Nicole R. Fram, MD, joins Sila Bal, MD, MPH, to discuss a case of a 68-year-old woman who presented as unhappy with her quality of vision 2 months after refractive cataract surgery. Dr. Fram reviews her typical preoperative screening process for refractive cataract patients, focusing on the ocular surface, patient lifestyle, and other diagnostic tools. She also describes how she educates patients preoperatively about their lens selection options. Drs. Bal and Fram further review common potential reasons that a refractive cataract patient might be unhappy with his or her vision, and Dr. Fram shares how she postoperatively assesses and manages these patients to improve outcomes.