In this national survey assessing US cataract surgery sedation practices, among 659 of 3,406 (19.3%) respondents, 578 (87.7%) routinely performed cataract surgery with anesthesia care. For sedation, 534 (81.0%) routinely used light-to-moderate IV sedation; 69 (10.5%) routinely used oral or no additional sedation. Forty-two (6.4%) performed cataract surgery in office-based surgery (OBS) suites. For future consideration of OBS, 76.0% (n=501), 76.0% (n=501) and 77.2% (n=509) indicated it was "moderately" or "very important" for Medicare to establish physician payment policies for OBS; to maintain access to ambulatory surgery center or hospital outpatient department privileges for complex cases; and for Medicare to continue allowing anesthesia services in the office when needed, respectively. Ophthalmologists nationwide rely heavily on anesthesia care for cataract surgery sedation. With appropriate training and favorable Medicare policies to make OBS financially viable and safe, ophthalmologists may be willing to assume additional, selected sedation roles traditionally performed by anesthesia teams.

Posterior chamber phakic intraocular lenses have a strong short-to-medium-term safety profile on the modern central-port platform, and a 2025 US Food and Drug Administration expansion of the indicated age range for a central-port phakic IOL to 21 to 60 years widens the eligible population. These lenses are to remain in the eye for decades, yet the field has defined what to monitor without building the infrastructure to deliver that monitoring reliably as patients age, change providers, and relocate. Existing guidance specifies endothelial and vault thresholds but does not address who monitors after the implanting surgeon, how baseline and longitudinal data transfer, or how late events are learned across practices. We propose three measures: upgrading the implant identification card into a longitudinal, portable surveillance record; a risk-stratified, age-informed surveillance framework developed through multisociety consensus; and a prospective implant registry with a defined minimum dataset. The device's clinical maturation now requires a parallel evolution in its care model.