Visual simulations of IOLs ‘can be reliably used’ to guide optimal presbyopic correction
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Key takeaways:
- Preoperative and postoperative perceptual scores highly correlated for all corrections and distances.
- Visual acuity was significantly associated with objective scatter index.
Visual simulations like SimVis Gekko are valuable tools to explore prospective postoperative vision in patients with cataract, according to a study published in the Journal of Cataract & Refractive Surgery.
“This study demonstrates the viability of visual simulators, particularly the SimVis Gekko, in patients with cataract,” Xoana Barcala, PhD, clinical development optometrist at 2Eyes Vision, and colleagues wrote. “The results demonstrate that in patients with mild and moderate cataract, the relative visual quality scores given to different presbyopic corrections preoperatively are preserved when the cataract is removed. This indicates that visual simulators can be reliably used to guide the optimal presbyopic correction for a patient, even in the presence of cataracts.”
In an observational, noninterventional pilot study conducted at San Carlos Clinical Hospital in Madrid, researchers tested the applicability of visual simulations of presbyopic correction in patients with cataract. They recruited 24 participants (mean age, 70 years), 15 of whom underwent bilateral implantation of monofocal-far IOLs.
Participants judged the visual acuity of images before and after surgery with the Multifocal Acceptance Score to Evaluate Vision at 4 M, 64 cm and 40 cm simulated with SimVis Gekko single vision, bifocal, monovision and modified monovision. Patients spanned a wide range on the objective scatter index (OSI), and some had varying OSI between eyes.
Researchers determined that visual acuity was significantly associated with OSI (P < .0005), and OSI difference between eyes also correlated with visual acuity between eyes (P = .002).
In addition, at far distance, perceptual scores decreased with increasing OSI for most corrections, but perceptual scores at near and intermediate distances were positively correlated with increasing OSI with the monofocal-far correction.
“The high correlation in the perceptual scores before and after cataract surgery demonstrates that the SimVis Gekko can be used in cataractous patients,” Barcala and colleagues wrote.
Perspective
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Optometrists have always played an important role in helping cataract patients select an optimal postoperative refractive correction. But with the myriad of multifocal IOL options now available, how do we help patients decide what’s best for them?
Visual simulators address this need by giving patients the ability to "try out" various options before surgery. They show patients what their vision would be like with any of the available refractive options, including various multifocal IOL designs. While this sounds like a great idea, there is currently little evidence to suggest that simulators improve patient satisfaction with their postop refractive outcome compared to standard practice.
The current study addresses one criticism of simulators, which is the extent to which a visually significant cataract degrades the simulator experience, making the whole process moot. The good news from this study is that there was no significant difference in how patients ranked the available refractive options before and after cataract removal, provided the cataract was not severe. So, whatever the patient liked best before surgery is probably what they will like best afterward.
This study provides evidence that simulators can help patients gain some appreciation of their postop refractive options. However, more outcomes-based research is needed to justify the use of these devices.
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