Vinas, M. | 2EyesVision

Multifocal contact lens vision simulated with a clinical binocular simulator (2022)

Barcala, X. — Tue, 06 Dec 2022 15:19:14 +0000

Citation

Barcala, X., Vinas, M., Ruiz, S., Hidalgo, F., Nankivil, D., Karkkainen, T., Gambra, E., Dorronsoro, D., & Marcos, S.; Multifocal contact lens vision simulated with a clinical binocular simulator. Contact Lens and Anterior Eye 2022, 45(6):101716. For more information, click here.

Abstract

Purpose

The purpose of this study is to compare the binocular visual perception of participants wearing multifocal contact lenses and these same lens designs viewed through a temporal multiplexing visual simulator.

Methods

Visual performance and perceived visual quality at various distances were obtained in 37 participants wearing soft M−CLs and through the SimVis Gekko programmed with the same lenses. In a pilot study (n = 10) visual performance was measured in terms of LogMAR visual acuity (VA) at far (4 m), intermediate (64 cm) and near (40 cm) distances and through-focus VA (TFVA) curves with the simulated M−CLs. In the follow-up study (n = 27), LogMAR VA at far, intermediate and near distances were measured both with the actual and simulated M−CLs. Perceived visual quality was measured in both studies using the Multifocal Acceptance Score (MAS-2EV), and a Participants Reported Outcomes Vision questionnaire. Differences between the metrics obtained with simulated and actual lenses were obtained.

Results

Both actual and simulated M−CLs increased depth-of-focus by a similar amount. Mean LogMAR VA differences with actual and simulated M−CLs ranged between 4 and 6 letters (0.08 ± 0.01, 0.12 ± 0.01 and 0.10 ± 0.01, for far, intermediate and near distances, respectively). MAS-2EV average score differences with actual and simulated M−CLs ranged between −1.00 and + 4.25. Average MAS-2EV scores were not correlated significantly with VA. However, MAS-2EV (average and individual scores) were highly correlated to visual quality questionnaire responses (p < 0.005).

Conclusions

A simultaneous vision simulator accurately represented vision with M−CLs both VA at various distances and perceived visual quality, as measured in a clinical setting. The MAS-2EV metric accurately captured participant reported outcomes of standard vision questionnaires. The combination of SimVis Gekko and MAS-2EV has the potential to largely reduce chair time in M−CLs fitting.

Optical and visual quality of real intraocular lenses physically projected on the patient’s eye (2021)

Benedí-García, C. — Fri, 17 Sep 2021 09:19:21 +0000

Citation

Benedi-Garcia, C., Vinas, M., Lago, C. M., Aissati S., De Castro, A., Dorronsoro, C, and Marcos, S.; Optical and visual quality of real intraocular lenses physically projected on the patient’s eye. Biomed. Opt. Express 12, 6360-6374 (2021). For more information, click here.

Abstract

Visual simulators aim at evaluating vision with ophthalmic corrections prior to prescription or implantation of intraocular lenses (IOLs) in the patient’s eye. In the present study, we present the design, implementation, and validation of a new IOL-in-cuvette channel in an Adaptive Optics visual simulator, which provides an alternative channel for pre-operative simulation of vision with IOLs. The IOL is projected on the pupil’s plane of the subject by using a Rassow system. A second lens, the Rassow lens, compensates for an IOL of 20 D while other powers can be corrected with a Badal system within a 5 D range. The new channel was evaluated by through-focus (TF) optical quality in an artificial eye on bench, and by TF visual acuity in patients, with various IOL designs (monofocal, diffractive trifocal, and refractive extended depth of focus).

Simulating Outcomes of Cataract Surgery: Important Advances in Ophthalmology (2021)

Marcos, S — Tue, 13 Apr 2021 09:26:45 +0000

Citation

Marcos, S., Martinez-Enriquez, E., Vinas, M., de Castro, A., Dorronsoro, C., Pil Bang, S., Yoon, G., Artal, P.; Simulating Outcomes of Cataract Surgery: Important Advances in Ophthalmology. Annual Review of Biomedical Engineering 2021 23:1, 277-306. For more information, click here.

Abstract

As the human eye ages, the crystalline lens stiffens (presbyopia) and opacifies (cataract), requiring its replacement with an artificial lens [intraocular lens (IOL)]. Cataract surgery is the most frequently performed surgical procedure in the world. The increase in IOL designs has not been paralleled in practice by a sophistication in IOL selection methods, which rely on limited anatomical measurements of the eye and the surgeon’s interpretation of the patient’s needs and expectations. We propose that the future of IOL selection will be guided by 3D quantitative imaging of the crystalline lens to map lens opacities, anticipate IOL position, and develop fully customized eye models for ray-tracing-based IOL selection. Conversely, visual simulators (in which IOL designs are programmed in active elements) allow patients to experience prospective vision before surgery and to make more informed decisions about which IOL to choose. Quantitative imaging and optical and visual simulations of postsurgery outcomes will allow optimal treatments to be selected for a patient undergoing modern cataract surgery.

Keywords

intraocular lens; cataract surgery; anterior segment imaging; optical coherence tomography; visual simulation; adaptive optics

Multifocal acceptance score to evaluate vision: MAS-2EV (2021)

Barcala, X. — Wed, 13 Jan 2021 10:30:21 +0000

Citation

Barcala X., Vinas, M., Romero, M., Gambra, E., Mendez-Gonzalez, L., Marcos, S. & Dorronsoro C.; Multifocal acceptance score to evaluate vision: MAS-2EV. Sci Rep 11, 1397 (2021). For more information, click here.

Abstract

We present a new metric (Multifocal Acceptance Score, MAS-2EV) to evaluate vision with presbyopic corrections. The MAS-2EV is based on a set of images representing natural visual scenes at day and night conditions projected in far and near displays, and a near stereo target. Subjects view and score the images through different binocular corrections (monofocal corrections at far; bifocal corrections; monovision and modified monovision) administered with soft contact lenses (in cyclopleged young subjects) or with a binocular simultaneous vision simulator (in presbyopic and cyclopleged young subjects). MAS-2EV scores are visually represented in the form of polygons, and quantified using different metrics: overall visual quality, visual degradation at far, visual benefit at near, near stereo benefit, visual imbalance near-far, overall visual imbalance and a combined overall performance metric. We have found that the MAS-2EV has sufficient repeatability and sensitivity to allow differentiation across corrections with only two repetitions, and the duration of the psychophysical task (3 min for subject/condition/correction) makes it useable in the clinic. We found that in most subjects binocular bifocal corrections produce the lowest visual imbalance, and the highest near stereo benefit. 46.67% of the subjects ranked binocular bifocal corrections first, and 46.67% of the subjects ranked monovision first. MAS-2EV, particularly in combination with visual simulators, can be applied to select prospective presbyopic corrections in patients prior to contact lens fitting or intraocular lens implantation.

Optical and Visual Quality With Physical and Visually Simulated Presbyopic Multifocal Contact Lenses (2020)

Vinas, M. — Thu, 10 Sep 2020 14:28:21 +0000

Citation

Vinas M, Aissati S, Gonzalez-Ramos A, Romero M, Sawides L, Akondi V, Gambra E, Dorronsoro C, Karkkainen T, Nankivil D, Marcos M; Optical and Visual Quality With Physical and Visually Simulated Presbyopic Multifocal Contact Lenses. Trans. Vis. Sci. Tech. 2020;9(10):20. For more information, click here.

Abstract

Purpose

As multifocal contact lenses (MCLs) expand as a solution for presbyopia correction, a better understanding of their optical and visual performance becomes essential. Also, providing subjects with the experience of multifocal vision before contact lens fitting becomes critical, both to systematically test different multifocal designs and to optimize selection in the clinic. In this study, we evaluated the ability of a simultaneous vision visual simulator (SimVis) to represent MCLs.

Methods

Through focus (TF) optical and visual quality with a center-near aspheric MCL (low, medium and high near adds) were measured using a multichannel polychromatic Adaptive Optics visual simulator equipped with double-pass, SimVis (temporal multiplexing), and psychophysical channels to allow measurements on-bench and in vivo. On bench TF optical quality of SimVis-simulated MCLs was obtained from double-pass (DP) images and images of an E-stimulus using artificial eyes. Ten presbyopic subjects were fitted with the MCL. Visual acuity (VA) and DP retinal images were measured TF in a 4.00 D range with the MCL on eye, and through SimVis simulations of the same MCLs on the same subjects.

Results

TF optical (on bench and in vivo) and visual (in vivo) quality measurements captured the expected broadening of the curves with increasing add. Root mean square difference between real and SimVis-simulated lens was 0.031/0.025 (low add), 0.025/0.015 (medium add), 0.019/0.011 (high add), for TF DP and TF LogMAR VA, respectively. A shape similarity metric shows high statistical values (lag κ = 0), rho = 0.811/0.895 (low add), 0.792/0.944 (medium add), and 0.861/0.915 (high add) for TF DP/LogMAR VA, respectively.

Conclusions

MCLs theoretically and effectively expand the depth of focus. A novel simulator, SimVis, captured the through-focus optical and visual performance of the MCL in most of the subjects. Visual simulators allow subjects to experience vision with multifocal lenses prior to testing them on-eye.

Translational Relevance

Simultaneous visual simulators allow subjects to experience multifocal vision non-invasively. We demonstrated equivalency between real multifocal contact lenses and SimVis-simulated lenses. The results suggest that SimVis is a suitable technique to aid selection of presbyopic corrections in the contactology practice.

Is SimVis Gekko able to simulate commercial Multifocal Contact Lenses?

Vinas, M. — Thu, 10 Sep 2020 06:57:45 +0000

Yes, it is. SimVis Gekko accurately replicates the through-focus optical performance of any contact lens model.

SimVis Gekko has proved high fidelity reproducing vision with multifocal contact lenses, isolating the optical performance from tear effects, movements and discomfort.^1,2

The visual experience through SimVis Gekko predicts the visual satisfaction obtained with the fitted multifocal contact lenses.³

¹Vinas, Maria, et al. “Optical and visual quality with physical and visually simulated presbyopic multifocal contact lenses.” Translational Vision Science & Technology 9.10 (2020): 20-20.

²Barcala, Xoana, et al. “Comparison of vision with multifocal contact lenses and SimVis Gekko in a clinical site.” ARVO 2020

³Barcala, Xoana, et al. “Multifocal contact lens vision simulated with a clinical binocular simulator.” Contact Lens and Anterior Eye (2022): 101716.

VioBio lab adaptive optics: technology and applications by women vision scientists (2020)

Marcos, S — Sun, 08 Mar 2020 15:33:57 +0000

Citation

Marcos S, Benedí‐García C, Aissati S, Gonzalez‐Ramos AM, Lago CM, Radhkrishnan A, Romero M, Vedhakrishnan S, Sawides L & Vinas M. VioBio lab adaptive optics: technology and applications by women vision scientists. Ophthalmic Physiol Opt 2020; 40: 75-87. For more information, click here.

Abstract

Purpose

Adaptive Optics allows measurement and manipulation of the optical aberrations of the eye. We review two Adaptive Optics set-ups implemented at the Visual Optics and Biophotonics Laboratory, and present examples of their use in better understanding of the role of optical aberrations on visual perception, in normal and treated eyes.

Recent findings

Two systems (AOI and AOII) are described that measure ocular aberrations with a Hartmann-Shack wavefront sensor, which operates in closed-loop with an electromagnetic deformable mirror, and visual stimuli are projected in a visual display for psychophysical measurements. AOI operates in infrared radiation (IR) light. AOII is provided with a supercontiniuum laser source (IR and visible wavelengths), additional elements for simulation (spatial light modulator, temporal multiplexing with optotunable lenses, phase plates, cuvette for intraocular lenses-IOLs), and a double-pass retinal camera. We review several studies undertaken with these AO systems, including the evaluation of the visual benefits of AO correction, vision with simulated multifocal IOLs (MIOLs), optical aberrations in pseudophakic eyes, chromatic aberrations and their visual impact, and neural adaptation to ocular aberrations.

Summary

Monochromatic and chromatic aberrations have been measured in normal and treated eyes. AO systems have allowed understanding the visual benefit of correcting aberrations in normal eyes and the adaptation of the visual system to the eye’s native aberrations. Ocular corrections such as intraocular and contact lenses modify the wave aberrations. AO systems allow simulating vision with these corrections before they are implanted/fitted in the eye, or even before they are manufactured, revealing great potential for industry and the clinical practice. This review paper is part of a special issue of Ophthalmic & Physiological Optics on women in visual optics, and is co-authored by all women scientists of the research team.

Pre-operative simulation of post-operative multifocal vision (2019)

Vinas, M. — Mon, 21 Oct 2019 14:54:13 +0000

Citation

11. Vinas M, Aissati S, Romero M, Benedi-Garcia C, Garzon N, Poyales F, Dorronsoro C, Marcos S. Pre-operative simulation of post-operative multifocal vision. Biomed. Opt. Express 10, 5801-5817 (2019) For more information, click here.

Abstract

While multifocal intraocular lenses (MIOLs) are increasingly implanted to correct for presbyopia, how one sees with a multifocal correction is hard to explain and imagine. The current study evaluates the quality of various visual simulating technologies by comparing vision with simulated MIOLs pre-operatively and the implanted MIOLs post-operatively in the same patients. Two simulation platforms were used: (1) a custom-developed adaptiveoptics (AO) system, with two visual simulator devices: a spatial light modulator (SLM) and an optotunable lens operating under temporal multiplexing (SimVis); and (2) a wearable, binocular, large field of view SimVis2Eyes clinical simulator (SimVis Gekko, 2Eyes Vision, Madrid, Spain). All devices were programmed to simulate a trifocal diffractive MIOL (POD F, FineVision, PhysIOL). Eight patients were measured pre-operatively simulating the trifocal lens and post-operatively with implantation of the same MIOL. Through-focus decimal visual acuity (TF VA) was measured (1) monocularly in monochromatic light using a four-alternative-forced-choice procedure in the AO system; and (2) binocularly using a clinical optotype in white light. Visual simulations pre-operatively predict well the TF VA performance found post-operatively in patients implanted with the real IOL. The average RMS difference between TF curves with the different visual simulators was 0.05 ± 0.01. The average RMS difference between the TF VA curves with the SimVis pre-operatively and the real MIOL post-operatively was 0.06 ± 0.01 in both platforms, and it was higher in cataract eyes (0.08 ± 0.01, on average across simulators) than in eyes with clear lens. In either group the shape of the TF curves is similar across simulators and pre- and post-operatively. TF curves cross-correlated significantly between simulators (lag k = 0, rho = 0.889), as well as with results with the real MIOL implanted (lag k = 0, rho = 0.853). Visual simulations are useful programmable tools to predict visual performance with MIOLs, both in an AO environment and in a clinical simulator. Pre-operative visual simulations and post-operative data are in good agreement.

Can patients with cataracts benefit from SimVis Gekko simulations?

Vinas, M. — Tue, 21 May 2019 06:57:09 +0000

Yes, they can. Even in the presence of a moderate cataract, SimVis Gekko can project the effect of the full lens design.

Binocular defocus curves before surgery in the presence of cataracts and after cataract surgery, have the same shape, although with reduced visual acuity.¹

Results from studies ^2,3 which included patients with several degrees of cataract -Objective Scattering Index between 1.1 to 11.75 and up to a visual acuity of 0.3 logMAR (0.5 decimal)- show that cataract patients have the same preferences when scoring different corrections through SimVis Gekko with and without cataracts.

¹Vinas, Maria, et al. “Pre-operative simulation of post-operative multifocal vision” Biomed. Opt. Express 10, 5801-5817 (2019)

²Barcala, Xoana et al. “Visual quality with pre-operative multifocal corrections simulated with SimVis Gekko in cataract patients”. ESCRS Online 2020.

³Barcala, Xoana et al. “Visual simulations of presbyopic corrections through cataract opacification.” Journal of Cataract and Refractive Surgery. 2022 Aug. DOI: 10.1097/j.jcrs.0000000000001040.

Visual Simulators replicate vision with multifocal lenses (2019)

Vinas, M. — Thu, 07 Feb 2019 16:06:26 +0000

Citation

Vinas M, Benedi C, Sissati C, Pascual D, Vias A, Dorronsoro C, et al. Visual Simulators replicate vision with multifocal lenses. Sci Rep 2019. For more information, click here.

Abstract

Adaptive optics (AO) visual simulators based on deformable mirrors, spatial light modulators or optotunable lenses are increasingly used to simulate vision through different multifocal lens designs. However, the correspondence of this simulation with that obtained through real intraocular lenses (IOLs) tested on the same eyes has not been, to our knowledge, demonstrated. We compare through-focus (TF) optical and visual quality produced by real multifocal IOLs (M-IOLs) -bifocal refractive and trifocal diffractive- projected on the subiect’s eye with those same designs simulated with a spatial light modulator (SLM) or an optotunable lens working in temporal multiplexing mode (SimVis technology). Measurements were performed on 7 cyclopleged subjects using a custom-made multichannel 3-active-optical-elements polychromatic AO Visual Simulator in monochromatic light. The same system was used to demonstrate performance of the real IOLs, SLM and SimVis technology simulations on bench using double-pass imaging on an artificial eye. Results show a general good correspondence between the TF performance with the real and simulated M-IOLs, both optically (on bench) and visually (measured visual acuity in patients). We demonstrate that visual simulations in an AO environment capture to a large extent the individual optical and visual performance obtained with real M-IOLs, both in absolute values and in the shape of through-focus curves.