Preoperative Binocular Visual Simulation Enables Personalized Intraocular Lens Selection Among Refractive Lens Exchange Patients

Purpose: To evaluate the impact of introducing binocular visual simulation, a decision-support tool for the prescription of IOLs considering the visual experience of the patient, in the clinical workflow of a private ophthalmology clinic.

The study aims to assess the impact on IOL confirmation or modification rate, distribution of prescribed IOLs types, visual performance, patient satisfaction, and chair time.

Clinique Jules Verne Nantes France

A retrospective analysis was conducted on 73 consecutive patients who underwent RLE following preoperative binocular visual simulation (SimVis Gekko). In 65% of patients, the surgeon proposed to use SimVis to confirm the perceptual acceptance of one IOL, while in 35% two or more potential IOL options were initially suggested. The final IOL prescribed after checking with SimVis the perceptual acceptance of different IOLs, between 1 and 4 per patient, was also recorded and analyzed. Finally, the feedback from the SimVis Gekko users about their experience (in all patients, cataract and RLE) was collected using a questionnaire specifically designed to assess the impact of SimVis in clinical consultation.

Simulations led to confirmation of the initial IOL recommended in 78% of the patients, and to the prescription of a better accepted lens in 22% of them. The final prescription distribution was 87% FRoF (3 different models) and 13% PRoF (10% Enhance/Extend, 3% Narrow). 4% were used in monovision or mix-and-match approaches. Postoperative uncorrected distance visual acuity was 0±0.1logMAR with a refractive error of 0.2±0.3D. In the survey, the users reported weekly use of SimVis, a higher number of surgeries, and a 100% increase in the number of FRoF lenses implanted, with a clear reduction in the number of unsatisfied patients. The highest value is perceived in demanding patients by managing expectations without increasing consultation time.

Preoperative simulation changed the initial recommendation, to provide a better accepted lens combination, in 22% of the RLE patients. In cases of preoperative decisional uncertainty, simulation facilitated definitive IOL selection through patient’s feedback, reducing postoperative dissatisfaction. Given the high visual demands and expectations of RLE patients, SimVis Gekko represents a valuable decision aid, supporting surgeon confidence and patient satisfaction, and contributing to more individualized surgical planning.