Visual Acuity Improvement (Supernormal Vision) after SmartSight lenticule extraction procedures: A Machine Learning Assisted Approach.

Abstract

Abstract Objectives To anticipate improvements in lenticule extraction, with the potential to enhance visual acuity, by employing SmartSight from SCHWIND eye-tech-solutions. This involves utilizing the advanced femtosecond laser system, SCHWIND ATOS, through a comprehensive analysis of patient data and specific details related to the surgical device. Methods This retrospective, observational case series includes 1262 eyes who underwent SmartSight with 86 features (sources of information). Procedures were performed with a SCHWIND ATOS femtosecond laser. Selection of those features that carry a high relevance in the change of Corrected Distance Visual Acuity (CDVA) was performed with Analysis of Variance (ANOVA) and Principal Components (PC) Analysis (PCA), whereas predicting the success probability (gain of CDVA) with various regression and classification methods. The full cohort was randomly split into training cohort (883 treatments) and test cohort (379 treatments). Results The initial 86 features reduced to 38 uncorrelated ones using a cross-correlation matrix. Subsequent refinement led to the identification of 3 PCs explaining 80% of the variance. PC1 was primarily associated with system settings, whereas PC2 and PC3 were correlated with gender and age at treatment. A successful dichotomous classifier (gain vs no-gain of CDVA) developed, showing consistent predictions in both training and test cohorts. Notably, lower pulse energy, larger spot distance, tighter track distance, higher spot to track distance ratio, lower dose, and lower average laser power were linked to a higher chance of CDVA gain. Conclusions Our findings demonstrate that employing the low-energy asymmetric spacing with the SmartSight instrument yields a notably safe and effective lenticule extraction process. This methodology significantly contributes to the improvement of visual outcomes in patients with myopic astigmatism undergoing SmartSight treatment. Introduction: Corneal refractive surgery, aiming to correct optical and visual imperfections, entails altering the corneal structure by surgically removing tissue that functions akin to a lens. SmartSight treatment (SCHWIND eye-tech solutions GmbH, Kleinostheim, Germany) is a lenticule creation and extraction implemented in the SCHWIND ATOS femtosecond system [1].