Functional Outcomes After Visual Simulation In Refractive Cataract Surgery: A Patient-Reported Analysis

To evaluate the impact of preoperative visual simulation on intraocular lens (IOL) selection, postoperative visual acuity (VA), satisfaction and decision regret score. To assess the perceived clinical value of the simulation and exploring its relationship with patient-reported satisfaction and regret.

Single-center ambispective study conducted at Vista Gutiérrez Amorós, a private ophthalmology clinic in La Coruña, Spain.

This ambispective comparative study included 42 patients, identified retrospectively, undergoing cataract surgery or refractive lens exchange with premium IOLs (EDOF, trifocal and Mix&Match). A Simulation Group (SG; n=25), which underwent preoperative IOL visual simulation with SimVis Gekko2, and a Control Group (CG; n=17) without preoperative simulation were established. Patients in the CG prospectively completed 2 postoperative questionnaires evaluating patient satisfaction and decision regret. Patients in the SG also completed a value perception questionnaire about SimVis Gekko2. Non-parametric analyses and Spearman correlations were applied to compare outcomes between groups and evaluate correlations among patient-reported measures.

Preoperative VA was comparable between groups at distance (CG 0.02±0.03, SG 0.05±0.06; p=0.20) and near (CG 0.00±0.04, SG 0.01±0.03; p=0.867). Halos were reported in both groups (CG 28.6% vs SG 31.7%; p=0.656); however, functional limitation due to halos was observed only in the control group (57.1% vs 0% in SG; p=0.01). No significant differences were observed in total postoperative satisfaction (p=0.650) or total Decision Regret Scale scores (DRS; p=0.23). The perceived value of SG was high (mean total score 20.4 ± 3.3) and consistent across subjects. Higher SimVis ratings were associated with greater postoperative satisfaction (p = 0.07). Patient feedback was associated with adoption of Mix&Match strategies (SG 41.7% vs CG 0%; p=0.053).

Preoperative visual simulation did not significantly modify overall satisfaction (high in both groups) or regret (low in both groups) but was associated with a drastic reduction in the reported functional limitation from halos despite a similar probability of perceiving them, likely due to a better expectation management. The perceived value of the simulation was high and associated with a greater postoperative satisfaction. The possibility of retrieving the feedback of the patient on different lens combinations, and the confidence of the surgeon, enabled an increase in mix-and-match strategies.