REAL-TIME DYNAMIC ABERROMETRY AND VSOTF AS PREDICTORS OF VISUAL FUNCTION: LSM VS. IOL COMPARATIVE OUTCOMES

To evaluate Laser Scleral Microporation (LSM), a biomechanical therapy for restoring visual function in presbyopia, and to compare outcomes with various presbyopia-correcting intraocular lenses (IOLs). Real-time dynamic wavefront aberrometry and Visual Strehl Optical Transfer Function (VSOTF) analysis were employed to quantify optical performance and assess whether these objective measures correlate with functional vision and patient satisfaction.

This retrospective clinical study was conducted at research centers specializing in refractive and presbyopia surgery, utilizing IOL data and LSM data collected from an IRB-registered pilot study in the Philippines, in accordance with the Declaration of Helsinki and the guidelines of Good Clinical Practice (GCP).

Fifty presbyopic subjects (15 male, 35 females; mean age 52.6 ± 4.0 years; mean add +2.00 ± 0.21 D) underwent bilateral LSM using an Er: YAG laser. Visual acuity was assessed using ETDRS LogMar charts at 40 cm, 60 cm, and 4 m pre- and postoperatively. Patient-reported outcomes were measured using the Near Activity Visual Questionnaire (NAVQ). A selection of case studies from the LSM therapy and various IOL’s  derived from Dynamic Shack–Hartmann wavefront aberrometry were quantified four visual quality components contributing to Dynamic Range of Focus (DRoF): objective accommodation (AoA), extended depth of focus (EDoF), pseudoaccommodation (DoF), and diaphragmatic pupil (pinhole) response. Both the Modulation Transfer Function (MTF) and the VSOTF were calculated from the wavefront data. DRoF, MTF, and VSOTF results were compared with those from monofocal, bifocal, trifocal, and EDoF IOLs.

LSM improved monocular DCIVA and DCNVA from 0.18 ± 0.16 and 0.48 ± 0.14 preoperatively to 0.10 ± 0.14 and 0.29 ± 0.15 at 24 months (significant for DCNVA; P < 0.001). Binocular DCNVA improved from 0.45 ± 0.10 to 0.27 ± 0.14 (P < 0.001) without reduction in distance vision. Add power decreased from +2.00 ± 0.21 D to +1.33 ± 0.41 D, and Rasch scores improved from 65.3 ± 13.7 to 39.8 ± 21.5 (p < 0.05). Sixty-two percent of patients reported improved computer vision and 73% easier phone use. Dynamic aberrometry showed an increase in DRoF from 1.11 D to 1.67 D and a 28% improvement in VSOTF, demonstrating enhanced optical quality and reduced higher-order aberrations. Real-time wavefront analysis with IOL correction in place provided a more accurate representation of functional visual quality and may support refined IOL selection.

Laser Scleral Microporation enhances near and intermediate visual function while preserving distance vision. Dynamic wavefront aberrometry and VSOTF analysis offer precise and objective predictors of optical performance that correlate with patient satisfaction. When applied to both LSM and IOL-based treatments, these dynamic measurements offer valuable insight into real-world visual quality and may inform personalized presbyopia management and IOL selection.