Pre-operative simulation of post-operative multifocal vision.

Maria Vinas,Mercedes Romero,Nuria Garzon,Sara Aissati,Susana Marcos,Carlos Dorronsoro,Francisco Poyales,Clara Benedi-Garcia

doi:10.1364/boe.10.005801

Abstract

While multifocal intraocular lenses (MIOLs) are increasingly implanted to correct for presbyopia, how one sees with a multifocal correction is hard to explain and imagine. The current study evaluates the quality of various visual simulating technologies by comparing vision with simulated MIOLs pre-operatively and the implanted MIOLs post-operatively in the same patients. Two simulation platforms were used: (1) a custom-developed adaptiveoptics (AO) system, with two visual simulator devices: a spatial light modulator (SLM) and an optotunable lens operating under temporal multiplexing (SimVis); and (2) a wearable, binocular, large field of view SimVis2Eyes clinical simulator (SimVis Gekko, 2Eyes Vision, Madrid, Spain). All devices were programmed to simulate a trifocal diffractive MIOL (POD F, FineVision, PhysIOL). Eight patients were measured pre-operatively simulating the trifocal lens and post-operatively with implantation of the same MIOL. Through-focus decimal visual acuity (TF VA) was measured (1) monocularly in monochromatic light using a four-alternative-forced-choice procedure in the AO system; and (2) binocularly using a clinical optotype in white light. Visual simulations pre-operatively predict well the TF VA performance found post-operatively in patients implanted with the real IOL. The average RMS difference between TF curves with the different visual simulators was 0.05 ± 0.01. The average RMS difference between the TF VA curves with the SimVis pre-operatively and the real MIOL post-operatively was 0.06 ± 0.01 in both platforms, and it was higher in cataract eyes (0.08 ± 0.01, on average across simulators) than in eyes with clear lens. In either group the shape of the TF curves is similar across simulators and pre- and post-operatively. TF curves cross-correlated significantly between simulators (lag k = 0, rho = 0.889), as well as with results with the real MIOL implanted (lag k = 0, rho = 0.853). Visual simulations are useful programmable tools to predict visual performance with MIOLs, both in an AO environment and in a clinical simulator. Pre-operative visual simulations and post-operative data are in good agreement.

Highlights

Multifocal corrections work under the principle of simultaneous vision, projecting simultaneously focused and defocused images on the retina, providing multifocality at the expense of reducing optical quality at all distances [1]
We compared TF optical and visual quality produced by real multifocal intraocular lenses (MIOLs) in a cuvette projected on the subject’s eye with those same designs simulated with simultaneous vision simulator (SimVis) technology and with a Spatial Light Modulator (SLM), incorporated in a custom-made multichannel 3active-optical-elements polychromatic Adaptive Optics (AO) Visual Simulator, and we found good correspondence between performance of the real and simulated MIOLs
This study presents pre-operative simulated TF visual performance in comparison with postoperative vision after implantation of a MIOL

Summary

Introduction

Multifocal corrections work under the principle of simultaneous vision, projecting simultaneously focused and defocused images on the retina, providing multifocality at the expense of reducing optical quality at all distances [1]. Visual simulators are proposed to provide patients the visual experience of a multifocal correction before this is applied to the eye (either in the form of intraocular lens, IOL, or contact lens, CL). Visual simulators based on Adaptive Optics (AO) have allowed probing the visual system under manipulated optics [2,3,4,5]. They are attractive to test vision in patients with new optical designs [2,6,7] prior to delivering surgical corrections to the patient or even manufacturing the lenses. Simulations of new corrections with AO primarily serve to investigate interactions between the patient’s optics and a given correction, to investigate differences across corrections,

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Results

Conclusion