Phoropter perception test predicts 96.9% success in laser blended vision for presbyopia across 1,341 patients

The test protocol starts with distance-optimized refraction, benchmarks it at 100%, then induces monovision defocus in each eye sequentially using the phoropter. Patients rating blended vision at least 80% as clear proceed to surgery, with the dominant eye assigned distance correction. This approach directly assesses neuroadaptation capacity rather than relying on refraction alone. Among 1,341 participants with myopia, hyperopia, or emmetropia, 30 were screened out preoperatively and the remainder showed 96.9% tolerance post-laser. The study was presented at the 2026 ESCRS Congress but has not yet undergone peer review.

Presbyopia affects nearly all adults over 40, with monovision LASIK historically showing variable tolerance rates of 60-80% in observational series. This test improves selection by quantifying subjective fusion before tissue ablation, addressing a gap where standard dominance checks miss subtle cortical blending deficits. It also avoids unnecessary procedures in the small fraction intolerant of anisometropia. However, the single-center design and lack of randomization limit causal inference about long-term visual quality or spectacle independence compared with multifocal IOLs.

Next steps require a prospective multicenter RCT comparing test-guided versus standard monovision selection, tracking 2-year outcomes on contrast sensitivity, stereopsis, and patient-reported outcomes. Regulatory bodies and insurers will need such data before endorsing routine adoption.