Prediction Of Visual Performance Following Cataract Surgery With Multifocal Intraocular Lenses.
Published 2024 - 42nd Congress of the ESCRS
Reference: FP30.10 | Type: Free paper | DOI: 10.82333/7pzm-9t49
Authors: Jorge Henriques* 1 , Tatiana Queirós 2 , Rita Coimbra 3 , Conceição Lobo 4 , Joaquim Murta 5
1Ophthalmology,HUC - ULSCoimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra ,Coimbra,Portugal;Faculty of Medicine, University of Coimbra ,Coimbra,Portugal, 2Ophthalmology,HUC - ULSCoimbra,Coimbra,Portugal, 3Associação para a Investigação Biomédica e Inovação em Luz e Imagem (AIBILI),Coimbra,Portugal, 4Ophthalmology,HUC - ULSCoimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra ,Coimbra,Portugal;Associação para a Investigação Biomédica e Inovação em Luz e Imagem (AIBILI),Coimbra,Portugal;Faculty of Medicine, University of Coimbra ,Coimbra,Portugal, 5Ophthalmology,HUC - ULSCoimbra,Coimbra,Portugal;Ophthalmology,Clinical Academic Center of Coimbra ,Coimbra,Portugal;Faculty of Medicine, University of Coimbra ,Coimbra,Portugal
Purpose
Cataract surgery with the implantation of multifocal intraocular lenses (mIOLs) is currently the ideal treatment for presbyopia in patients with significant cataracts. However, postoperative patient satisfaction and visual performance may vary and may fall short of patients' expectations. The purpose of this paper is to explore the predictive capability of preoperative optical simulation with SimVis Gekko (SVG) and light disturbance analyzer (LDA) on patients' overall performance in cataract surgery with mIOLs.
Setting
This study was held at Ophthalmology Department of University Hospital of Coimbra, Unidade Local de Saúde de Coimbra, EPE, Portugal.
Methods
A cohort observational study was designed, including patients aged > 40 years with cataracts and a minimum best-corrected distance visual acuity of 4/10, undergoing consecutive bilateral cataract surgery with the implantation of trifocal diffractive or enhanced depth of focus (EDOF) IOLs. All patients underwent a comprehensive ophthalmological evaluation, auxiliary exams for long-term safety prediction, LDA, aberrometry, and Quality of Vision (QoV) and CatQuest 9SF questionnaires, both pre- and at the 4th month postoperatively. Furthermore, all patients underwent preoperative simulation with SVG visual simulator, with distance, intermediate, and near visual acuity, stereopsis, and subjective visual score performance (SVSP) recorded.
Results
We included 88 eyes from 44 patients (n=44), with mean age 56 (+/- 7,9) years; 26 patients received the trifocal and 18 the EDOF IOL. Both groups showed improved CatQuest scores, with trifocals achieving the highest scores. Rasch analysis of QoV revealed halos, starbursts, and glare as the most prevalent, with the trifocals scoring highest. Visual acuity curves from preoperative simulations were comparable to the real postoperative ones for both IOL types. Both groups experienced a significant reduction in Light Disturbance Index (LDI) from the LDA. Postoperative QoV score correlated with preoperative LDI: a lower preoperative LDI was associated with a higher postoperative Rasch QoV scores (p=0.002) for both EDOF and trifocal groups.
Conclusions
The SVG demonstrated a good ability to simulate mIOLs, and the overall expected outcomes surpassed those measured during preoperative simulation. A low preoperative LDI from LDA may predict a higher postoperative dysphotopsia perception. Combining preoperative see-through simulation with LDA assessment may enhance the selection of presbyopia-correcting IOLs for each patient and anticipate postoperative dysphotopsia complaints.