Robert Ang, MD, explains why a small-aperture IOL is "not a niche product"

At the 2025 American Society of Cataract and Refractive Surgeons (ASCRS) meeting in Los Angeles, California, Robert Ang, MD, head of cornea and refractive surgery at the Asian Eye Institute in Makati City, Philippines, spoke to the Eye Care Network. He shared the research findings he brought to the ASCRS congress, focused on the IC-8 Apthera small-aperture IOL (Bausch & Lomb).

"For patient selection, first, we are targeting a very important group of patients, who are difficult to treat and also difficult to please," Dr Ang said. "These patients [underwent] these surgeries before because they don't want glasses, and now they don't want glasses again after cataract surgery." According to Dr Ang, a small aperture IOL will benefit all patients, but especially those with complex corneal pathologies and a history of prior surgeries.

"Refractive targeting is very, very crucial. We want them to be between 0.75 to -1," Dr Ang continued, calling this refractive zone the "sweet spot" for small aperture IOL implantation. Accurate and informative keratomety readings are also crucial, he said, though they can be difficult to achieve. "In this tough, tough population, sometimes it's hard to do," he said. "But the good surprise is that even if we miss target, distance vision remains good."

Overall, Dr Ang said he wants clinicians to remember that a small aperture IOL is suitable for a wide range of patient needs. "The small aperture IOL is not a niche product," he emphasised. "Before we [focused on] the challenging, post-refractive patients, we [studied] the population of normal eyes with normal corneas. That's how we found out that this small aperture optic extends depth of focus and gives good intermediate and near vision. So don't hesitate to use them on normal corneas and normal patients...they're applicable to everybody who wants cataract surgery. Just target well and counsel well."