AI In Medicine: Artificial Intelligence Enhances Decision-Making For LASIK Patients Navigating Cataract Surgery

AI In Medicine: Since the advent of LASIK eye surgery in 1989, millions of individuals have benefited from this groundbreaking procedure, which effectively corrects refractive errors by reshaping the cornea. However, as time goes by, some LASIK patients may develop cataracts and require additional corrective lenses. With the continuous expansion of intraocular lens (IOL) options, researchers are now harnessing the power of computational simulations to assist patients and surgeons in making informed choices regarding cataract surgery.


 
A recent AI In Medicine study conducted by researchers from the University of Rochester-New York, Instituto de Óptica-Spain, Eyes Vision SL, Madrid-Spain, explored how artificial intelligence (AI) and computational modeling can be used to provide clarity and precision to LASIK patients facing cataract surgery.
 
The Role of Computational Models in Cataract Surgery
The researchers from the University of Rochester developed computational eye models that incorporated the corneas of post-LASIK surgery patients. These models aimed to investigate how standard intraocular lenses and lenses designed to enhance depth of focus performed in eyes that had undergone LASIK surgery.

The driving force behind this research is the need for more comprehensive pre-operative data to assist in selecting the most suitable lens for cataract surgery patients. Currently, the primary criteria for lens selection are the length and curvature of the cornea. However, this approach lacks the detailed anatomical information required to make optimal decisions.
 
Dr Susana Marcos, the David R. Williams Director of the Center for Visual Science and a key figure in this study, emphasized the significance of these computational models. By reconstructing the eye in three dimensions, these models provide a holistic view of the cornea and crystalline lens, where the intraocular lens is implanted. With this detailed anatomical information, surgeons are better equipped to choose the lens that will produce the best post-operative visual outcomes.
 
Enhancing Patient Engagement with Technology
In addition to aiding surgeons in making informed decisions, researchers have developed technology to empower patients in their lens selection process. It's not just about what the surgeon thinks is the best fit; patients want to see for themselves.
 
To bridge this gap, the research team employed an optical bench, utilizing technology initially designed for astronomy. This setup included adaptive optics mirrors and spatial light modulators, allowing researchers to manipulate the optics of the eye as an intraocular lens would. These experiments have enabled the team to collaborate with industry partners to test new products.
 
One noteworthy development from this technology is a commercial headset version called SimVis Gekko. With this device, patients can experience firsthand how different lens options would affect their vision in the real world, simulating the post-surgery experience. This innovation empowers patients to actively participate in the decision-making process, increasing their confi dence in the selected intraocular lens.
 
Expanding Applications Beyond Cataract Surgery
While the immediate focus of this research is on improving cataract surgery outcomes for LASIK patients, the applications extend beyond this realm. The team is actively applying their computational methods to study other prevalent eye conditions, including presbyopia and myopia.
 
Presbyopia, the age-related loss of near vision, is a common concern for older adults. By leveraging AI-driven models and computational simulations, researchers aim to develop more effective treatments and lens options to address this condition. Similarly, myopia, or nearsightedness, affects millions worldwide, and these computational tools can aid in devising better solutions for myopic patients.
 
A Deep Dive into the Computational Simulation
The heart of the study lies in the computational simulation of the optical performance of an extended depth of focus (EDOF) intraocular lens in post-LASIK eyes. The researchers utilized computer pseudophakic eye models that incorporated known post-LASIK corneal aberrations, spanning a range of refractive corrections from -7.5 to +4.5 diopters.
 
The study considered two types of intraocular lenses: a monofocal lens (Acrysof IQ) and an EDOF lens (Acrysof IQ Vivity). To assess retinal image quality, the researchers employed the Visual Strehl (VS) metric. Additionally, they calculated the depth of focus (DOF) from the through-focus VS curves and estimated the presence of halos based on the light spread in the image of a pinhole. These measurements were taken for both 5.0 and 3.0-mm pupil diameters.
 
Key Findings and Insights
The computational simulations revealed several important insights into the performance of these intraocular lenses in post-LASIK eyes. Here are some of the key findings:
 
Benefit of EDOF IOLs: Simulated eyes without prior LASIK surgery showed that EDOF IOLs provided a substantial benefit in terms of depth of focus, even if there was some compromise in far vision compared to monofocal IOLs. This finding suggests that EDOF lenses are a promising option for patients who value intermediate vision.
 
Impact of LASIK-Induced Aberrations: The simulations demonstrated that LASIK-induced spherical aberration (SA) had a significant impact on retinal image quality, particularly with larger pupil diameters. Interestingly, the effect of LASIK-induced aberrations differed between myopic and hyperopic LASIK patients, leading to varying outcomes with different types of IOLs.
 
Consistency in EDOF IOL Performance: In post-LASIK eyes, the performance of EDOF IOLs remained relatively consistent across a wide range of corneal aberrations, suggesting that EDOF lenses may be particularly suitable for post-myopic LASIK patients.
 
Halo Reduction with EDOF IOLs: Halos, which can be a concern for patients, were reduced with EDOF IOLs compared to monofocal IOLs when positive spherical aberration was induced (as in myopic LASIK). This reduction in halos is a significant benefit for patients' post-surgery visual comfort.
 
Conclusion
The application of computational simulations and AI-driven models is revolutionizing the field of cataract surgery, particularly for LASIK patients. These tools provide surgeons with comprehensive data to make more informed decisions about intraocular lens selection. Moreover, they empower patients to visualize and participate in the lens selection process, enhancing their confidence and satisfaction.
 
The study sheds light on the promising performance of extended depth of focus (EDOF) intraocular lenses, especially in post-LASIK eyes. This research not only benefits cataract surgery but also holds potential for addressing other prevalent eye conditions, offering hope for improved vision and quality of life for countless individuals. As AI and computational modeling continue to advance, the future of ophthalmology looks increasingly clear and bright.
 
The study findings were published in the Journal of Cataract & Refractive Surgery,
https://journals.lww.com/jcrs/abstract/9900/computational_simulation_of_the_optical.247.aspx
 
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