Simulated vs. real visual performance of an EDOF intraocular lens using adaptive optics technology.

PURPOSE: To evaluate the predictive accuracy of an adaptive optics visual simulator (SimVis Gekko™) in replicating the optical performance of a nondiffractive extended depth-of-focus (EDOF) intraocular lens (IOL), AcrySof® IQ Vivity™ (Alcon, Fort Worth, USA), prior to cataract surgery. METHODS: Prospective, single-center, observational, comparative study. A total of 16 eyes from 16 patients with early-stage cataract underwent simulation of the AcrySof® IQ Vivity™ IOL using the SimVis Gekko™ device prior to phacoemulsification. Postoperative outcomes were assessed 1 month after bilateral implantation of the IOL. Monocular defocus curves, visual acuity (VA) at far, intermediate and near distances, and contrast sensitivity were compared between the simulated and actual postoperative results. Correlation between VA and pupil size was analyzed. RESULTS: The simulated defocus curve closely matched the postoperative performance, with VA differences of less than one line for vergences between − 1.50 D and + 1.00 D. The only point with more than 1 line of difference occurred at − 3.00 D. Simulated contrast sensitivity was slightly lower than postoperative values but followed a similar trend across spatial frequencies. Distance and intermediate visual acuity were significantly better postoperatively than under simulation, while near VA showed no significant differences. A significant Pearson correlation was found between pupil size and near visual acuity. CONCLUSION: The SimVis Gekko™ device demonstrated high accuracy in simulating the visual outcomes of the AcrySof® IQ Vivity™ IOL, suggesting it may be a valuable tool for preoperative patient counseling and personalized lens selection in clinical practice.