Predictions of Through-Focus Performance of Presbyopia-Correcting Intraocular Lenses in Presbyopic Subjects Using a Visual Simulator.

Purpose: To validate whether visual simulations of multifocal intraocular lenses and extended depth of focus (EDOF) intraocular lenses (IOLs) in phakic presbyopes replicate postoperative vision, and to compare performance across these lenses in the same subject. Design: A cross-sectional study; evaluation of technology. Subjects: Twenty-three presbyopes with clear crystalline lenses were evaluated binocularly using SimVis Gekko visual simulator (2EyesVision). Methods: Six commercial multifocal and EDOF IOLs were simulated using the principle of temporal multiplexing: AcrySoft IQ PanOptix, FineVision POD F, AT Lisa tri, Tecnis Symfony, AcrySoft IQ Vivity, and AT Lara. Defocus visual acuity (DFVA) curves were measured for each simulated IOL under photopic conditions. Simulated IOLs were programmed from published through-focus modulation transfer function data at 15 cycles/degree. Defocus visual acuity curves through simulated IOLs were compared to average postoperative DFVA data from peer-reviewed publications (108-322 pseudophakic patients per IOL). Main Outcome Measures: Cross-correlation, root mean square error (RMSE), depth of focus (DOF), and relative visual benefit/degradation at far, intermediate, and near distances. Results: Simulated IOLs accurately reproduced on-bench optical profiles in terms of through-focus Visual Strehl Ratio (cross-correlation >0.98, RMSE <0.04). Defocus visual acuity curves through simulated IOLs closely matched postoperative curves in subjects implanted with the corresponding IOL (cross-correlation ≥0.94, RMSE ≤0.07), with far vision differences ≤0.09 logarithm of the minimum angle of resolution (logMAR). Discrepancies were largest at high near vergences (up to 0.17 logMAR). Trifocal IOLs (PanOptix, FineVision, AT Lisa) expanded DOF by ∼1.5 D compared with monofocal IOLs, while EDOF IOLs (Symfony, Vivity, AT Lara) expanded DOF by ∼0.7 D. Visual simulations replicated relative gains at intermediate/near and degradations at far, consistent with clinical outcomes in implanted patients. Intersubject variability observed in simulations mirrored that reported postoperatively. Conclusions: The SimVis Gekko visual simulator reproduces, in a simulated preimplantation context, the reported postoperative visual performance, both with multifocal and EDOF IOLs, capturing both group-level and subject-specific variability. The results suggest that this tool can provide patients with a representative preview of relative visual performance of different IOLs prior to surgery. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.