BACKGROUND: Advanced-technology intraocular lenses (IOLs) can provide greater spectacle independence compared with single-focus (monofocal) IOLs, without significantly compromising visual quality. However, usage rates are variable and lower than those of single-focus lenses.

RESEARCH, DESIGN, AND METHODS: This prospective survey study investigated practice patterns and perspectives on IOL selection among a representative sample of US cataract surgeons (“surgeons”; N=127) and in those with recognized expertise in advanced-technology IOLs (“experts”; N=7). Using survey findings, an expert panel identified knowledge/confidence gaps.

RESULTS: Optical biometry was considered essential by 87.4% of surgeons and 100% of experts. Confidence in IOL selection was high (78.8% vs 100%), while 53.5% vs 100% offered advanced-technology IOLs to all qualifying patients. Confidence in post-operative management of advanced-technology IOLs was lower among surgeons (42.5%) than experts (100%). Experts reported a 30% lower threshold for treating astigmatism with toric IOLs than surgeons (0.71 D vs 1.01 D) and showed more consistent decision-making patterns driven by patient factors.

CONCLUSIONS: Findings indicated variability in IOL-selection confidence and decision-making patterns, pre-operative assessment rigor, and comfort with postoperative management, highlighting opportunities for targeted education and standardization. An IOL selection decision-making tool was outlined to support IOL-selection standardization based on objective clinical criteria and subjective patient factors.