To the majority of EYE-CARE patients, laser-based refractive surgery is probably the most recognizable advance in the field in the past decade. LASIK has become the surgery that most of the population associates with ophthalmology. That is a reflection, to some degree, of its success rate and positive impact on the quality of patients' lives, and to some degree, of the fact that it's heavily advertised.

With the FDA's U.S. marketing approval of the first accommodating IOL, we're taking the first step toward changing that scenario. Though there is clearly a long way to go before we can say that there is a safe and effective device or surgical technique that successfully restores accommodation, this is at least a toe in the water.

Whether IOL technology ever delivers on that challenge to the point that presbyopes become the target of LASIK-style marketing is equally uncertain, but we can hope for the best. The attitudes of many of the members of our National Panel provide some reason for that hopeful outlook.

For one thing, cataract surgeons tend to be from Missouri, or are at least honorary Missourians, if our panel is indicative. They want to be shown. Shown not just that the FDA has pronounced a product safe, but that it delivers real benefits to their patients. Technologies such as multifocal IOLs and toric IOLs, for example, are still working their way through the real-world clinical trial that always follows FDA approval. So far, less than 20 percent of surgeons use the former, and less than 10 percent use the latter, according to our unscientific survey (See article for more). That's not to say they don't work or provide a benefit. Phaco machines, inserters, viscoelastics all go through the same trial in which all of the investigators are from Missouri, and patients are better for it.

So let the accommodating lens trial begin. And may others soon join the fray. We're fortunate this month to have Dr. Mike Colvard share his experience as a clinical investigator of the new lens (See article). If ever there were a surgeon with an admirably underdeveloped sense of hyperbole, I believe it's Dr. Colvard. But you'll decide that for yourself, and I'm glad you do.