ESCRS - FP06.10 - Accuracy And Predictability Of A Virtual Postoperative Simulation Algorithm (Foresight) In Corneal Wavefront-Guided Transepithelial Prk For Keratoconus

Accuracy And Predictability Of A Virtual Postoperative Simulation Algorithm (Foresight) In Corneal Wavefront-Guided Transepithelial Prk For Keratoconus

Published 2026 - 44th Congress of the ESCRS

Reference: FP06.10 | Type: Free paper | DOI: 10.82333/xf39-mw97

Authors: Dr Maria A. Henriquez* 1 , Dr Paola Padilla-Torrico 1 , Mr Rolando Rojas 1 , Mr Jose Chauca 2 , Dr Luis Izquierdo Jr. 3

1Research department,Oftalmosalud Institute of Eyes,Lima,Peru, 2Research department,Oftalmosalud Institute of Eyes,Lima,Peru;Department of Statistics, Demography, Humanities and Social Sciences,Universidad Peruana Cayetano Heredia,Lima,Peru, 3Research department,Oftalmosalud Institute of Eyes,Lima,Peru;San Fernando School of Medicine ,Universidad Nacional Mayor de San Marcos, Lima, Peru,Lima,Peru

Purpose

To evaluate the accuracy and predictability of a virtual postoperative corneal simulation algorithm (Foresight) in keratoconus (KC) eyes undergoing corneal wavefront-guided (CWG) transepithelial photorefractive keratectomy (trans-PRK).

Setting

Research Department at Oftalmosalud, Instituto de Ojos, Lima, Peru.

Methods

This prospective, consecutive case-series included 26 KC eyes evaluated between November 2024 and October 2025, performed in Lima, Peru. Preoperative parameters—including steep keratometry (Ks), central stromal thickness (CST), corneal astigmatism (Astg), and high-order aberrations (HOAs)—were processed using the Foresight algorithm (Schwind Amaris). The software calculated the required ablation profile and depth based on the correction of HOAs and/or low-order aberrations (LOAs) to predict postoperative outcomes. Accuracy was determined by comparing these predicted values against actual clinical outcomes at 1 month postoperatively.

Results

Mean predicted vs. actual postoperative values were: Astig: 3.24 ± 1.57 vs. 3.94 ± 1.98 (p=0.0004); Ks: 46.31 ± 2.80 vs. 46.91 ± 3.48 (p=0.07); CST: 409.22 ± 35.99 vs. 359.67 ± 44.64 (p<.001); HOA: 0.83 ± 0.39 vs. 1.15 ± 0.61 (p=0.0002); coma aberrations: 0.37 ± 0.28 vs. -0.48 ± 0.74 (p=0.003).  A moderate to strong positive correlation was observed between simulated and actual postoperative data across all primary variables: Astig (r=0.87, p<.001), Ks (r=0.90, p<.001), CST (r=0.80, p<0.001), coma (r=67, p=0.001).

Conclusions

The virtual simulation algorithm Foresight demonstrated excellent predictability for topographic and aberrometric outcomes in KC eyes undergoing CWG trans-PRK. This technology shows promise for enhancing surgical planning in complex corneal cases.