Simvis Simulation Of Lasik Corneal Ablation Patterns For Presbyopia Correction - Computational, On-Bench And Clinical Validations

Published 2022 - 40th Congress of the ESCRS

Reference: PO465 | Type: Free paper | DOI: 10.82333/6pkh-9n90

Authors: Irene Siso-Fuertes* ¹ , Carmen M Lago ² , Amal Zaytouny ³ , Carlos Dorronsoro ¹ , Victor Derhartunian ⁴ , Samuel Arba-Mosquera ⁵ , Lucie Sawides ¹

¹2EyesVision,Madrid,Spain, ²Instituto de Optica, Consejo Superior de Investigaciones Científicas (IO-CSIC) ,Madrid,Spain;2EyesVision,Madrid,Spain, ³Instituto de Optica, Consejo Superior de Investigaciones Científicas (IO-CSIC),Madrid,Spain, ⁴EyeLaser,Vienna,Austria, ⁵SCHWIND eye-tech-solutions GmbH, Kleinostheim,Germany

Purpose

Lasik for presbyopia correction combines the LASIK ablation pattern to correct for the patient’s refractive distance error and the correction for near/intermediate distances to reduce the spectacle dependency in presbyopes. To date, there is no clinical device able to simulate those irreversible refractive corrections. SimVis Gekko (2EyesVision, Spain), a binocular visual simulator, allows patients to experience vision through different multifocal corrections preoperatively. It has proved to accurately replicate the optical quality of vision in patients with contact lenses or intraocular lenses before surgery and now is used to evaluate presbyLASIK corneal ablation patterns (PresbyMAX, SCHWIND, Germany in patients before surgery.

Setting

Visual Optics and Biophotonics Laboratory (Viobio Lab), Instituto de Optica, Consejo Superior de Investigaciones Científicas (IO-CSIC)

Methods

We simulated the SCHWIND presbyMAX ablation profiles where dominant (DE) and non-dominant (NDE) eyes are corrected with a hybrid micro-monovision profile and 1.75D add. SimVis through focus (TF) optical quality were calculated for DE and NDE and a 3mm pupil diameter and on-bench validated with a high speed focimeter. 11 healthy presbyopic patients (54±5yo) were included. Motor dominance was assessed and binocular TF- VA curves (-4.0 to +1.5 D), with and without compensation for micro-monovision, were measured through SimVis simulated presbyMAX patterns and compared to (1) binocular TF-VA curve through SimVis Gekko simulated monofocal-FAR in both eyes and (2) published binocular TF-VA curves of patients that underwent presbyMAX surgery.

Results

The experimental SimVis TF optical quality replicated the optical quality of the corneal ablation patterns with a curve shape similarity metric (cross-correlation) >0.99. Mean binocular LogMAR VA at far was -0.1±0.01 (bilateral monofocal), -0.06±0.05 (hybrid micro-monovision) and -0.07±0.03 (micro-monovision compensated). The Hybrid micro-monovision simulation extends the depth of focus by around 1.75D compared to bilateral monofocal maintaining a binocular VA above 0.2LogMAR. Binocular TF-VA curve through SimVis Gekko compensating the Hybrid micro-monovision matches on average those reported in literature from patients that underwent presbyLASIK with an RMS error of 0.13µm and a shape similarity metric of 0.9906 (range of -3.5D to 0.5D).

Conclusions

We demonstrated that SimVis Gekko is able to accurately simulate corneal ablation patterns, using the local corneal refractive correction information of the ablation profile. The excellent match between the estimated optical quality of the ablation pattern in terms of through focus visual Strehl TFVS, and the experimental SimVis TFVS suggests that SimVis Gekko is a reliable simulator to capture vision through simulated corneal ablation patterns before surgery. Patients can try the particular visual experience prior refractive surgery as we found that binocular TF-VA curves measured in patients that underwent presbyLasik match TF-VA curves in patients through SimVis Gekko presbyMAX simulations measured in similar experimental conditions.