
Dr Lena Beckers (Germany), returned to AUSCRS, this year with her 11-week-old son attending all her talks. Her presentation ‘The cataract that never happened (is there a move towards refractive lens exchange?)’, reported research into European cataract surgery practice patterns from 2008 to 2017.
There’s a move toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes, she said. Complication rates showed PCO at 20–40%, IOP elevation/secondary glaucoma at 1–5%, cystoid macular oedema at 1–3%, endophthalmitis at 0.03–0.1%, and retinal detachment at 0.5–2% (higher in myopic eyes).
Earlier RLE, around mean age 45–55 vs traditional cataract surgery around 70–75, means the procedure must last 30–40 yrs for RLE patients while for older cataract patients it need only last 10–15 years.
She explained that lens dislocation increased from around 0.1–0.3% after 10 years to 1.5–3% over 20 years, to 5% with further elapsed time. Associated risk factors included pseudoexfoliation (the most important individual risk factor), as well as high myopia, previous vitrectomy, and uveitis.
We must remain conscious of possible early and long-term complications. Choose your patients wisely; earlier isn’t automatically better, Dr Beckers advised.
IOL Options
In ‘So long, farewell to reading glasses?’, Dr Tanya Trinh (Sydney), a new AUSCRS committee member, and Dr Dan Black (Sunshine Coast), expertly moderated a diverse group of speakers who covered a variety of proprietary IOL designs, light adjustable lenses (LALs) – to tweak post-op refractive targets/blended vision – wavefront analysis, and more.
Dr Alison Chiu (Sydney), the other new AUSCRS committee member, compared use of monofocal IOLs to extended depth of field (EDOF) designs. IOL calculations matter more than ever and modified keratometry and surgeon discretion are non-negotiable.
Good outcomes are not accidental. Refractive accuracy and biometry anxiety in post laser-assisted in situ keratomileusis (LASIK) eyes are no longer barriers to premium IOL surgery. Understanding aberration profiles of different designs helps guide a choice, where it might help counter post-LASIK aberrations.
Refractive Laser
Dr Patrick Versace (Sydney) and Prof Damien Gatinel (France) chaired a session titled, ‘Refractive laser: The not-so-lonely goatherd’, which included a broad spectrum of talks delving into, among other things, irregular astigmatism and customised topographical and aberration guided ablations. Other discussion explored data, vectors, and age-adjusted nomograms to analyse long term outcomes of various refractive surgery procedures.
Associate Professor Smita Agarwal (Wollongong) reported that early results indicate kerato-refractive lenticule extraction surgery for hyperopia can offer safe and predictable treatment, where other options, e.g. spectacles, contact lenses, RLE, implantable collamer lenses, photorefractive keratectomy and LASIK, were not suitable/preferred. She said more data and longer-term results are needed to determine long term stability.
IOLs in Space
Dr Morgan Micheletti (USA) took us into orbit with ‘IOLs in SPAAAAACE: The jointassessment for material exposure in space missions’. There are potential issues relating to older astronauts with cataracts or IOLs taking part in prolonged space missions. IOLs and other ophthalmic devices must remain stable, safe, and optically reliable after launch and prolonged space exposure.
IOLs exposed to the environment outside a space craft demonstrated dramatic crazing and opacification that could significantly affect the vision of astronauts; however, IOLs kept within space craft seem to be stable. Dr Micheletti said the main issues in low earth orbit include UV, x-rays, electrons, protons, thermal cycling and extremes, space particles,and atomic oxygen (reactive oxygen atoms) that are harmful to polymers.
Radiation exposure and microgravity can affect ocular health and vision, such as spaceflight associated neuro-ocular syndrome (SANS).
For long missions, self-care is needed, Dr Micheletti said, as opportunities for evacuation, resupply, and replacement are limited.
Micro- and nanoplastics are now ubiquitous; spectroscopic analysis and fluorescent microscopy have shown that they are present in the eye
The Threat of Microplastics
Associate Professor Abi Tenen (Melbourne) delivered an important talk on ‘Microplastics and the eye’ asking, should we be concerned? Micro- and nano-plastics are now ubiquitous; spectroscopic analysis and fluorescent microscopy have shown that they are present in the eye. Assoc Prof Tenen explained that possible modes of entry include contact lenses, topical medication, intraocular surgery, and transfer via the blood-retinal barrier. In terms of intraocular surgery, there were literally dozens of potential opportunities for plastics to be introduced. We have yet to see the long-term implications, but inflammation is of course a concern. Should we be informing patients that plastic particles might be introduced via ophthalmological procedures?
Meeting High Expectations
In ‘Beyond factory specs: Precision IOL power strategies for modified corneas’, Dr Andrea Ang (Perth) looked at the unique challenges in post-laser vision correction (LVC) patients who have enjoyed spectacle freedom, and are increasingly requesting presbyopia-correcting IOLs, with high expectations and visual demands.
She said the challenge is to achieve the desired refractive/visual outcome in the presence of increased higher-order aberrations, coupled with small or decentred optical zones and altered topography.
Refractive unpredictability is due to a miscalculated refractive index, which affects the typical ratio of anterior to posterior curvature. Keratometry (K) and topography measure paracentral corneal power but when extrapolated to the central corneal power leads to estimation errors. Previous myopic LASIK leads to a hyperopic error while hyperopic LASIK creates a myopic error, where some formulae use corneal power to calculate the effective lens position.
Dr Ang analysed a variety of data sets, that rank legacy and newer formulae, to help surgeons pick the best for their specific case, with or without posterior keratometry. To improve toric outcomes, use multiple K readings and integrated K. Modified corneas demand modified strategies for more precise outcomes that keep patients happy.
In ‘Changing gears from monofocal to EDOF as a routine IOL choice: The thrills and spills’, Dr Ben La Hood (Adelaide) showed how, over the past year alone, his IOL choice has changed dramatically from around 70% trifocals to around 50%, while EDOF lenses have jumped from around 10% to around 50%. He spoke about the pros and cons of various lens designs and technologies and compared monofocal results with EDOF.
TropFest Film Festival
Professors Graham Barrett AM (Perth) and Gerard Sutton hosted AUSCRS’s annual TropFest Film Festival, where brave surgeons once again showcased their challenges and how they overcame them.
This year’s winner – Dr Dylan Joseph from South Africa – presented a unique case of a patient undergoing laser vision correction who was non-responsive to anaesthesia.
Dr Joseph regularly works with a hypnotherapist who uses suggestive hypnosis during surgical procedures to implant positive suggestions into sedated patients’ psyche, aiding neuroadaptation and recovery. In the featured case, the hypnotherapist spent time hypnotising the patient so they could undergo the procedure without any anaesthesia. It was a pain-free resounding success, with a fast recovery. The patient was delighted with the outcome as was a relieved surgeon and hypnotherapist. A judge queried the video, suggesting the whole event must have been preplanned and staged to have such fantastic videos of the patient arriving, being treated and post-op too. But it turns out that Dr Joseph has a resident videographer filming every procedure as a patient keepsake, or for sharing on social media.
In Closing
Several trends were observed at AUSCRS 2026. Artificial intelligence was prominent and applied to many purposes. Multifocal IOLs, in particular EDOF, are now more widely used, comprising 50% of implants for some surgeons, although not for Prof Barrett who remains firmly in the monofocal camp. During a discussion on dysfunctional lens syndrome, he asked “why implant a dysfunctional lens in dysfunctional lens syndrome?”, attracting much mirth, a few head nods, and some vehement contradictions.
RLE, presbyopic, and hyperopic laser refractive surgery are also increasingly being performed to address an ever more demanding populace frustrated with presbyopia and hyperopia. LALs are making an impact, while true accommodating IOLs remain much anticipated ‘IOLs of the future’.
Dr Ang, AUSCRS Vice President summed it all up saying, “This year’s ‘Sound of AUSCRS’ meeting brought plenty of music, costumes, and laughter”.
“Beneath the fun was what makes AUSCRS so special – scientific rigour, thought-provoking presentations, and honest discussions about the challenges and opportunities we face in cataract and refractive surgery. By setting aside formality, we create an environment that is welcoming, inclusive, and engaging – and the focus shifts even more to learning and sharing ideas. AUSCRS continues to grow in strength.”
Describing the opportunity to co-convene the 2026 meeting with Dr Beltz, as “a privilege” she said the meeting “was also bittersweet as we celebrated and thanked Jenny Boden. Jenny has moved on from conference organiser to AUSCRS executive officer and has been part of the AUSCRS journey since Graham Barrett and Rick Wolfe founded the society 30 years ago”.
“We are deeply grateful for Jenny who has been the heart behind countless meetings.”
The meeting ended on a high with the Biennale Carnivale di Venezia gala dinner and some amazing costumes.
In 2027, AUSCRS will be themed ‘Beyond the Canopy’ and will take place at Peppers Noosa from 14–17 July.
