Predictive Modeling Of Presbyopia Progression And Personalized Laser Scleral Microporation (Lsm) Treatment Planning Using A Digital Twin Finite Element Model

To assess a novel predictive modeling framework for presbyopia progression using the Virtual Eye Simulation Analyzer (VESA)—a Digital Twin finite element platform capable of simulating age-related changes in central optical power (COP) and forecasting outcomes of Laser Scleral Microporation (LSM) through biomechanical analysis.

A combined experimental and computational investigation conducted as part of an IRB-registered pilot study in the Philippines and in parallel in silico. The study integrated patient-specific ocular biomechanics with optical modeling to support a precision-medicine approach for presbyopia management.

A representative 50-year-old presbyopic eye was modeled in VESA to establish baseline COP and simulate age-related accommodative decline. The framework combined finite element analysis of scleral biomechanics with optical ray-tracing to assess changes in COP and accommodative amplitude. Ten eyes from five patients were simulated to evaluate variability. The LSM procedure was modeled using 49 micropores at 85% scleral depth; outcomes at age 50 were compared with untreated projections at 55. An expanded 64-micropore pattern was also tested. Predicted COP values were validated against published age–accommodation data.

Baseline simulations estimated COP at 0.54 ± 0.1 D at age 50, declining to 0.37 ± 0.2 D by age 55 without intervention, reflecting progressive accommodative loss. LSM using 49 micropores increased COP to 0.59 ± 0.1 D (+9.3%), demonstrating improved accommodative function. By age 55, retained benefit ranged from 0% to 9% (best case) versus untreated progression. An enhanced 64-micropore pattern further increased COP to 0.64 ± 0.1 D, showing a significant additive biomechanical effect (p < 0.05). Across ten simulated eyes, postoperative COP predictions remained within ±10% of clinical reference values (mean absolute error 0.18 ± 0.05 D; p < 0.05), confirming strong accuracy, reproducibility, and support for individualized treatment planning.

VESA provides accurate predictions of presbyopic progression and LSM-induced biomechanical and optical changes. Serving as a digital twin of the aging eye, the platform enables patient-specific simulation, dose optimization, and personalized planning of presbyopia therapies. These results underscore the value of predictive modeling in enhancing clinical decision-making and improving long-term outcomes in scleral-based presbyopia treatment.