Anthony DeFino , 2025-04-25 22:02:00
April 25, 2025
2 min read
Key takeaways:
- Refractive surgery planning needs a paradigm shift to a more prospective approach.
- Simulation software designed to build a virtual eye may help individualize treatment.
LOS ANGELES — Simulation software designed to build a virtual eye may help predict the outcomes of laser vision correction before surgery, resulting in a more individualized treatment approach, according to a speaker here.
At Refractive Day at the American Society of Cataract and Refractive Surgery meeting, William J. Dupps Jr., MS, PhD, MD, FARVO, said that the current refractive surgery paradigm is retrospective, probabilistic, minimally personalized and population based. A shift in the approach to surgical planning may be needed.
Image: Anthony DeFino
“The new approach, hopefully, can be more prospective, more deterministic and more individualized for the eye in front of us,” he said.
A promising tool to yield this paradigm shift, Dupps said, is computational modeling, specifically the finite element method. This involves creating a “digital twin” of an eye through structural engineering.
Using tomography, the 3D geometry of a cornea is obtained and imported into software that builds a whole eye model using the patient’s demographic information along with axial eye length and other variables.
“At that point, the user can pick a surgery or procedure they would like to simulate,” Dupps said.
Dupps and colleagues have built modules that simulate procedures including LASIK, PRK, lenticule extraction, cross-linking and astigmatic keratotomy.
“The laser vision correction approach is something we have been very focused on recently,” he said. “We are as truly as possible simulating the reality of the procedure we are thinking about.”
To validate the software’s efficacy, Dupps and colleagues collected data from 19 LASIK cases and compared the simulated predicted outcomes with the actual outcomes from 3 months postoperatively, showing a “very tight correlation.” However, there are limitations that must be addressed to improve the simulation’s accuracy.
“We are assuming that everybody has the same biomechanical properties of the cornea,” Dupps said. “Even with that assumption, we can get pretty close. But we need to do better.”
To improve simulation accuracy, Dupps recommended measuring corneal hysteresis before surgery.
“We don’t have the answer prior to modeling this, but we can get closer to the right outcome if we take into account that simple marker,” he said. “That gives me great hope that, when we incorporate more spatially sensitive approaches like Brillouin microscopy and others, we can even further refine these outcomes.”
Sources/Disclosures
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Dupps WJ. Simulation software to predict postoperative shape and biomechanical outcomes before laser vision correction. Presented at: American Society of Cataract and Refractive Surgery meeting; April 25-28, 2025; Los Angeles.
Disclosures:
Dupps reports having intellectual property in biomechanical measurement and modeling (Cleveland Clinic), consulting for Alcon and receiving grant funding from NIH/NEI.
