Predictability of Biometry in Patients Undergoing Cataract Surgery

Comparison of biometry measurements and intraocular lens power prediction between 2 SS-OCT-based biometers

PURPOSE

To evaluate the agreement in biometry measurements and intraocular lens (IOL) power prediction between the Eyestar 900 and the IOLMaster 700.

SETTING

Institutional.

DESIGN

Retrospective comparative study.

METHODS

Patients were evaluated before cataract surgery using both devices on the same visit. Axial length, anterior and posterior keratometry, anterior chamber depth, corneal diameter (CD), central corneal thickness, and lens thickness were recorded by both devices. The agreement in measurements and in IOL power calculations was evaluated using the Barrett Universal II (BU-II) formula with either predicted or measured posterior keratometry.

RESULTS

In total, 402 eyes of 402 consecutive patients were included. The mean age was 72.0 ± 9.2 years. Clinically, mean differences in measured variables were small, albeit slightly larger for posterior flat and steep keratometry (0.43 diopters [D] and 0.42 D, respectively). The measurement correlation and agreement between the devices were good for all variables with slightly lower agreement in CD measurements. Consistent bias was seen in measurements of posterior flat and steep keratometry. Good agreement was also found in anterior and posterior astigmatism measurements. Good IOL power calculation agreement was found using either predicted posterior keratometry (95% limits of agreement [LoA] of -0.40 to +0.30 D) or measured posterior keratometry (95% LoA of -0.45 to +0.40 D). The agreement was within ±0.5 D in 394 eyes (98.0%) using predicted posterior keratometry and in 386 eyes (96.0%) using measured posterior keratometry.

CONCLUSIONS

The Eyestar 900 and the IOLMaster 700 show strong agreement in biometry measurements and IOL power prediction by the BU-II formula using either standard or total corneal keratometry and can be used interchangeably.

A Review of the Use of Confidence Intervals for Bland-Altman Limits of Agreement in Optometry and Vision Science

SIGNIFICANCE

Confidence intervals are still seldom reported for Bland-Altman 95% limits of agreement. When they are reported, 50% of articles use approximate methods and 50% use exact methods.

PURPOSE

Bland-Altman limits of agreement can be unreliable estimates, especially for small sample sizes. However, authors seldom use confidence intervals for limits of agreement. This article reviews their use in Optometry and Vision Science.

METHODS

A keyword search for "Bland," "Altman," "Bland-Altman," "LoA," and "limits of agreement" was conducted on the Optometry and Vision Science website within a time range from January 2016 to December 2018.

RESULTS

Fifty articles were reported or were judged to use Bland-Altman analysis; sample sizes ranged from 3 to 2072. Eight of these article reported confidence limits for limits of agreement, four of which used exact methods and four used Bland and Altman's approximate method.

CONCLUSIONS

Use of confidence intervals for limits of agreement has increased in Optometry and Vision Science but is far from universal. To assist researchers in calculating exact confidence limits for Bland-Altman limits of agreement, spreadsheets are included for performing the calculations and generating Bland-Altman plots with the confidence intervals included.

Intrasession Repeatability of Biometric Measurements Obtained with a Low-Coherence Interferometry System in Pseudophakic Eyes

Purpose: To evaluate the intrasession repeatability of the biometric measurements obtained with a low-coherence reflectometry optical biometer in pseudophakic eyes implanted with two different types of intraocular lens (IOL).Methods: Prospective, single-center, comparative study including 69 eyes of 69 patients with ages ranging from 51 to 92 years. Previous uncomplicated cataract surgery had been performed in all patients 1 to 2 months before measurements, with implantation of the Acrysof SN60WF IOL in 35 eyes (35 patients, group 1) and the IOL Akreos MI60 in 34 eyes (34 patients, group 2). A complete postoperative ophthalmological examination was performed including three consecutive measurements with the "Aladdin" system from (Topcon, Japan). Intrasession repeatability of axial length (AXL), anterior chamber depth (ACD) and IOL thickness (IOLT) were assessed with the within-subject standard deviation (S_w), intraobserver precision (1.96 × S_w), coefficient of variation (CV) and intraclass correlation coefficient (ICC). Results: The S_w for AXL measurements was 0.03 and 0.05 mm in groups 1 and 2, respectively, with ICC of 1.000 and 0.999 (CV: 0.14% and 0.22%) (p ≤ 0.031). Concerning pseudophakic ACD, the S_w was 0.03 and 0.09 mm in groups 1 and 2, respectively, with ICC of 0.992 and 0.956 (CV: 0.55% and 1.75%) (p ≤ 0.021). The variability of IOLT measurements was high in both groups, with S_w of 0.12 and 0.29 mm for groups 1 and 2 (p = .008), respectively, and ICC of 0.065 and 0.770 (CV: 20.84% and 62.39%).Conclusions: The optical biometer "Aladdin" (Topcon, Japan) provides consistent measurements of AXL and ACD in pseudophakic eyes. However, there is a limitation in the consistency of IOLT measurements that should be investigated further.

Post-operative Refractive Prediction Error After Phacovitrectomy: A Retrospective Study

Introduction

Many authors have reported on a myopic post-operative refractive prediction error when combining phacoemulsification with pars plana vitrectomy (phacovitrectomy). In this study we evaluate the amount of this error in our facility and try to elucidate the various factors involved.

Methods

This was a retrospective study which included 140 patients who underwent phacovitrectomy (39 with macular holes, 88 with puckers, and 13 with floaters). Post-operative refractive error was defined as the difference between the actual spherical equivalent (SEQ) and expected SEQ based on the SRK/T and Holladay-II formulas. Both univariate (paired t test, independent t test, one-way analysis of variance, or Mann–Whitney test) and multivariate (regression analysis) statistical analyses were performed.

Results

Overall, a refractive error of − 0.13 dpt (p = 0.033) and − 0.26 dpt (p < 0.01) were found in the SRK/T and Holladay-II formulas, respectively. For the independent diagnoses, only macular holes showed a myopic error with the SRK/T (− 0.31 dpt; p < 0.01) and Holladay-II (− 0.44 dpt; p < 0.01) formulas. In univariate analysis, significant factors involved in myopic refractive error were macular hole as diagnosis (p < 0.01 for SRK/T and Holladay-II), gas tamponade (SRK/T p = 0.024; Holladay-II p = 0.025), pre-operative myopia (p < 0.01 for SRK/T), and optical technique for axial length measurement (SRK/T and Holladay-II p < 0.01). In the multivariate analysis, pre-operative axial length (p = 0.026), optical technique for axial length measurement (p < 0.01), and pre-operative SEQ (p < 0.01) were independent predictors for myopic refractive error in the SRK/T formula. For the Holladay-II formula, optical technique for axial length measurement (p < 0.01) and pre-operative SEQ (p = 0.04) were predictive.

Conclusion

Various factors are involved in determining the myopic refractive error after phacovitrectomy. Not every factor seems to be as important in each individual patient, suggesting a more tailored approach is warranted to overcome this problem.