Preoperative Visual Simulation Of Presbyopic Correccions With Natural Vs Dilated Pupils

To compare the through focus visual acuity (TFVA) curves obtained preoperatively through simulated commercial presbyopia-correcting intraocular lenses (IOLs) in the same subjects under pupil dilation or with natural pupils. To measure the potential effect of cyclopegia on the visual simulations provided by SimVis Gekko, and demonstrate the compensatory effect of the artificial pupil projected onto the eye during the simulation.

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

This control study was performed on 5 healthy presbyopic subjects (56±3yo). Binocular TFVA curves (-3.5 to +1.0D) and subjective perceived visual quality (score 0 to 10) at far were obtained through SimVisGekko, a Simultaneous Vision binocular simulator, matching the optical quality at all distances of plano lenses and presbyopic corrections (Vivity and FineVision IOLs), bilaterally. Measurements were conducted under natural pupil conditions and after instillation of Tropicamide 1%. Photoretinoscopy (PowerRefractor, Plusoptix) was used to measure the photopic pupil and the amplitude of accommodation (AA). TFVA curves -natural and cyclopeged- were compared using shape similarity (cross-correlation) and Root Mean Square (RMS) difference.

The mean monocular AA was 0.73±0.02 D. Cyclopegia did not induce significant differences for any of the simulated lenses. The mean subjective perceived visual quality was 9.8±0.4, 8.2±0.8 and 7.2±0.8 with natural pupil, and 10±0, 7.8±0.4 and 7.2±0.8 in dilated pupil conditions, for the monofocal, Vivity and FineVision SimVis Gekko simulations, respectively. The average TFVA shape similarity between simulated IOLs in natural and dilated pupil conditions was 0.984/0.978/0.916, and the RMS difference was 0.02/0.03/0.03 logMAR, respectively for the monofocal, Vivity and FineVision SimVis Gekko simulations.

The results obtained show a very high similarity in subjective perceived visual quality and between both TFVA curves, independently on the eye’s pupil diameter. This supports the fact that the simulated performance with presbyopic IOLs is dominated by the IOL design (which in the SimVisGekko is programmed  for specific pupil diameters). This study demonstrates that SimVis Gekko replicates the through-focus optical performance of multifocal IOLs even under both natural and dilated pupil conditions, and that the residual accommodation that may be present under natural conditions plays a negligible role in the simulation outcomes.