Eye surgery: the technological innovations

Eye surgery advances in small steps rather than through spectacular breakthroughs. More versatile cataract implants, faster lasers, longer-acting retinal treatments, finer imaging and artificial intelligence to support diagnosis: here, without overselling, is what has genuinely changed since 2024 for a patient who consults in Paris 13 or Cachan and is considering eye surgery — and what still belongs to the realm of research or remains available only abroad.

KEY POINTS

CATARACT AND IMPLANTS

Cataract: the progress lies in the implant

Cataract surgery remains the most frequently performed surgical procedure in France, with about 700,000 patients operated on each year (ATIH, 2023). Its core technique — ultrasound phacoemulsification — has been proven over decades and delivers good results in the large majority of cases. Recent developments do not overturn this foundation: they mainly concern the choice of intraocular implant and the precision with which it is calculated and positioned.

A wider, more refined choice of implants

The real choice comes down to the implant placed in the position of the natural lens. Several families now coexist:

• monofocal implants, which provide sharp vision at a single distance (most often far vision), with glasses needed for near work;
• “enhanced” monofocals (enhanced monofocal, such as the Tecnis Eyhance), which keep the comfort and low sensitivity to haloes of a monofocal while slightly improving intermediate vision — a good compromise for many patients;
• EDOF implants (extended depth of focus, such as Vivity, PureSee or LuxSmart), which favour a smooth transition between distances, generally with fewer haloes;
• trifocal implants (PanOptix, FineVision), which offer more independent near vision but carry a greater risk of night-time haloes.

The arrival of enhanced monofocals is one of the most useful developments of recent years: it widens the range between the classic monofocal and premium implants, without necessarily resorting to a multifocal implant. No implant is “ideal” in absolute terms — the right choice depends on your lifestyle, your tolerance of night-time visual effects, the health of your retina and your budget, since premium implants involve an out-of-pocket cost.

More precise placement: assisted calculation and alignment

A well-chosen implant is not enough on its own: its power must still be calculated and its orientation set correctly, particularly to correct astigmatism with a toric implant. Two advances contribute here: swept-source optical biometry, which measures the eye at high speed and makes the power calculation more reliable, and image-guided systems, which project markers to align the toric implant precisely during surgery. Calculation-support algorithms, sometimes enhanced by artificial intelligence, further refine the prediction of the refractive outcome.

And the femtosecond laser (FLACS)? It can perform certain steps of the operation (incisions, opening of the capsule, fragmentation of the lens). Recent scientific literature, however, does not show a systematic clinical superiority over manual phacoemulsification, that is, without laser assistance, carried out by an experienced surgeon. It is therefore not an automatic guarantee of a better result, but one option among others, whose value is discussed on a case-by-case basis.

Finally, you may sometimes hear about the light-adjustable lens (LAL), whose power can be fine-tuned after surgery using ultraviolet light. This is an innovation developed mainly in the United States: it is not commonly available in France as of September 2026. It is therefore better to reason on the basis of the implants actually offered in our practices.

REFRACTIVE SURGERY

Refractive: faster, more personalised lasers

The correction of short-sightedness, astigmatism and long-sightedness rests on three main approaches: flap techniques (LASIK), surface techniques (PRK) and small-incision lenticule extraction (SMILE). Recent developments do not overturn these principles: they make them faster, more reproducible and better suited to each cornea.

SMILE Pro and VisuMax 800: a faster procedure

The SMILE technique involves cutting a thin disc of tissue (the lenticule) inside the cornea using a femtosecond laser, then removing it through a micro-incision of a few millimetres, without lifting a flap. Its most recent version, SMILE Pro, is built on the VisuMax 800 laser: it creates the lenticule in about ten seconds per eye according to the manufacturer (compared with around thirty previously), with eye-tracking and compensation for the eye’s rotation. This is the laser Dr Tourabaly uses to operate on his patients at the Clinique Laser Victor Hugo; this laser received FDA authorisation in January 2024.

This same laser also speeds up the creation of the LASIK flap: where previous generations needed around fifteen seconds, the VisuMax 800 creates the flap in about five seconds, according to the manufacturer. The aim is not to transform the final result, but to make the procedure shorter, more comfortable and more stable. In the published series, accuracy remains high. SMILE and LASIK are not suitable for every visual defect or every cornea: only a full pre-operative assessment can determine which technique is best suited to your case.

Ablation profiles guided by measurement

Beyond the “standard” correction, modern lasers can tailor the treatment to the precise shape of your cornea (topography-guided treatment) or to an analysis of the eye’s entire optical path. These personalised approaches aim above all to limit the optical aberrations responsible for haloes or discomfort in night vision. They rely entirely on the quality of the pre-operative examinations: corneal topography and aberrometry, carried out before any decision. Some recent platforms that calculate the profile by “ray-tracing” are deployed abroad and are being evaluated in the European Union: their real value is measured case by case, not as an automatic advance for everyone.

ICL EVO: the phakic implant without a prior iridotomy

For high degrees of short-sightedness or corneas too thin for laser treatment, the phakic ICL implant (a lens placed inside the eye, without removing the natural lens) is a valuable alternative. Its recent version, the ICL EVO, incorporates a central micro-channel (KS-AquaPORT) that allows the aqueous humour to circulate. In practical terms, this avoids the peripheral laser iridotomy that previously had to be performed before placement. This implant, available in Europe for several years, is reversible and suits high corrections; the indication is determined after a full examination, notably of the cornea’s endothelial cell density.

PRECISION DIAGNOSIS

Seeing better to decide better: imaging the eye

The most useful day-to-day advances are often invisible to the patient: they concern the measuring devices that precede surgery. A well-calculated implant or a well-analysed cornea is worth more than a state-of-the-art laser used on imprecise data.

• Corneal tomography: devices such as the Pentacam or hybrid topographers (Scheimpflug imaging combined with the Placido disc) map both surfaces of the cornea and help detect early keratoconus, a major contraindication to LASIK and SMILE; the ICL implant remains debatable on a case-by-case basis. At the Cachan practice, corneal analysis is carried out with a Sirius+ topographer.
• Next-generation biometry: swept-source optical biometers measure the length of the eye at high speed to calculate the power of the cataract implant with greater reliability.
• OCT and OCT-angiography: this non-invasive imaging, now a standard, makes it possible to analyse the retina and its vasculature layer by layer — essential for AMD, glaucoma or diabetic retinopathy.

This fine imaging also changes the management of keratoconus: detected early, it can be stabilised by corneal cross-linking (strengthening the collagen with riboflavin and UV light), an established technique practised in France, whose protocols have become faster. Detecting keratoconus before any refractive surgery also means avoiding operating on a fragile cornea.

RETINA AND ARTIFICIAL INTELLIGENCE

Medical retina: spacing out the injections

For retinal diseases treated with intravitreal injections (wet AMD, diabetic macular oedema), one of the most concrete advances concerns longer-acting medicines. Two recent molecules illustrate this trend: faricimab (a bispecific antibody) and aflibercept 8 mg (a higher-dose form of aflibercept, approved in the European Union in January 2024). In patients who respond well, they allow injections to be spaced out to several months — four months for the first, up to six months for the second — while maintaining efficacy. This is a real easing of an often burdensome follow-up. These treatments are prescribed on a case-by-case basis, according to each patient’s response, and do not eliminate injections: they reduce their frequency.

Other avenues are progressing but remain removed from everyday French practice. Gene therapy is the subject of real advances, but it remains reserved for rare and specific genetic diseases; it does not concern common conditions such as cataract, short-sightedness or ordinary AMD. Likewise, home OCT self-monitoring of AMD — a small device the patient uses at home — is a device under evaluation, authorised in the United States but not yet rolled out in France as of September 2026. Caution is warranted in the face of sweeping announcements.

Artificial intelligence: support, not replacement

Artificial intelligence is gradually being integrated into imaging equipment: automated analysis of OCT, help in screening for diabetic retinopathy, glaucoma or AMD, and implant-calculation support models. Used as a decision-support tool, it can save time and pick up faint signals. It replaces neither the clinical examination nor the surgeon’s judgement, who remains solely responsible for the indication and the procedure. In practice, AI is a co-pilot: it informs the decision, it does not make it.

IN PRACTICE

Should you wait for the “next” technology?

This is a common question in consultation. The answer is almost always no: the current techniques for correcting short-sightedness and operating on cataracts are mature and proven. Waiting indefinitely for an “ultimate” innovation can mean postponing a possible visual benefit today, with no certainty that the next new development will change anything about your situation.

What matters most is not having the most recent laser or the most expensive implant, but that the indication is sound, that the assessment is rigorous and that the technique is suited to your eye. To find out which options match your case, the first step remains the eligibility test and then a consultation.

FAQ

Frequently asked questions

FURTHER READING

Scientific sources

• DREES, “Primary cataract treatment is the most frequent of all surgical procedures”, 2024.
• Carl Zeiss Meditec, VisuMax 800 documentation (SMILE pro and LASIK flap creation); comparative study of operating times, Scientific Reports, 2025.
• Bayer / European Medicines Agency (EMA), Eylea 8 mg (aflibercept) — treatment interval extended up to 6 months, EU approval 2024-2025.
• European Medicines Agency (EMA) and Haute Autorité de Santé (HAS), Vabysmo (faricimab) — neovascular AMD and diabetic macular oedema.
• Johnson & Johnson Vision, Tecnis Eyhance — next-generation monofocal implant (CE marking, Europe).
• STAAR Surgical, Visian ICL EVO / V4c implant with central port (CE marking).
• Société Française d’Ophtalmologie (SFO) and Les Cahiers d’Ophtalmologie — corneal cross-linking and literature reviews.

This article is intended for general information and does not replace a medical consultation. Only a full ophthalmological examination can determine the indication and the technique suited to your case. The devices and medicines mentioned require a medical prescription and their availability may change.