Impact of Intraocular Lens Design on Refractive Endpoint Selection: A Call for a New Paradigm

As intraocular lens (IOL) technology continues to evolve, the selection of an optimal refractive target has become increasingly complex and critical to achieving patient satisfaction following cataract surgery or refractive lens exchange. A recently proposed classification system divides IOLs into partial- and full-range-of-field categories based on defocus curve characteristics. However, this framework does not fully capture the diversity of modern IOL designs or account for key optical factors such as spherical aberration and lens-specific tolerance to residual refractive error. This review highlights the importance of understanding the interaction between IOL optical properties-particularly spherical aberration profiles-and refractive target strategies. It examines how different IOL designs, including enhanced monofocal, extended depth-of-field (EDOF), and full-range-of-vision lenses (eg, multifocal or spiral optics), respond to various refractive targets. The evidence suggests that a universal refractive target (eg, plano) may be suboptimal for many advanced IOLs and that customized refractive planning-often incorporating mini-monovision or asymmetrical targets-can improve visual outcomes. Future research should aim to standardize defocus measurement techniques and refine classification systems to better guide clinical decision-making.