To evaluate whether multifocal contact lenses (CLs) can serve as preoperative simulators of postoperative vision with enhanced monofocal and extended depth of focus (EDOF) intraocular lenses (IOLs), using the SimVis Gekko™ adaptive-optics visual simulator.

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 (IOLs). Setting: Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal. Design: Single-center prospective observational cohort study. Methods: Patients aged between 40 and 69 years with mild to moderate cataract and corrected distance visual acuity (VA) of >20/50, with indication to undergo bilateral cataract surgery with EDOF/trifocal IOL implantation, were included. A trifocal, an EDOF, and a monofocal IOL were simulated for each patient preoperatively. Distance, intermediate, and near VA; subjective visual performance score (VSco) (from 0 to 10); and stereopsis were measured preoperatively and postoperatively. Results: 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 the trifocal group. 92.2% of patients found the simulation very useful for choosing between IOLs. Conclusions: SVG showed a good ability to simulate EDOF/trifocal IOLs in the shape of the VA curve, stereopsis, and VSco. This instrument seemed to be very useful for the patient's decision-making process and may reduce dissatisfaction after surgery.

To evaluate the feasibility of implementing fitting guides for multifocal contact lenses (MCLs) using the SimVis Gekko visual simulator and, through a preliminary assessment with a novel metric (3D-VA, which integrates visual acuity at multiple distances and patient visual needs), determine whether this combined approach can optimise initial MCL selection.