Journal of refractive surgery最新文献

{"title":"Viscoelastic-Assisted Patient Interface Docking: A Technical Optimization in LenSx Femtosecond Laser-Assisted Cataract Surgery.","authors":"Danmin Cao, Wenjing Luo, Juan Li, Tingting Peng, Huafang Guo, Anqi Xie, Ying Sun, Yong Wang","doi":"10.3928/1081597X-20260728-05","DOIUrl":"10.3928/1081597X-20260728-05","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of viscoelastic-assisted patient interface docking in LenSx (Alcon Laboratories, Inc) femtosecond laser-assisted cataract surgery (FLACS).</p><p><strong>Methods: </strong>This was a randomized controlled trial. Patients undergoing FLACS from January to August 2025 at Aier Eye Hospital of Wuhan University were randomized via a random number table to receive balanced salt solution (BSS) or visoeleastic as the patient interface docking medium. The primary outcome was docking efficiency, measured by one-time docking success rate, the number of docking attempts, and mean docking time. Secondary outcomes included surgical safety (subconjunctival hemorrhage, capsulotomy completeness/tear rate), laser treatment duration (anterior capsulotomy time, nucleus pretreatment time, total laser emission time), and patient comfort (post-laser pain sensation).</p><p><strong>Results: </strong>A total of 100 patients were enrolled, 50 in each group. Suction loss occurred in 7 patients (14%) in the BSS group and 1 patient (2%) in the viscoelastic group; the one-time docking success rate was significantly higher in the viscoelastic group (98%) than in the BSS group (86%) (chi-square = 3.93, <i>P</i> < .05). The viscoelastic group also had fewer mean docking attempts (1.02 ± 0.14) than the BSS group (1.16 ± 0.42), showing a significant difference (<i>t</i> = 2.23, <i>P</i> < .05). The viscoelastic group exhibited significantly shorter mean docking time (44.66 ± 4.47 seconds) compared to the BSS group (48.62 ± 3.11 seconds) (<i>t</i> = 2.17, <i>P</i> < .05). No significant differences were observed between the groups in subconjunctival hemorrhage, capsulotomy completeness/tear rate, anterior capsulotomy time, nucleus pretreatment time, total femtosecond laser emission time, or patient-reported pain sensation (all <i>P</i> > .05).</p><p><strong>Conclusions: </strong>Viscoelastic-assisted patient interface docking in FLACS effectively elevates one-time docking success rate, reduces docking attempts, and shortens docking time.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e954-e960"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920360","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":"Preoperative Versus Intraoperative Detection of Asymptomatic EBMD in LASIK/SMILE: Risk of Recurrent Corneal Erosion Requiring PTK, PTK Success, and Need for Repeat PTK.","authors":"Dan Z Reinstein, Timothy J Archer, Ruchi Gupta, Joseph G Potter","doi":"10.3928/1081597X-20260702-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260702-01","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the risk of recurrent corneal erosion syndrome requiring therapeutic treatment in eyes undergoing laser in situ keratomileusis/small incision lenticle extraction (LASIK/SMILE) with preoperatively diagnosed asymptomatic epithelial basement membrane dystrophy (EBMD) versus eyes in which EBMD was only detected intraoperatively.</p><p><strong>Methods: </strong>This was a retrospective analysis of 25,204 eyes that underwent femtosecond laser-assisted LASIK or SMILE at London Vision Clinic between February 2009 and March 2019. All eyes underwent preoperative slit-lamp examination with fluorescein screening for EBMD. Eyes with moderate or symptomatic EBMD were treated with primary photorefractive keratectomy (PRK) and excluded from the LASIK/SMILE epithelial safety analysis. Eyes with mild asymptomatic EBMD and no signs or history of recurrent corneal erosion were considered for LASIK/SMILE with additional informed consent. An epithelial stress test was performed at the clinician's discretion based on the severity and location of map-dot-fingerprint changes or other features suggestive of epithelial instability; marked epithelial displacement prompted triage to PRK. Eyes with no preoperative signs of EBMD that developed an intraoperative epithelial slide were classified as intraoperatively detected (subclinical) EBMD. The incidence of recurrent erosion syndrome requiring phototherapeutic keratectomy (PTK), the success rate of initial PTK, and the rate of repeat PTK between groups were compared.</p><p><strong>Results: </strong>EBMD was diagnosed preoperatively in 802 eyes (3.18%) that underwent LASIK/SMILE. Intraoperative epithelial slide occurred in 72 of these eyes (8.98%). Among eyes without preoperative EBMD (n = 24,377), 365 experienced intraoperative epithelial slide (1.50%) and were classified as intraoperatively detected EBMD. PTK for recurrent erosion was required in 12 eyes (1.50%) in the preoperatively diagnosed group and in 19 eyes (5.21%) in the intraoperative group. Repeat PTK was needed in 5 of 12 eyes (41.7%) in the preoperative EBMD group and 2 of 19 eyes (10.5%) in the intraoperative EBMD group.</p><p><strong>Conclusions: </strong>With modern femtosecond laser platforms and careful preoperative assessment, femtosecond laser-assisted LASIK and SMILE can be performed safely in eyes with preoperatively detected asymptomatic EBMD. Eyes with preoperatively identified mild asymptomatic EBMD had a lower risk of recurrent erosion syndrome requiring PTK compared with eyes in which EBMD was only detected intraoperatively. Although a small proportion of eyes required PTK, postoperative epithelial complications were infrequent and effectively managed.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e924-e932"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920453","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 Symptoms and Optic Clarity Disturbances Associated With Intraocular Lenses in U.S. Food and Drug Administration Device Reports.","authors":"Idan Hecht, Ruti Sella, Piotr Kanclerz, Raimo Tuuminen","doi":"10.3928/1081597X-20260701-01","DOIUrl":"10.3928/1081597X-20260701-01","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize postoperative visual symptoms and optic clarity issues across intraocular lens (IOL) types, reported in U.S. Food and Drug Administration (FDA) device reports.</p><p><strong>Methods: </strong>A retrospective observational analysis of FDA Manufacturer and User Facility Device Experience (MAUDE) reports on visual symptoms and/or IOL optic clarity issues, from January 1, 2016 through December 31, 2025. Structured MAUDE fields served as the primary data source, with report narratives analyzed using automated natural language processing to supplement classification.</p><p><strong>Results: </strong>A total of 17,204 postoperative MAUDE reports met inclusion criteria (16,198 with visual symptoms and 2,510 with clarity issues; both present in 1,504 reports). Multifocal and extended depth of focus (EDOF) IOLs showed a higher proportion reporting of visual symptoms than monofocal IOLs (97.5%, and 98.6% vs 85.5%, respectively, <i>P</i> < .001) and specifically glare (21.8% and 24.8% vs 8.6%, <i>P</i> < .001) and halos (29.7% and 30.1% vs 8.6%, <i>P</i> < .001). Clarity issues were reported more frequently in monofocal IOLs than in multifocal and EDOF IOLs (27.8% vs 11.0% and 8.8%, <i>P</i> < .001). Overall, clarity issues were reported later than visual symptoms (64.9 ± 72.6 vs 7.9 ± 20.9 months, <i>P</i> < .001), and visual symptoms more often required IOL exchange than clarity issues (62.9% vs 20.8%, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In MAUDE postoperative reports, multifocal and EDOF IOLs had a higher proportion of visual symptoms and specifically glare and halos, whereas monofocal IOLs had a higher proportion of later reported clarity issues. These findings reflect differences in reported events rather than population-level risk and may inform post-market surveillance priorities.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e968-e977"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920444","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":"Report Laser Fluence in Lenticule Extraction as a Dual-Plane, Raster-Dependent Quantity.","authors":"Ivan Gabrić, Dan Z Reinstein, David Sung Yong Kang, Andrea Russo, Sri Ganesh","doi":"10.3928/1081597X-20260811-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260811-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e985-e986"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920362","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":"Centration and Torsion Control Following Lenticule Creation With Keratorefractive Lenticule Extraction: Effect on Aberration and Astigmatism.","authors":"Ashton Z Lau, Jaycie Koh, Nicole M Sie, Ashraf Mahmoud, Yu-Chi Liu, Cynthia J Roberts, Jodhbir S Mehta","doi":"10.3928/1081597X-20260706-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260706-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of the post-docking centration and cyclotorsion control functions of the ELITA femtosecond laser system (Johnson & Johnson Vision) on visual, refractive, and optical zone outcomes following Smooth Incision Lenticular Keratomileusis (SILK; Johnson & Johnson Vision).</p><p><strong>Methods: </strong>This clinical study prospectively enrolled 59 eyes from 30 patients who underwent SILK at the Singapore National Eye Centre between May 2022 and May 2023. Surgeon decision determined whether eyes required post-docking manual centration or cyclotorsion adjustment. Functional optical zone (FOZ), decentration, astigmatism, and higher order aberrations were compared between the movement and no movement groups up to 12 months postoperatively.</p><p><strong>Results: </strong>Centration and cyclotorsion adjustments were required in 29 of 59 eyes (49.2%). Mean movement was 0.07 mm superior and 0.13 mm nasal, and mean cyclotorsion was 4.3° counterclockwise. Suction time showed a borderline significant association with adjustment (<i>P</i> = .050). At 12 months, postoperative spherical equivalent, astigmatism, higher order aberrations, and FOZ did not differ significantly between groups. Mean FOZ area was 27.67 ± 3.17 mm² (movement) and 28.56 ± 3.54 mm² (no movement) (<i>P</i> = .35). All eyes achieved an uncorrected distance visual acuity of 20/40 or better; 66% and 53% achieved 20/20 or better in the movement and no movement groups, respectively (<i>P</i> = .492). No intraoperative or postoperative complications occurred.</p><p><strong>Conclusions: </strong>Semi-automated centration and cyclotorsion control in SILK allows for precise alignment with comparative results to non-adjusted cases with respect to refractive, astigmatic, optical zone, or higher order aberration outcomes at 12 months.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e906-e915"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920152","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":"Characteristics of the Haptic Position and Its Impact on Vault After Horizontal or Vertical ICL Implantation.","authors":"Chiwen Cheng, Yichen Xiao, Ruoyan Wei, Rui Xiong, Lanhui Yu, Xiaoying Wang, Xingtao Zhou, Shengtao Liu","doi":"10.3928/1081597X-20260708-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260708-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the haptic positioning and its impact on postoperative vault after horizontal versus vertical Implantable Collamer Lens (ICL) implantation.</p><p><strong>Methods: </strong>Eighty eyes (80 patients) undergoing ICL V4c (STAAR Surgical) implantation were stratified into horizontal (n = 40) and vertical (n = 40) groups. Ultrasound biomicroscopy measured ciliary sulcus-to-sulcus, crystalline lens to ciliary sulcus-to-sulcus, central vault (C-Vault), peripheral vault, and categorized haptic positions relative to ciliary anatomy (supratemporal, inferotemporal, supranasal, inferonasal). Statistical analyses compared intergroup differences and associations between parameters.</p><p><strong>Results: </strong>Haptic distribution in the horizontal group varied by quadrant: 42.6% of haptics were in the ciliary sulcus (vs 40.8% vertical, <i>P</i> = .601), 29.4% of haptics were under the ciliary process (vs 23.7% vertical, <i>P</i> = .797), 21.8% of haptics were on the anterior angle of the ciliary process (vs 24.9% vertical, <i>P</i> = .302), and 6.1% of haptics were inserted into the ciliary process (vs 10.6% vertical, <i>P</i> = .023). The final tip of the ICL haptic negatively correlated with C-Vault in the horizontal (<i>P</i> = .009) and vertical (<i>P</i> = .049) groups, but showed no significant correlation with peripheral vault.</p><p><strong>Conclusions: </strong>No statistically significant differences in haptic distribution patterns were observed between the horizontal and vertical implantation groups, whereas haptic position demonstrated significant correlations with central vault.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e887-e894"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920159","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":"Comparative Accuracy of the Barrett Toric Calculator With or Without the Incorporation of Posterior Corneal Astigmatism and the Castrop Formula.","authors":"Fangyu Zhao, Yaning Li, Jiayi Shi, Fang Tian, Yuanfeng Jiang, Shaochong Bu","doi":"10.3928/1081597X-20260728-02","DOIUrl":"https://doi.org/10.3928/1081597X-20260728-02","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the predictive accuracy of the Barrett Toric IOL formula-when incorporating either Predicted or Measured posterior corneal astigmatism (PCA)-with the Castrop Toric formula.</p><p><strong>Methods: </strong>In this retrospective study, patients diagnosed as having age-related cataract who underwent phacoemulsification with the implantation of a monofocal non-toric IOL were reviewed. Four methods of calculating a toric IOL-the Castrop formula based on Predicted PCA (C-PPCA), the Castrop formula based on Measured PCA (C-MPCA), the Barrett Toric Calculator based on Predicted PCA (B-PPCA), and the Barrett Toric Calculator based on Measured PCA (B-MPCA)-were applied to calculate the predicted residual astigmatism and spherical equivalent (SE). The mean absolute astigmatic prediction error (MAPEastig), centroid of astigmatic prediction error (PE), proportion of eyes within the astigmatic prediction error of ±0.50, ±0.75, and ±1.00 diopters (D), and PE of SE were all calculated for the four methods.</p><p><strong>Results: </strong>One hundred eyes of 100 patients were reviewed. No significant differences were seen for MAPEastig (<i>P</i> = .379) or the centroid vectors of astigmatic PE among the four methods (<i>P</i> = .138), although the differences of the predictability rate within ±1.00 D were significant (<i>P</i> = .008). B-PPCA and B-MPCA yielded better clinical results, with 89% and 90% of eyes achieving an astigmatic PE of less than 1.00 D, compared to that of the Castrop Calculator (<i>P</i> = .006 and <i>P</i> = .002, respectively). For the 71 eyes with axial length of 22 to 26 mm and anterior corneal refractive power of 42.00 to 46.00 diopters, no significant differences in the PE of SE were seen between B-PPCA and B-MPCA (<i>P</i> = 1.000), or between C-PPCA and C-MPCA (<i>P</i> = .078). Further comparison showed that the PE of the SE of the Castrop Calculator was significantly greater than the Barrett Toric Calculator (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>The current study revealed comparable outcomes of the accuracy of cylindrical power calculation between the Barrett Toric and Castrop Calculators, both using Predicted and Measured PCA mode, although the Barrett Toric Calculator showed a lower PE than the Castrop Calculator in IOL spherical power calculation.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e961-e967"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920278","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":"Optical Character Recognition-based Biometry Scanner for Easy and Efficient Biometry Calculations.","authors":"Issac Levy, H Burkhard Dick, Arbel Israeli, Amit Schendel, Mayank A Nanavaty","doi":"10.3928/1081597X-20260701-02","DOIUrl":"https://doi.org/10.3928/1081597X-20260701-02","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the development and validation of an optical character recognition (OCR)-based mobile application (Biometry Scanner, Version 1.0; Ocumetric Innovations Ltd) designed to automate biometric data entry into the European Society of Cataract and Refractive Surgeons (ESCRS) intraocular lens (IOL) calculator, thereby reducing transcription errors and improving workflow efficiency in cataract surgery planning.</p><p><strong>Methods: </strong>A cross-platform mobile application integrating artificial intelligence-powered OCR technology (Google Gemini 2.5) was developed for iOS and Android. The app processes biometry printouts from any device, extracts numerical data, and automatically populates the ESCRS IOL calculator. Validation comprised two components: a user experience survey of 21 ophthalmologists using 5-point Likert scales after 4 weeks of clinical use, and a prospective time-and-motion study comparing manual versus app-based data entry across five biometry calculations performed by 10 ophthalmologists. Paired <i>t</i>-tests were used for statistical comparison.</p><p><strong>Results: </strong>Twelve ophthalmologists completed the survey, with 50% reporting more than 11 uses and 30% more than 21 uses. Mean Likert scores were 4.5 ± 0.67 for OCR accuracy, 4.5 ± 0.8 for ease of use, and 4.67 ± 0.65 for recommendation to colleagues. The time-motion analysis demonstrated significantly faster app-based entry (91.72 ± 5.59 seconds) than manual entry (179.42 ± 22.12 seconds), resulting in a 48.9% time reduction (<i>P</i> < .001). Time savings were consistent across all five biometry calculations (43.1% to 52.7% reduction).</p><p><strong>Conclusions: </strong>The Biometry Scanner provides a streamlined, accurate, and user-friendly solution for automating IOL power calculations. By eliminating manual transcription, it enhances accuracy, saves time, and promotes safer, more efficient preoperative cataract surgery planning.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e978-e984"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920369","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":"Anna.","authors":"Mareiras","doi":"10.3928/1081597X-20260730-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260730-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e867"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920068","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":"Association Between Pseudoaccommodation Measured With the Salzburg Reading Desk Versus the Reading Chart in Pseudophakic Patients.","authors":"Mayank A Nanavaty, Ritika Mukhija, Zahra Ashena, Catey Bunce, David J Spalton","doi":"10.3928/1081597X-20260714-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260714-01","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To assess the incidence and contributing factors of pseudoaccommodation in pseudophakic eyes implanted with aspherically neutral monofocal intraocular lenses (IOLs), comparing printed chart reading under standardized ambient illumination with assessment using the backlit Salzburg Reading Desk (SRD) (SRD Vision, LLC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prospective, non-randomized, single-eye cohort study of patients undergoing monofocal IOL implantation for cataract surgery. Uncorrected near visual acuity (UNVA) was measured at 1 and 3 to 9 months postoperatively using both the Precision Vision Chart (chart-based, 40 cm) and the SRD (screen-based, 40 cm). Chart-based assessment was performed first, followed by SRD-based assessment, in a consistent order. Both assessments were conducted in the same room under standardized ambient illumination (∼500 lux). Pseudoaccommodation was defined as simultaneous uncorrected distance visual acuity (UDVA) better than 20/40 (0.3 logarithm of the minimum angle of resolution [logMAR]) and UNVA 0.3 logMAR (J4). Binary logistic regression (backward and forward stepwise, with Firth-penalized regression as a sensitivity analysis) identified independent predictors. A worst-case attrition sensitivity analysis and a sensitivity analysis restricted to eyes within ±0.50 diopters (D) of emmetropia were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 412 patients recruited, 301 (73.1%) had complete data (27.0% were lost to follow-up due to the coronavirus disease 2019 pandemic). Pseudoaccommodation occurred in 21 patients (6.9%) with printed charts versus 29 patients (9.6%) with SRD; only 9 patients (3.0%) met criteria by both methods. In a worst-case attrition analysis, rates were 5.1% (chart) and 7.0% (SRD), preserving the directional difference. Multivariable analysis revealed total spherical aberration as the sole independent predictor of chart-based pseudoaccommodation (odds ratio [OR]: 3.3 × 10&lt;sup&gt;-6&lt;/sup&gt;, 95% CI: 0.00 to 0.08, &lt;i&gt;P&lt;/i&gt; = .02). For SRD-based pseudoaccommodation, independent predictors were lower (more myopic) spherical equivalent (OR: 0.49, 95% CI: 0.31 to 0.78, &lt;i&gt;P&lt;/i&gt; = .01), smaller mesopic pupil diameter (OR: 0.41, 95% CI: 0.24 to 0.72, &lt;i&gt;P&lt;/i&gt; &lt; .01), lower total spherical aberration (OR: 9.6 × 10&lt;sup&gt;-6&lt;/sup&gt;, 95% CI: 0.00 to 0.02, &lt;i&gt;P&lt;/i&gt; = .01), and shorter preoperative axial length (OR: 0.40, 95% CI: 0.22 to 0.73, &lt;i&gt;P&lt;/i&gt; &lt; .01). In a sensitivity analysis restricted to eyes within ±0.50 D of emmetropia (n = 218), spherical aberration and mesopic pupil size remained significant predictors, indicating their contribution is independent of residual refractive error.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pseudoaccommodation is multifactorial, with the assessment method and nature of the visual stimulus (self-luminous backlit screen versus reflective printed chart) significantly influencing its incidence and predictive factors. Spherical aberration was the sole","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 9","pages":"e942-e953"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920149","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}