Clinical Workflow Integration Options Of A Binocular Visual Simulator Of Intraocular Lenses

To quantify alignment time, alignment stability, comfort and experience with three implementations of SimVis Gekko (2EyesVision), to evaluate their integration into standard clinical workflows: 1) Head Mounted (HM); 2) Head Mounted with Eye Monitoring System (HM-EMS); and 3) Table Top with EMS (TT-EMS). 

Setting:

2EyesVision, Madrid, Spain.

Instituto Zaldivar, Autonomous City Of Buenos Aires, Argentina

SimVis Gekko is a see through visual simulator that lets patients experience intraocular lenses before surgery. This scientifically validated technology has several implementation options. HM allows natural head movement. TT provides fast alignment but requires big eye movements. EMS monitors eye movements and aligns quickly. The study involved 5 presbyopic (48-57 years) and 10 non-presbyopic (21-42 years) subjects. They rated image quality (1-5) for monofocal, full range (PanOptix), and partial range (Vivity) lenses at far and near distances using HM, HM-EMS, and TT-EMS. Each test was repeated three times. A survey assessed comfort, satisfaction, and clinical fit. Statistical tests analyzed differences in alignment time and image quality.

SV-TT had the fastest alignment at 27±12s, followed by HM-EMS at 40±15s and HM at 46±16s. A learning effect was noted for HM but not for EMS devices. The average measurement time was 64±21s. Alignment was consistent, with brief misalignment in HM-EMS (4%) and TT-EMS (13%). Vignetting affected less than 7% of the pupil area (13% in TT-EMS). Presbyopes tolerated full (+1.07) and partial (+0.33) ranges better than non-presbyopes. Perception differences were minimal across devices. Comfort was similar, with 36% preferring HM, 36% HM-EMS, and 28% TT. HM-EMS, allowing head movements, offered the best experience. All subjects found the devices suitable for clinical use.

The three implementations of the visual simulator provided similar perceptual scores through the lens simulations and comparable comfort, but HM-EMS provided a better experience. TT-EMS provided the shortest alignment times, but more transient misalignments and vignetting due to eye movements, which are not clinically relevant. The three devices are clinical instruments suitable for integration into standard clinical workflows.