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Moderator
Richard Tipperman, MD
Panelists
Jason J. Jones, MD; James Katz, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
William B. Trattler, MD
Co-Authors
David Wirta (MD), Konstantinos Charizanis (PhD, MBA), Mitchell Brigell (PhD), Jay Pepose (MD, PhD)
Purpose
To evaluate the efficacy, durability and safety of 0.75% phentolamine ophthalmic solution (POS) for improving distance corrected near visual acuity (DCNVA) in presbyopic patients.
Methods
In the multicenter, randomized, double-masked, placebo-controlled VEGA-3 Phase 3 trial, 569 presbyopic subjects ?40 and ? 64 years of age with binocular photopic DCNVA of 20/50 or worse were randomized 3:2 to receive either 0.75% POS (n=341) or placebo (n=228) nightly. The primary endpoint was the percentage of subjects gaining ?3 lines of DCNVA with loss of <5 letters binocular best corrected distance visual acuity (BCDVA) at Day 8. DCNVA, distance corrected intermediate visual acuity (DCIVA), and safety were assessed at multiple time points through Week 6. Treatment groups were compared using logistic regression.
Results
At Day 8, 27% of POS-treated subjects gained ?15 letters in DCNVA without significant BCDVA loss vs. 12% in the placebo group (p<0.0001), meeting the primary endpoint. A statistically significant difference was observed as early as 1 hour post dosing (21% POS vs 6% placebo; p<0.001) and across all visits. POS treated subjects also showed a statistically significant improvement in mean DCIVA at all time points. There was no evidence of tachyphylaxis over 6 weeks of repeated dosing. Adverse events were mostly mild and transient. Most frequent POS AEs were conjunctival hyperemia (26%), eye irritation (5.6%), instillation site irritation (15%) and dysgeusia (5.9%). Headache was only 2.6%.
Conclusion
Phentolamine ophthalmic solution demonstrated rapid, sustained, and clinically meaningful improvements in near vision in presbyopic patients. The treatment was well tolerated, with a favorable safety profile and no evidence of tachyphylaxis over six weeks of dosing.
Presenting Author
Florence Cabot, MD
Co-Authors
Marco Ruggeri (PhD), Carolina Parra Rosas (MD), Alex Gonzalez (BA), Fabrice Manns (PhD), Bianca Maceo Heilman (PhD)
Purpose
To assess the effect of pilocarpine 0.4% on pupil, crystalline lens and ciliary muscle accommodative response using a custom-made OCT, on presbyopic patients.
Methods
Prospective single center study. Subjects with age ranging from 45 to 64 years old with a spherical equivalent ranging from -4.00D to +2.00D old were included. Subjects with history of ocular surgery or any ongoing ocular comorbidities were excluded. Subjects underwent baseline imaging of the anterior segment with a dual custom-made extended depth OCT with accommodative targets simulating 0 D (distance), 1.5 D (intermediate), and 2.5 D (near). Subjects underwent repeat testing 1 hour after administration of 0.4% and balanced salt solution (BSS, control). Pupil diameter, lens and ciliary muscle thickness changes were extracted from the OCT images.
Results
Twenty-five subjects were screened and 10 subjects were enrolled in the study. Mean age of patient was 51,5 yo [46.3 - 64.3]. Mean spherical equivalent was -0.50D ranging from -2.50D to +2.00D. There was a statistically significant decrease in pupil diameter after instillation of pilocarpine 0.4% vs BSS (p<0.05%). There was no statistically significant difference in lens thickness and ciliary muscle accommodative response after instillation of pilocarpine 0.4% vs BSS.
Conclusion
Preliminary results suggest that pilocarpine 0.4% decrease the pupil diameter but has limited effect on lens thickness and ciliary muscle accommodative response.
Presenting Author
Frederic Hehn, MD
Purpose
the author explain a new way to achieve a continous extended depth of focus EDOF , without a gap, called optics by dilution
Methods
after 15 years of fondamental research in optics, we discover a new way to increase the deph of focus, in using not at all a myopic target. optics by dilution is based on reverse Fraunhofer Wavefront, Point Spread Function, Circle of Confusion, Rayleigh threshold and back ground optical noise. optics by dilution consist as a modification of negative asphericity, as a discrete value. at that threshold the divergent rays fall under the Rayleigh detection, and become undetectatble.then only the direct rays focus on the retina for giving an endless depth of focus at any distance
Results
we expose no clinical data, only scientific purpose. we can build now a new optical shape, in cornea , chrytalline lens or any others lenses given the properties of EDOF. it could be use in presby-LASIK for instance given the same good vision at any distance , in each eye, by the same manner, without using a myopic target. this symetrical presby-LASIK is called IsoVision, by opposition of the monovision techniques.
Conclusion
optics by dilution could offer your patients, for the very first time, a symetrical correction at any distance without compormise cause it using not at all a myopic target
Presenting Author
Raghu Raj Singh Thakur, PhD
Co-Authors
AnnMarie Hipsley (PhD), Shubhamkumar Baviskar (PhD), Lalit Vora (PhD), Tracy Swartz (MS, OD), Inder Singh (MD)
Purpose
This study aimed to characterise laser scleral microporation (LSM) micropores created using a 2.94-?m Er:YAG laser in ex vivo porcine sclera. An advanced evaluation of micropore morphology, collagen architecture, and the impact on drug permeation was conducted to assess the feasibility of LSM to enhance ocular drug delivery.
Methods
Porcine sclera was microporated with a 2.94-?m Er:YAG laser at 50% and 85% depths with a power of 0.9 W, pore density of 10%, and an array size of 5 mm. Micropore morphology was analysed using: Multiphoton microscopy (MP-SHG) to visualise collagen architecture (depths 200-1000 µm), Haematoxylin and Eosin (H&E) staining for structure and collateral damage assessment, Scanning Electron Microscopy (SEM) for surface micropore analysis, and Transmission Electron Microscopy (TEM) to compare collagen integrity in treated vs. untreated sclera. Drug permeation was evaluated using Franz-diffusion Cells (FDCs) with prednisolone acetate (PA), comparing untreated and laser microporated sclera.
Results
Imaging confirmed well-defined micropores with minimal collateral damage. Pore depths in LSM-treated sclera ranged from 250-750 µm while the average scleral thickness was 1000 µm. MP-SHG, SEM, and TEM revealed distinct pore morphology and intact collagen on the walls of LSM micropores following LSM treatment. FDC studies demonstrated significantly enhanced PA permeation in 85% LSM-treated sclera vs. 50% and untreated controls (n=3). PA delivery increased from 4.4 µg (untreated sclera) to 76.4 µg (85% LSM depth) over 24 hours, confirming improved drug permeation through the scleral tissue.
Conclusion
LSM enhances scleral drug permeation by creating controlled micropores with minimal disruption, supporting the use of LSM for ocular drug delivery in both anterior and posterior segment diseases. Integrating nanotechnology-based drug delivery with LSM could further enhance localized, sustained ocular drug delivery.
Presenting Author
Robert Edward T. Ang, MD
Co-Authors
AnnMarie Hipsley (PhD), Mitch Jackson (MD), Tracy Swartz (MS, OD)
Purpose
To investigate whether prior laser vision correction (LVC) influences visual and functional outcomes of Laser Scleral Microporation (LSM) in emmetropic presbyopes.
Methods
This prospective cohort study enrolled two groups of emmetropic presbyopes: (1) post-LVC patients corrected to plano from (-4.5 D to +1.75 D sphere)(n=14), and untreated virgin emmetropes (n=34). All eyes underwent LSM. Endpoints included uncorrected near and intermediate visual acuity (UNVA, UIVA), which are elements of Dynamic Range of Focus (DRof), and patient-reported quality-of-vision scores. Safety and adverse events were also monitored.
Results
Both post-LVC and virgin cohorts demonstrated significant improvements in near and intermediate vision, along with high levels of satisfaction. Safety outcomes were favorable in both groups. Although post-LVC patients began with slightly better UNVA before LSM, there was no difference between groups in the change in UNVA following LSM (P=0.93). Similarly, there was no difference between groups in the change in UIVA (P=0.55) or Rasch score (P=873) following LSM.
Conclusion
LSM appears to be a safe and effective treatment for emmetropic presbyopia regardless of prior refractive history. These findings support its potential as a non-lens-based option that can address presbyopia in both post-refractive surgery and untreated patients.
Presenting Author
Damien Gatinel, PhD, MD
Purpose
To present a surgeon‑facing, interactive simulator that models how corneal asphericity (Q) modulation affects corneal wavefront, ablation depth, induced spherical aberration, local power (vergence), optical quality, and through‑focus visual performance—moving presbyopia LASIK planning from “black‑box” empiricism to parameter‑driven decision‑making.
Methods
The tool accepts user‑defined Q‑modulations, optical zone/pupil size, and corneal/optical parameters, then computes: (1) surface sag and ablation depth to achieve the target asphericity; (2) resulting wavefront terms including Z(4,0) spherical aberration (SA); (3) point‑spread function and through‑focus MTF (TF‑MTF) curves across physiologic pupils; (4) local vergence maps; and (5) convolved optotype images across defocus. Real‑time parameter sweeps allow side‑by‑side comparisons. Primary endpoints are changes in mean SA and depth of focus; secondary endpoints include TF‑MTF area/peak, and simulated optotype legibility at clinically relevant spatial frequencies.
Results
Across synthetic and example clinical eyes, parametric Q-sweeps produced predictable changes in spherical aberration and depth of focus: moderate negative-Q profiles broadened TF-MTF within a clinically useful defocus range while reducing peak contrast, consistent with the trade-off between extended focus and image sharpness. Local vergence maps and convolved optotypes mirrored TF-MTF predictions, enabling intuitive visualization across tasks and pupils. The simulator delivered instant feedback, facilitated profile comparisons, and revealed the consequences of asphericity choices that are usually hidden in proprietary presbyLASIK algorithms.
Conclusion
This physics-based interactive simulator provides a transparent framework for understanding and teaching the optical consequences of corneal asphericity modulation in presbyLASIK. By linking ΔQ to through-focus image quality, it reduces empirical trial-and-error, supports rational profile selection, and improves teaching of trainees.
Presenting Author
Selim Ayata, MD
Co-Authors
Nilay kandemir Besek (MD), Sibel Ahmet (FEBO, FRCSEd, MD), Gülay Yalç?nkaya çak?r (FEBO), Seda Liman Uzun (FRCSEd), Ahmet Kirgiz (FEBO)
Purpose
This study aims to evaluate the clinical and visual outcomes of corneal inlay explantation and its impact on keratometry and corneal thickness.
Methods
Patients who underwent corneal inlay (KAMRA, AcuFocus Inc., Irvine, CA, USA) explantation between May 2014 and December 2024 in a single-center tertiary referral hospital were retrospectively analyzed. Twenty three eyes of 23 patients were included in the study. Patient demographics, post-operative results and complications were collected. Pre-operative and post-operative corrected distance visual acuity (CDVA), manifest refraction and Scheimpflug corneal topography (Sirius, CSO, Florence, Italy) were analyzed to evaluate outcomes. CDVA were measured using Snellen Chart and converted to logMAR.
Results
The mean age was 69.55±4.78 years and the mean interval between implantation and explantation was 9.67±3.75 years.The mean follow-up was 24.07±7.14 months after the explantation.Significant differences were observed between pre and postop mean CDVA(0.39±0.20, 0.20±0.14 logMAR respectively;p<0.01).The mean flat(K1) and steep axis(K2) were 45.43±2.08, 46.24±2.09diopters(D) preoperatively and 44.68±2.10, 45.76±2.14D postoperatively (p=0.01).Although a slight hyperopic shift was observed after explantation, it wasn't significant(-0.37±3.18D, 0.06±1.58 D respectively;p=0.37).22 patients(95.65%) had postoperative residual donut-shaped corneal haze. During follow-ups 6 patients had cataract surgery
Conclusion
Corneal inlay removal is a safe option for patients with visual complaints. However, patients should be informed about the potential risks of postoperative hyperopic shift and donut haze.
Presenting Author
David Sung Yong Kang, MD
Co-Authors
Tae-im Kim (MD, PhD), Byunghoon Chung (MD), Kangyoon Kim (MD), Samuel Arba Mosquera (PhD)
Purpose
To analyze the 6-month outcomes of the bi-aspheric ablation profile (PresbyMAX) photorefractive keratectomy for correction of presbyopia in eyes with previous laser vision correction.
Methods
This was a retrospective case review of 45 patients (90 eyes) who had previous laser vision correction and underwent uneventful bi-aspheric ablation photorefractive keratectomy to correct presbyopia between January 2023 and March 2025. Monocular and binocular uncorrected distance visual acuity (UDVA) and near visual acuity (UNVA), and corrected distance visual acuity and near visual acuity were analyzed postoperatively.
Results
At 6 months postoperatively, mean binocular UDVA (logMAR) was -0.01 ± 0.02 and mean binocular UNVA (Jaeger) was 1.26± 0.52. Furthermore, all eyes achieved 20/24 or better binocular UDVA, and 98% achieved 20/20 or better binocular UDVA. All patients achieved J3 or better in binocular cumulative UNVA, and 73% achieved J1.
Conclusion
Presbyopia correction using the PresbyMAX Photorefractive keratectomy is a safe and effective treatment for presbyopia in patients with previous laser vision correction.
Presenting Author
Laurent Sabatier, MSc
Co-Authors
AnnMarie Hipsley (PhD), Cristos Ifantides (MD, MBA), John Marshall (PhD)
Purpose
To evaluate how micropore geometry and orientation influence scleral stiffness reduction in Laser Scleral Microporation (LSM), and to assess the value of combining Artificial Intelligence (AI) with Digital Twin (DT) biomechanical modeling for treatment planning in presbyopia.
Methods
A 3D eye Digital Twin with Finite Element Analysis (FEA) was calibrated to age-specific properties for an "in silico" study using subjects from an IRB-approved pilot. Simulations compared square, diamond, and cylindrical pores (265 µm, 6.2% volume) at orientations (0°, 45°, 90°) and fiber architectures. The endpoint was percent change in scleral stiffness. An AI-based Virtual Eye Simulation Analyzer used patient biometrics to forecast dose needs and biomechanical response. A parallel LSM cohort provided calibration and validation; clinical metrics (e.g., DRoF) were recorded but not used as endpoints.
Results
Pore geometry and orientation produced significant differences in stiffness reduction. Diamond pores at 45° achieved the greatest effect (~6.1% reduction in younger sclera vs ~4.1% in older). Square pores showed moderate, and cylindrical the least effect. Interwoven fiber regions consistently enhanced outcomes compared with non-woven. AI-driven predictions aligned with modeled direction and magnitude of biomechanical response, supporting its role in preoperative planning.
Conclusion
Micropore shape and orientation dictate stiffness reduction after LSM. Diamond pores at 45° produced the greatest flexibility; square and cylindrical were less effective. Older sclera required higher treatment volumes. AI + DT/FEA modeling enables tailored LSM planning and supports personalized presbyopia therapy.
Presenting Author
Kubra Gul Olke, MD
Co-Authors
Gokhan Celik (MD), Furkan Ciftci (MD), Tuncay Karacocuk (MD)
Purpose
The aim of this study was to evaluate the effect of pupil-optimized multifocal soft contact lenses (POMfSCLs) on contrast sensitivity (CS) in presbyopic individuals.
Methods
This prospective study included 38 healthy presbyopic participants aged 40-60 years. Following detailed refraction and ophthalmologic examination, pupil diameters were measured under mesopic conditions using a biometry device (Figure 1). At baseline, defocus curves for distance and near visual acuity were obtained using trial lenses, after which POMfSCLs were fitted according to the manufacturer's protocol. After one week of lens wear, defocus curves were reassessed (Figure 2). At both visits, binocular CS was evaluated using the Pelli-Robson test under mesopic (~3 lux) and photopic (~500 lux) conditions.
Results
The mean age of participants was 47.6 ± 5.5 years (23 females, 15 males). Mean spherical equivalent measured +1.38 ± 1.34 D in right eyes and +1.25 ± 1.22 D in left eyes. Mesopic pupil diameter averaged 5.17 ± 0.32 mm (right) and 5.09 ± 0.47 mm (left), yielding an overall mean of 5.13 ± 0.65 mm. Under mesopic conditions, mean contrast sensitivity (CS) with trial lenses was 1.88 ± 0.08 logMAR, decreasing to 1.76 ± 0.09 logMAR after POMfSCL wear (p<0.05). Photopic CS values were 1.93 ± 0.04 logMAR and 1.85 ± 0.04 logMAR, respectively (p<0.05). No significant correlation was found between mesopic pupil size and CS under either modality (p=0.154 and p=0.427).
Conclusion
This study is among the first to evaluate CS with POMfSCLs under varying illumination conditions. The findings suggest that POMfSCLs may reduce CS, particularly under mesopic conditions. Furthermore, the pupil-optimized lens design may eliminate the association between pupil diameter and mesopic CS.
Presenting Author
AnnMarie Hipsley, PhD
Co-Authors
George Waring (MD), Robert Edward Ang (MD), James Katz (MD), Laurent Sabatier (MSc)
Purpose
To validate Laser Scleral Microporation (LSM) clinically and mechanistically as a treatment for presbyopia. The study used dynamic wavefront aberrometry, speckle interferometry, and finite element digital twin modeling with AI/ML to measure treatment effects, restore accommodation, and confirm biomechanical proof.
Methods
How about this: Three-platform biomechanical assessment of LSM: a) Dynamic wavefront aberrometry (+5D to -5D) compared 30 vs 49 yrs and 24 vs 54 yrs pre/post-LSM; DRoF, VSOTF, videos, and PSFs confirmed outcomes. b) ESPI on donor cadaver eyes with globe inflation produced fringe and 2D maps of scleral compliance via laser and cameras. c) Digital Twin finite element analysis used specimen-specific models with six regions; Neo-Hookean parameters optimized. IRB-approved data (100 eyes) integrated with AI and ray tracing to quantify COP and predict progression/treatment timelines.
Results
Case study comparison showed post-LSM pupil response, wavefront profile, and point spread functions of a 49-year-old presbyope closely mirrored a 30-year-old control. In a 54-year-old, 1.88 D of DRoF was restored post-LSM with VSOTF improvement across all ranges. ESPI confirmed biomechanical compliance and stress redistribution, visualized in real time with high-resolution fringe mapping. Digital twin modeling validated COP improvements, with RMS error of 17.5 µm between numerical and experimental displacements. Finite element analysis showed significant agreement with human eye data (p < 0.005 OD, p < 0.001 OS).
Conclusion
Dynamic aberrometry, ESPI, and AI-driven digital twin modeling converge to demonstrate restoration of DRoF and biomechanical proof of mechanism for LSM. Statistically significant agreement with human eye data strengthens translational validity, supporting LSM as the first clinically viable biomechanical therapy for presbyopia.
Presenting Author
Daniel R Neal, PhD
Co-Authors
AnnMarie Hipsley (PhD), George Waring (MD), Xifeng Xiao (PhD)
Purpose
To evaluate the application of dynamic wavefront aberrometry in the objective assessment of presbyopia, with a focus on measuring the Dynamic Range of Focus (DROF) as a clinically meaningful and reproducible indicator of visual function.
Methods
Dynamic wavefront sensing was used to continuously measure ocular aberrations in presbyopic subjects during accommodative tasks and simulated near-vision scenarios. The DROF, defined as the range over which the eye maintains high-quality retinal image focus during dynamic tasks, was quantified in real time. This novel metric was compared with traditional static measures such as subjective refraction, depth of focus, and near visual acuity. Correlation analyses were conducted against patient-reported outcomes and functional visual performance scores.
Results
The dynamic wavefront was measured and VSOTF calculated from wavefront measurements of several human eyes to test the DROF concepts. For example, a 26 y.o. subject had only 4.1D of accommodation range, but had DROF > 7D, which more closely matches the subjective result. The pupil size DOF contributed 1D, and aberrations an additional 1D DOF.
Conclusion
Dynamic Range of focus is an effective metric for evaluating presbyopic performance. It matches real-world visual experience since it includes accommodation range, depth-of-focus and pupil size effects. It also provides a means for separating the various phenomena to help understand the various causes and effects.
