Evaluation Of A Holographic Vision Simulator For Predicting Postoperative Visual Acuity In Cataract Surgery: A Double-Blind Observational Study
Published 2025 - 43rd Congress of the ESCRS
Reference: FP29.04 | Type: Free paper | DOI: 10.82333/18hr-s216
Authors: Argyrios Tzamalis* 1 , Chrysanthos Christou 1 , Michael Tsatsos 1 , Ioannis Tsinopoulos 1 , Nikolaos Ziakas 1
1Aristotle University of Thessaloniki,Thessaloniki,Greece
Purpose
Cataract surgery outcomes are highly dependent on preoperative assessments, yet accurately predicting postoperative visual acuity remains a challenge. Current methods lack precision in estimating visual function after surgery. The KATSIM project aims to address this gap by developing a novel holographic vision simulator that predicts postoperative best-corrected visual acuity (BCVA). Using computer-generated holography (CGH) and real-time pupil tracking, KATSIM projects visual stimuli through non-cataractous regions of the lens, enabling a more accurate assessment of potential visual acuity. This study evaluates the device’s predictive accuracy and its role in reducing uncertainty in surgical decision-making.
Setting
This double-blind observational study was conducted at Koç University Hospital and Varna University Hospital as part of the KATSIM project. A novel holographic vision simulator integrating computer-generated holography (CGH) and real-time pupil tracking was tested on cataract patients. Standard ophthalmic assessments, including best-corrected visual acuity (BCVA) and postoperative visual performance, were compared to simulator predictions.
Methods
This double-blind observational study evaluated the KATSIM device in 16 eyes from 12 cataract patients scheduled for surgery. KATSIM used CGH and real-time pupil tracking to project stimuli through clearer lens regions to estimate postoperative BCVA. Preoperative KATSIM test results were compared to postoperative BCVA measured 1 week after surgery. Normally distributed data were summarized with mean±SD, and non-normally distributed data with median and IQR. To assess prediction accuracy as the main outcome measure, we employed Median Absolute Error (MedAE) and Root Median Square Error (RMdSE). A categorical accuracy analysis was conducted to determine the percentage of correctly predicted BCVA within 0.0, 0.1, 0.2, and 0.3 decimal units.
Results
A total of 16 eyes from 12 patients (6 male, 6 female) aged 56–85 was evaluated using the KATSIM device. Baseline preoperative visual acuity had a mean of 0.241±0.095. Predicted postoperative visual acuity had a median of 0.8 and an IQR of 0.025, while actual postoperative visual acuity had a median of 0.9 and an IQR of 0.025. Preoperative holographic visual acuity demonstrated high accuracy in predicting postoperative BCVA. Accuracy analysis showed 31.2% exact matches, 56.2% within 0.1 decimal, 93.7% within 0.2 decimal, and 100% within 0.3 decimal units of actual BCVA. The Median Absolute Error (MedAE) was 0.10, and the Root Median Square Error (RMdSE) was also 0.10, indicating that the typical prediction error was 0.10 decimal units.
Conclusions
The KATSIM holographic vision simulator demonstrated high accuracy in predicting postoperative visual acuity, providing a reliable preoperative assessment tool for cataract patients. With a MedAE of 0.10 and a RMdSE of 0.10, the typical prediction error was only 0.10 decimal units, confirming its clinical precision. The device accurately simulated postoperative vision in 93.7% of cases within 0.2 decimal units of actual BCVA, which can aid in managing patient expectations. Patients reported reduced anxiety, and surgeons found KATSIM helpful for preoperative discussions. These findings suggest that KATSIM could significantly improve cataract surgery planning, enhance patient satisfaction, and lead to better surgical outcomes.