Prediction accuracy of intraoperative aberrometry compared with preoperative biometry formulae for intraocular lens power selection

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BACKGROUND

To evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.

METHODS

This was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.

RESULTS

There were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.

CONCLUSIONS

Less surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Intraoperative Aberrometry versus Preoperative Biometry for Intraocular Lens Power Calculations: A Report by the American Academy of Ophthalmology

PURPOSE

To evaluate the published literature to compare intraoperative aberrometry (IA) with preoperative biometry-based formulas with respect to intraocular lens (IOL) power calculation accuracy for various clinical scenarios.

METHODS

Literature searches in the PubMed database conducted in August 2022, July 2023, and February 2024 identified 157, 18, and 6 citations, respectively. These were reviewed in abstract form, and 61 articles were selected for full-text review. Of these, 29 met the criteria for inclusion in this assessment. The panel methodologists assigned a level of evidence rating to each of the articles; 4 were rated level I, 19 were rated level II, and 6 were rated level III.

RESULTS

Intraoperative aberrometry performed better than traditional vergence formulas, including the Haigis, HofferQ, Holladay, and SRK/T, and similarly to the Barrett Universal II and Hill-RBF with respect to minimization of spherical equivalent (SE) refractive error. For toric IOLs, IA outperformed formulas that only considered anterior corneal astigmatism and was similar to formulas like the Barrett Toric Calculator (BTC), which empirically account for the contribution from the posterior cornea. In eyes with a history of corneal refractive surgery, IA performed similarly to the Barrett True-K and slightly better than other tested methods, including the Haigis-L, Shammas, and Wang-Koch-Maloney formulas.

CONCLUSIONS

Intraoperative aberrometry corresponds well with modern vergence formulas, including the Barrett Universal II, Hill-RBF, BTC, and Barrett True-K. It has greater accuracy than traditional vergence-based IOL power calculation formulas in eyes with and without a history of corneal refractive surgery.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser

Purpose

To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA).

Methods

This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm).

Results

Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively.

Conclusion

The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Accuracy of the Majority Voting Method with Multiple IOL Power Formulae

Purpose

This study aimed to evaluate the efficacy of a majority decision algorithm that integrates intraoperative aberrometry (IA) and two intraocular lens (IOL) frequency formulas. The primary objective was to compare the accuracy of three formulas (IA; Sanders, Retzlaff, and Kraff/Theoretical (SRK/T); and Barrett Universal II (BUII)), in achieving emmetropia in eyes implanted with TFNT lenses (Alcon).

Patients and Methods

A total of 145 eyes of 145 patients were included in the evaluation. Preoperative data were obtained from IOLMaster 700, while intraoperative data were collected from ORA SYSTEMTM. Visual acuity ≥0.8 at the 3-month post-surgery mark was confirmed. We assessed refractive prediction error (RPE), which is the difference between predicted refraction (PR) and postoperative subjective refraction. This evaluation aimed to identify the optimal IOL power with the implemented algorithm.

Results

Among the 145 eyes evaluated, 55.9%, 78.7%, and 97.2% achieved postoperative subjective refraction within ±0.13 Diopters (D), ±0.25 D, and ±0.50 D, respectively. The percentages of eyes within ±0.25 D of PR varied by formula type, with values of 57%, 57%, and 54% for IA, BUII, and SRK/T, respectively. For eyes with short to medium axial length (AL<26.00 mm), the percentages within ±0.25 D of RPE were 52%, 58%, and 58% for IA, SRK/T, and BUII, respectively. In contrast, for eyes with long axial length (≥26.00 mm) the percentages were 68%, 52%, and 45% for IA, BUII, and SRK/T, respectively.

Conclusion

The proposed majority decision algorithm incorporating IA and two IOL frequency formulas was effective in reducing postoperative refractive error. IA was particularly beneficial for eyes with long axial length. These findings suggest the algorithm has potential to optimize IOL power selection to improve quality of life of patients and clinical practice outcomes.

Intraoperative aberrometry: an update on applications and outcomes

PURPOSE OF REVIEW

There is now a large body of experience with intraoperative aberrometry. This review aims to synthesize available data regarding intraoperative aberrometry applications and outcomes.

RECENT FINDINGS

The Optiwave Refractive Analysis (ORA) System utilizes Talbot-moiré interferometry and is the only commercially available intraoperative aberrometry device. There are few studies that include all-comers undergoing intraoperative aberrometry-assisted cataract surgery, as most studies examine routine patients only or atypical eyes only. In non-post-refractive cases, studies have consistently shown a small but statistically significant benefit in spherical equivalent refractive outcome for intraoperative aberrometry versus preoperative calculations. In studies examining axial length extremes, most studies have shown intraoperative aberrometry to perform similarly to preoperative calculations. Amongst post-refractive cases, post-myopic ablation cases appear to benefit the most from intraoperative aberrometry. For toric intraocular lenses (IOLs), intraoperative aberrometry may be used for refining IOL power (toricity and spherical equivalent) and alignment, and most studies show intraoperative aberrometry to achieve low postoperative residual astigmatism.

SUMMARY

Intraoperative aberrometry can be utilized as an adjunct to preoperative planning and surgeon's judgment to optimize cataract surgery refractive outcomes. Non-post-refractive cases, post-myopic ablation eyes, and toric intraocular lenses may have the greatest demonstrated benefit in intraoperative aberrometry studies to date, but other eyes may also benefit from intraoperative aberrometry use.