Journal of refractive surgery最新文献

{"title":"Stromal Lenticule Addition Keratoplasty (SLAK) for the Management of Severe Corneal Flattening After Corneal Cross-linking.","authors":"George D Kymionis, Vasileios A Tsagkogiannis, Dionysios G Vakalopoulos, Petros C Petrou","doi":"10.3928/1081597X-20260629-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260629-01","url":null,"abstract":"<p><strong>Purpose: </strong>To report the first case of stromal lenticule addition keratoplasty performed for the management of severe progressive corneal flattening following corneal cross-linking (CXL).</p><p><strong>Methods: </strong>A 63-year-old woman with keratoconus, previously treated with combined topography-guided photorefractive keratectomy and CXL (Athens protocol), presented with progressive corneal flattening and a hyperopic shift in the left eye. Corrected distance visual acuity (CDVA) was 20/50 with manifest refraction of +5.00 -1.50 × 123° and the mean keratometry was 36.20 diopters (D). Stromal lenticule addition keratoplasty was performed using a stromal lenticule obtained from a myopic small incision lenticule extraction treatment. A femtosecond laser was used to create an intrastromal pocket, and the lenticule was inserted and centered within the stromal interface.</p><p><strong>Results: </strong>Postoperatively, mean keratometry increased to 41.20 D and refraction improved to +0.50 -2.00 × 110°, with 20/40 CDVA. Corneal curvature remained stable at 12 months postoperatively.</p><p><strong>Conclusions: </strong>Stromal lenticule addition keratoplasty may represent a safe and effective minimally invasive surgical option for inhibiting the progressive corneal flattening, restoring corneal curvature and correcting the excessive hyperopia in cases of severe corneal flattening following CXL.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e852-e856"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-device Agreement of Device-Designated Chord Mu and Chord Alpha Measurements in Patients Undergoing Preoperative Cataract Evaluation.","authors":"Karanpreet S Multani, Anushka Raj, Liam D Redden, Jascha Wendelstein, Osamah Mian, Achim Langenbucher, Kamran M Riaz","doi":"10.3928/1081597X-20260622-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260622-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate inter-device agreement of device-designated chord mu and chord alpha measurements, defined as device-designated linear displacements between the Purkinje reflex and the pupil center (chord mu) or limbal center (chord alpha), by four common devices: IOLMaster 700 (Carl Zeiss Meditec AG), Lenstar 900 (Haag-Streit), iTrace (Tracey Technologies), and Pentacam (Oculus Optikgeräte GmbH).</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study of patients undergoing preoperative cataract evaluation at a tertiary academic center. Eyes with measurements from all four devices between 2020 and 2023 were included. Exclusion criteria included prior ocular trauma, surgery, or pathology affecting imaging. Chord mu and alpha were analyzed using bivariate methods, including centroid direction and inter-device comparisons. Biometry and corneal curvature were also analyzed.</p><p><strong>Results: </strong>A total of 110 eyes from 77 patients (mean age: 63 ± 11 years) were included. Across devices, mean chord mu values were approximately 0.35 ± 0.20 mm and mean chord alpha values were approximately 0.45 ± 0.23 mm, with substantial variability in both magnitude and orientation. Most pairwise inter-device comparisons demonstrated statistically significant differences for both chord mu and chord alpha. The IOLMaster 700 consistently demonstrated temporal centroid displacement and the widest directional dispersion, whereas other devices showed predominantly nasal centroid orientation. Left and right eyes demonstrated similar patterns but were analyzed separately.</p><p><strong>Conclusions: </strong>Clinically relevant inter-device differences in magnitude and orientation of chord mu and chord alpha were observed, with systematic centroid shifts and directional dispersion. These device-specific offsets indicate that such measurements are not interchangeable across platforms and should be interpreted in the context of the measuring device when applied to surgical planning.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e787-e796"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Chord Mu and Chord Alpha in Relation to Post-ICL Implantation Visual Quality.","authors":"Zhuotong Wu, Ziyi Guo, Zhongjun Tang, Linda Zheng, Xingtao Zhou, Shengtao Liu","doi":"10.3928/1081597X-20260422-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260422-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical influence patterns of pre-operative chord mu and chord alpha on optical quality after Implantable Collamer Lens (ICL) (Visian; STAAR Surgical) implantation, thereby providing evidence-based guidance for surgical planning.</p><p><strong>Methods: </strong>This study included 92 patients (181 eyes) who underwent ICL implantation. The OPD-Scan III system (Nidek) was employed for the preoperative assessment of both chord mu and chord alpha. Changes in higher order aberrations were analyzed 3 months postoperatively. Postoperative optical aberration patterns were assessed for their dependence on preoperative chord mu and chord alpha measurements.</p><p><strong>Results: </strong>The mean value of chord mu was 0.25 ± 0.13 mm, and the median chord alpha was 0.22 mm (interquartile range: 0.19 mm). Chord mu exhibited a relatively dispersed distribution, whereas chord alpha was primarily distributed along the horizontal axis. Notably, 1/chord alpha exhibited a significant linear positive correlation with axial length (<i>R</i>^<i>2</i> = 0.1739, <i>P</i> < .001), reflecting the non-linear decay of chord alpha with axial elongation. The relationship was characterized by a generalized estimating equation using Gamma distribution and inverse link function. At 3 months postoperatively, analysis revealed statistically significant elevation in vertical coma and oblique trefoil (<i>P</i> < .05), whereas other optical parameters including total higher order aberrations, primary coma, trefoil, spherical aberration, and horizontal coma remained stable (<i>P</i> > .05). Correlation analysis revealed no significant association between changes in higher order aberrations and preoperative chord mu or chord alpha (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Neither preoperative chord mu nor chord alpha significantly affects higher order aberrations after ICL implantation, suggesting that the procedure has a relatively high tolerance regarding chord mu and chord alpha selection.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e750-e758"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Outcomes of SmartSight (SCHWIND ATOS) Refractive Surgery in the Correction of Myopia and Myopic Astigmatism: A Systematic Review.","authors":"Nabila Arifaizha, Muhammad Wahyu Kuncoro Adji, Azzahra Virda Rachmani, Sophia Pujiastuti","doi":"10.3928/1081597X-20260609-01","DOIUrl":"10.3928/1081597X-20260609-01","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review visual outcomes, refractive predictability, astigmatic correction, and safety of SmartSight refractive surgery (SCHWIND eye-tech-solutions GmbH) for the correction of myopia and myopic astigmatism.</p><p><strong>Methods: </strong>A systematic search of six databases was conducted for studies published from 2020 onward. Peer-reviewed clinical studies reporting visual or refractive outcomes following SmartSight refractive surgery using the SCHWIND ATOS platform (SCHWIND eye-tech-solutions GmbH) were included. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Risk of bias was assessed using the Joanna Briggs Institute checklist for case series. Due to heterogeneity in study design and outcome reporting, a narrative synthesis was performed.</p><p><strong>Results: </strong>Six studies comprising 877 eyes were included, all observational case series. Postoperative uncorrected distance visual acuity (UDVA) outcomes were favorable, with 59% to 98% of eyes achieving UDVA of 20/20 or better than preoperative corrected distance visual acuity. Refractive predictability ranging from 40% (postoperative day 1) to 98% (3 months) of eyes within ±0.50 diopters (D) and 89% to 100% within ±1.00 D of the intended spherical equivalent correction. Astigmatic correction was favorable, with ⩾96% of eyes achieving residual postoperative cylinder ⩽1.00 D from pre-operative mean cylinder ranging from 0.46 to 1.30 D across studies. Loss of two or more lines of corrected distance visual acuity was uncommon, and reported complications were predominantly mild and transient, occurring both intraoperatively (opaque bubble layer, suction loss) and postoperatively (epithelial defects, incision-related issues).</p><p><strong>Conclusions: </strong>SmartSight refractive surgery demonstrates favorable visual and refractive outcomes with an acceptable safety profile. However, current evidence remains early, derived mainly from case series with limited follow-up, potential conflicts of interest, and no randomized controlled trials. Further prospective and comparative studies are required to confirm long-term outcomes.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e857-e866"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Quality of Vision in a Prospective Trial of Wavefront-Guided LASIK and PRK Performed by Corneal Fellows in Training.","authors":"Megan E Chung, Edward E Manche","doi":"10.3928/1081597X-20260508-01","DOIUrl":"10.3928/1081597X-20260508-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate patient-reported outcomes following wavefront-guided laser in situ keratomileusis (WGF-LASIK) and photorefractive keratectomy (WFG-PRK) performed by corneal fellows in training.</p><p><strong>Methods: </strong>In this prospective, nonrandomized clinical trial, 66 eyes of 33 patients underwent WFG-LASIK and 71 eyes of 36 patients underwent WFG-PRK at one institution. Main outcomes included results from the Patient-Reported Outcomes with LASIK (PROWL) questionnaire at the postoperative 3-month visit.</p><p><strong>Results: </strong>At 3 months postoperatively, self-reported worry related to vision (LASIK, <i>P</i> < .001; PRK, <i>P</i> < .001), work productivity (<i>P</i> < .001 for both), and ability to perform activities (LASIK, <i>P</i> = .03; PRK, <i>P</i> < .001) significantly improved after surgery. The prevalence of double images, glare, halos, and starbursts decreased from 65% preoperatively to 56% in the LASIK group and from 74% preoperatively to 34% in the PRK group. Only 5% and 4% of participants reported \"very\" or \"extremely bothersome visual symptoms in the LASIK and PRK groups, respectively, and no patients reported significant difficulty performing activities due to double images, glare, halos, or starbursts. Dry eye symptoms per Ocular Surface Disease Index score were similar preoperatively and at month 3 in both the LASIK and PRK groups. A total of 88.2% and 96.0% of participants were satisfied with their visual outcome after LASIK or PRK, respectively.</p><p><strong>Conclusions: </strong>WFG-LASIK or WFG-PRK performed by corneal fellows in training yielded marked improvements in the presence and severity of most visual symptoms. Vision-related quality of life metrics significantly improved, and overall satisfaction in this study was high.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e770-e779"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Visual Outcomes After Implantation of Refractive Segmental Multifocal Rotational Asymmetric Intraocular Lens.","authors":"Thomas Kohnen, Jakob Wend, Zubeida H Omerovic, Klemens Paul Kaiser, Petra Davidova, Annika Klinkenbusch, Eva Hemkeppler, Marvin Lucas Biller, Myriam Susanne Böhm","doi":"10.3928/1081597X-20260621-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260621-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate visual outcomes with particular attention to visual acuity of a segmental refractive multifocal intraocular lens, the ACUNEX VarioMax (Teleon Surgical).</p><p><strong>Methods: </strong>This prospective, non-randomized, non-comparative study was conducted at the Department of Ophthalmology, University Hospital, Goethe University, Frankfurt, Germany. Thirty-four eyes (17 patients) were included. Inclusion criteria were bilateral cataract, age older than 30 years, and predicted corneal astigmatism ≤0.75 diopters (D) postoperatively. Exclusion criteria were prior ocular surgeries, amblyopia, or potential postoperative corrected distance visual acuity worse than 0.3 logarithm of the minimum angle of resolution (logMAR). Uncorrected visual acuities for distance, intermediate, and near and distance-corrected visual acuities at 4 m, 80 cm and 40 cm, contrast sensitivity, defocus curve, and questionnaires on optical quality, quality of life, and spectacle independence were assessed after 3 months.</p><p><strong>Results: </strong>The mean monocular uncorrected distance visual acuity was 0.02 ± 0.09 logMAR at 4 m, uncorrected intermediate visual acuity was 0.15 ± 0.12 logMAR at 80 cm and uncorrected near visual acuity was 0.24 ± 0.10 logMAR at 40 cm. Defocus curve testing showed a distance-corrected binocular visual acuity range between 0.00 and -2.50 D (from -0.06 to 0.12 logMAR). Median contrast sensitivity under photopic and mesopic conditions was 1.48 ± 0.18 and 1.25 ± 0.29 logCS, respectively.</p><p><strong>Conclusions: </strong>This segmental multifocal intraocular lens provides good visual acuity at all distances, particularly providing good intermediate visual acuity and depth of focus. It showed good contrast sensitivity and high spectacle independence with a high degree of patient satisfaction.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e780-e786"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Riboflavin for Sunlight-Induced Corneal Cross-linking: Efficacy Assessment in a Rabbit Model In Vivo Using Extensometry and OCT Elastography.","authors":"Emilio A Torres-Netto, M Enes Aydemir, Nan-Ji Lu, Sabine Kling, Nikki Hafezi, Mark Hillen, Michalina L Depczynska, Farhad Hafezi","doi":"10.3928/1081597X-20260622-02","DOIUrl":"https://doi.org/10.3928/1081597X-20260622-02","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether a non-invasive approach to treat keratoconus with corneal cross-linking (CXL) using oral riboflavin and natural sunlight could represent a cost-effective alternative.</p><p><strong>Methods: </strong>In a prospective, controlled study, 16 male New Zealand White rabbits (32 eyes) underwent a two-step protocol. Step 1 quantified stromal riboflavin in 4 rabbits (8 eyes) after 14 days of oral riboflavin (6 mg/kg/day). Step 2 randomized the remaining 12 rabbits (24 eyes) 1:1 to oral riboflavin plus natural sunlight or sunlight alone. After a 2,700 klux·h cumulative sunlight dose, corneal biomechanics were assessed by optical coherence tomography elastography and uniaxial stress-strain extensometry.</p><p><strong>Results: </strong>The mean stromal riboflavin concentration after oral administration was 0.000081% ± 0.000011%. Stress-strain testing showed no significant differences in stress at 0.1 strain (152 ± 11.5 kPa in controls vs 146 ± 7.0 kPa in treated eyes; <i>P</i> = .57) or mean elastic modulus between 0.1 and 0.2 strain (4.1 vs 4.0 MPa; <i>P</i> = .870). OCT elastography demonstrated significantly higher posterior corneal strain in treated eyes (0.551‰ vs 0.398‰; <i>P</i> = .039), consistent with reduced apparent stiffness.</p><p><strong>Conclusions: </strong>Oral riboflavin combined with ambient sunlight did not induce corneal stiffening under the tested conditions. Stromal riboflavin levels were nearly 500-fold lower than those achieved with standard CXL, indicating the tested approach is unlikely to serve as an effective standalone cross-linking strategy. The observed posterior corneal stiffness reduction may reflect ultraviolet-A-induced stromal degradation or subthreshold photochemical effects rather than true cross-linking.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e797-e803"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Winged Glance.","authors":"Manuel Brotons Mollá","doi":"10.3928/1081597X-20260721-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260721-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e749"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual and Refractive Outcomes Across Low, Medium, and Large Cyclorotation Angles in Myopic LASIK With Automated Cyclorotation Compensation.","authors":"Dror Ben Ephraim Noyman, Margarita Safir, Adir Sommer, Waseem Nasser, Tzahi Sela, Gur Munzer, Igor Kaiserman, Michael Mimouni","doi":"10.3928/1081597X-20260608-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260608-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate visual and refractive outcomes across different cyclorotation magnitudes in myopic laser in situ keratomileusis (LASIK) using automated cyclorotation compensation.</p><p><strong>Methods: </strong>This retrospective comparative study included consecutive patients who underwent myopic LASIK between 2012 and 2023. Patients were divided into three groups according to their cyclorotation angle magnitude. A comparison of baseline and intraoperative parameters was performed. Refractive and visual outcomes were assessed, including efficacy and safety indices, and an Alpins vector analysis was performed. Multiple linear regression was used to identify the effect of potential confounders.</p><p><strong>Results: </strong>Overall, 6,920 eyes of 4,454 patients were included. The mean age was 30.7 ± 8.7 years and 47.7% (2,130) were women. Analysis indicated significant differences in corrected distance visual acuity between the groups, but post-hoc analysis revealed no significant pairwise differences. Other visual and refractive outcomes including the calculated indices showed no significant differences. Alpins vector analysis showed no significant differences between the groups in any of the vectors in either magnitude or direction, nor were there significant differences in the calculated indicators. Multiple linear regression suggested age, maximum ablation depth, rotation direction, preoperative axis, and treated axis had confounding effects mostly on Alpins vectors. However, no significant effect was noted for outcomes that showed significant differences.</p><p><strong>Conclusions: </strong>Cyclorotational angle magnitude did not significantly impact visual or refractive outcomes in myopic LASIK when using modern laser devices. These findings suggest limited clinical relevance of cyclorotation degrees in LASIK outcomes, with other factors potentially playing a more significant role in surgical planning.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e832-e840"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-Plane Shack-Hartmann Wavefront Sensing in a Computer Eye Model Implanted With Rotationally Asymmetric Bifocal Intraocular Lenses.","authors":"Suman Sangiri, Vyas Akondi","doi":"10.3928/1081597X-20260511-03","DOIUrl":"https://doi.org/10.3928/1081597X-20260511-03","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate wavefront aberrations in eyes implanted with rotationally asymmetric refractive bifocal intraocular lenses (IOLs) using a modified Shack-Hartmann wavefront sensor (SHWS) designed to mitigate artifactual coma.</p><p><strong>Methods: </strong>In this simulation study, postoperative optical quality was evaluated using wavefront analysis in the presence of various ocular aberrations. A bifocal phase map (3.00 diopter [D] near addition, 50% energy distribution) was introduced in a computer eye model (5-mm pupil; 850-nm light source). The emerging wavefront displaced the simulated SHWS lenslet images from their reference positions. Wavefronts were evaluated using: (1) the standard integration method, considering lenslet images across the entire circular pupil, and (2) the proposed method, which captures SHWS data at near and far foci and combines in-focus lenslet images from the corresponding zones of the bifocal IOL. The interaction between the pupillary phase and induced wavefront aberrations (0.25 µm amplitude) was further analyzed using both methods.</p><p><strong>Results: </strong>In the absence of ocular aberrations, standard integration detects a substantial artifactual primary vertical coma with a wavefront root mean square (RMS) of 0.57 µm. In contrast, the proposed method reduced the residual RMS to 0.01 µm. In the presence of aberrations up to the fourth order, the proposed method achieved a mean residual RMS of 35 nm, enabling diffraction-limited wavefront sensing.</p><p><strong>Conclusions: </strong>The proposed SHWS integration method overcomes the phase asymmetry of segmented bifocal IOLs. By providing precise postoperative wavefronts and through-focus visual quality metrics, this approach offers a robust tool for clinical evaluation of patients implanted with these IOLs.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e759-e769"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}