When Digital Training Enhances Neuroadaptation

A new wave of visual simulators is proving useful in helping understand neuroadaptation in the real world of IOL performance, training, and pre- and postoperative visual function, according to Susana Marcos PhD.

Neural adaptation is a very rapid process that occurs over seconds to minutes and can be observed through after-effects of colour, blur, facial expressions, or orientation, reflecting the brain’s effort to maintain perceptual constancy. For instance, exposure to certain visual patterns can temporarily alter how subsequent images are perceived, she explained.

“This is something that can be demonstrated with the simulated images, but this is also something that happens with a standard astigmatic correction,” Professor Marcos said.

Astigmatic correction can lead to a shift in perception, making neutral images appear blurred along the astigmatic axis. A study demonstrated that patients with astigmatism who were tested before and after wearing corrective lenses showed rapid adaptation to neutral perception.¹ However, these rapid changes in perception do not necessarily reflect immediate improvements in visual function, as measured by visual acuity over six months. In fact, individuals may have a long-term bias toward their original visual condition, she noted.

Innovation makes it possible to simulate presbyopic correction through adaptive optic systems or temporal multiplexing-based simulators, such as the SimVis Gekko (2EyesVision), allowing patients to experience real-world vision with different lens corrections, she explained.² The SimVis Gekko is wearable, wireless, programmable, and has a wide field of view, making it a realistic representation of different lens designs.

A recent paper published in Ophthalmology Science showed the system accurately simulates postoperative vision with real IOLs, comparing preoperative and postoperative visual acuity.³ Also, the system can simulate halos produced by different lens designs and assess how patients are able to adapt to these simulated corrections. Neuroadaptation to presbyopic corrections can be measured, as a study shown by Prof Marcos demonstrated.⁴ However, careful testing methods, such as smooth transitions between images, are needed to avoid bias from adaptation to a previous image blur or sharpness.

Over weeks to months, changes in vision are better explained by perceptual learning rather than neuroadaptation, which involves specific improvements in visual tasks through training and experience. This can lead to permanent improvements in tasks such as hyperacuity, orientation discrimination, and contrast sensitivity. The underlying mechanism is the plasticity of the visual cortex, which happens even in adults, along with changes in receptive visual fields.

Studies show targeted visual training can enhance acuity, even in adults with conditions like amblyopia or in patients with multifocal lenses.⁵ Visual simulators can be combined with perceptual learning to enhance vision training. A new generation of binocular see-through simulators with advanced features such as convergence control, spatial lens representation, dynamic aberrometry, and accommodation tracking enable viewing of the real world in a realistic environment, as will future applications.

“Visual simulators may expand to include detailed training for myopia control, early presbyopia correction, and also in multifocal or EDOF intraocular lenses for presbyopia,” Prof Marcos concluded.

Prof Marcos spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Susana Marcos PhD is Director of the Center for Visual Science at the University of Rochester, New York, US. smarcos2@ur.rochester.edu

1. Vinas M, et al. PLoS One, 2012; 7(9): e46361. doi:10.1371/ journal.pone.004361

2. Marcos S, et al. Biomed Opt Express, 2025 Feb 13; 16(3): 1025–1042.

3. Papadogiannis P, et al. Ophthalmology Science, 2026; 6. doi:10.1016/j.xops.2026.101140

4. Radhakrishnan A, et al. PLoS One, 2014; 9(3): e93089. doi:10.1371/journal.pone.0093089

5. Polat U, et al. Proc Natl Acad Sci USA, 2004 Apr 27; 101(17): 6692–6697. doi:10.1073/pnas.0401200101; Kaymak H, et al. J Refract Surg, 2008: 24(3): 287–293. doi:10.328/1081597X-20080301-11