Comparison of multifocal visual simulations in patients before and after implantation of diffractive trifocal lenses

Abstract

Purpose : Multifocal intraocular lenses (M-IOLs) represent a completely new visual experience, sometimes difficult to explain to patients. Visual simulators based on Adaptive Optics (AO)/SimVis are increasingly used to provide patients the experience of a new correction, prior to its implantation. The current study evaluates visual simulation of M-IOLs using different simulators in patients before/after implantation of M-IOLs.

Methods : Two simulation platforms were used: (1) a custom polychromatic AO system, with 2 visual simulators: a Spatial Light Modulator (SLM_AO), which mapped spatially the lens power profile, and an optotunable lens operating under temporal multiplexing (SimVis_AO); and (2) a wearable, binocular, large field of view SimVis prototype (SimVis_prot). All devices simulated a trifocal diffractive M-IOL (POD F,FINeVision,PhysIOL). 4 patients (age:53-74) were measured before surgery simulating the M-IOL and after its implantation (30 days post-surgery). Through-focus decimal visual acuity (TFVA) was measured (1) monocularly using a 4AFC procedure with tumbling E letters in monochromatic light projected in a Digital Micromirror device, while changing vergences in the AO system; and (2) binocularly using a clinical optotype in white light, and the SimVis prototype with trial lenses. Differences of TF VA curves between methods, as well as pre- and post-operatively, were evaluated in terms of Root Mean Square (RMS) difference between the curves.

Results : Similar maximum VA was found pre-operatively [monofocal 1.10±0.09; multifocal 0.90±0.08], and post-operatively (multifocal 0.98±0.06) with both simulation platforms. There are statistically significant differences between pre-operative multifocal simulations (SimVis_AO-SLM_AO,p=0.025; SimVis_AO-SimVis_prot,p=0.011), while no statistically significant differences were found between pre- and post-operative data (SimVis_AO,p=0.926; SLM_AO,p=0.925; SimVis_prot,p=0.287). Average RMS difference pre-operative TFVA with the simulated M-IOL and post-operative with the implanted IOL was 0.08 (SLM_AO), 0.09 (SimVis_AO) and 0.08 (SimVis_prot).

Conclusions : Visual simulations are useful programmable tools to predict visual performance with M-IOLs, both in an AO environment and in a large field of view SimVis prototype. Pre-operative visual simulations and post-operative data are in good agreement, as well as SimVis and SLM simulations.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.