Impact of preoperative see-through visual simulation in cataract surgery of presbyopia-correcting intraocular lenses.

Purpose: To assess the real-life impact of preoperative visual simulations with SimVis Gekko (SVG) on predicting postoperative visual performance in patients undergoing bilateral cataract surgery with trifocal or extended depth of focus (EDOF) intraocular lenses (IOL).

Setting: Centro Hospitalar Universitário de Coimbra, Portugal.

Design: Single-center prospective observational cohort study.

Methods: We included patients aged between 40 and 69 years with mild to moderate cataract and distance corrected visual acuity > 20/50, with indication to underwent cataract surgery with EDOF/trifocal IOL implantation. A trifocal, an EDOF and a monofocal IOL were simulated for each patient preoperatively. Distance, intermediate and near visual acuity (VA), subjective visual performance score (VSco) (from 0 to 10) and stereopsis were measured pre- and postoperatively.

Results: A total of 51 patients were tested and 44 (n=44) were included. The mean age of included patients was 56.0 (± 7.9) years, 26 patients received the trifocal IOL and 18 the EDOF IOL. The shape of the VA curve was comparable between preoperative simulation and the achieved postoperative VA for both IOLs; stereopsis was similar with and without simulation; VSco improved at the postoperative for both IOLs and was higher for trifocal group. Ninety-two-point-two percent of patients found the simulation very useful for choosing between IOLs.

Conclusion: SVG showed a good ability to simulate EDOF/trifocal IOLs in terms of the shape of the VA curve, stereopsis and VSco. This instrument appears to be very useful for the patient's decision-making process and may reduce dissatisfaction after surgery.