Subjective Satisfaction Prediction Before Intraocular Lens Implantation Surgery Using Simvis Gekko

This study aims to evaluate individual preferences in terms of subjective satisfaction scores and binocular BCVA in cataract patients before intraocular lens (IOL) implantation using the binocular visual simulator SimVis Gekko with three different types of presbyopia correction. 

The study was conducted at Instituto de Microcirugía Ocular (IMO Barcelona) Grupo Miranza, Barcelona (Spain).

Fifteen subjects aged 50-85 were recruited for bilateral cataract surgery with IOL implantation. Inclusion criteria were: subjective refraction between +4 and ‑6D, BCVA ≤ 0.3 logMAR with no previous intraocular surgery. Exclusion criteria were: astigmatism greater than 2.50D, anisometropy ≥ 1.50D and other binocular vision disorders. Prior to surgery, three types of corrections were simulated using SimVis Gekko: Monovision (0.75D offset), EDOF and Trifocal, VA at three distances (4, 0.66 and 0.40m) and overall subjective satisfaction Score Points (0 to 10) of natural images through the device. The surgeon’s choice following standard clinical practice was compared at one month postop with the best-scored correction using SimVis Gekko.

The surgeon recommended monovision, EDOF and Trifocal in 20%, 26.67% and 53.33% of cases, respectively. The subjective satisfaction score across subjects was 6.38±1.40 for monovision, 6.21±1.59 for EDOF and 5.09±2.02 for Trifocal through SimVis Gekko preoperatively. When simulated VA at far was compared with VA at intermediate and near, the mean differences were 0.16±0.14 and 0.25±0.16 logMAR for monovision, 0.13±0.20 and 0.25±0.02 logMAR for EDOF and 0.09±0.21 and 0.14±0.22 logMAR for Trifocal. These results suggest that the trifocal correction provided more balanced visual performance among distances. The correction with the highest subjective satisfaction score (difference ≥1 SP) matched the IOLs selected by the surgeon in 73% of cases.

The SimVis Gekko binocular clinical simulator allowed a sample of cataractous subjects to experience vision with different presbyopic corrections. These subjects experienced the relative differences at each distance for several corrections both in terms of VA and perceived subjective satisfaction. SimVis Gekko allows to manage patients' expectations in the field of cataract surgery and presbyopia treatment. Furthermore, SimVis Gekko can assist the surgeon in selecting premium IOLs to enhance final patient satisfaction with the cataract process. The use of a visual simulator allowed to identify before surgery corrections potentially providing better subjective satisfaction than the one suggested by the surgeon in >25% of the patients.