How do you approach IOL exchange in a patient who is unhappy after cataract surgery with a premium IOL?

The first step is determining why they are unhappy, is it a quality of vision issue? Something else, like diplopia or eye pain?

Assuming it's a visual quality issue, the next step is assessing the reason: a careful evaluation of corneal surface (dry eye, ABMD, Salzmann's nodules), evaluating for lens issues (PCO or lens tilt), evaluating the posterior segment (ERM or CME, AMD, Glaucoma, optic neuropathy). Most importantly, refractive error: a careful refraction without relying on an auto refract...

This is a tough but very important question. I always ask a few questions, assuming this is MF premium.

1. What are the problems you are having with your vision? Unlike floater details (which do not help), the sad tales of the crescents, glare, and halos are important. Try to sort out if it is the usual halos that 20% of MF people will have (that usually get better) or if it is more like positive or negative dysphotopsia seen in all IOLs. Best reference for me is (must read): Masket & Fram, PMID 32...