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Gatinel D, Hoffmann PC, Cooke DL, Chingan A, Debellemanière G, Langenbucher A, Wendelstein JA. Leaving trusted paths: Estimating corneal keratometric index in cataract surgery eyes with zero-power implants. Graefes Arch Clin Exp Ophthalmol 2024; 262:2533-2539. [PMID: 38456928 DOI: 10.1007/s00417-024-06435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/27/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE This study aimed to estimate the corneal keratometric index in the eyes of cataract surgery patients who received zero-power intraocular lenses (IOLs). METHODOLOGY This retrospective study analyzed postoperative equivalent spherical refraction and axial length, mean anterior curvature radius and aqueous humor refractive index to calculate the theoretical corneal keratometric index value (nk). Data was collected from 2 centers located in France and Germany. RESULTS Thirty-six eyes were analyzed. The results revealed a mean corneal keratometric index of 1.329 ± 0.005 for traditional axial length (AL) and 1.331 ± 0.005 for Cooke modified axial length (CMAL). Results ranged from minimum values of 1.318/1.320 to maximum values of 1.340/1.340. CONCLUSION The corneal keratometric index is a crucial parameter for ophthalmic procedures and calculations, particularly for IOL power calculation. Notably, the estimated corneal keratometric index value of 1.329/1.331 in this study is lower than the commonly used 1.3375 index. These findings align with recent research demonstrating that the theoretical corneal keratometric index should be approximately 1.329 using traditional AL and 1.331 using CMAL, based on the ratio between the mean anterior and posterior corneal curvature radii (1.22).
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Affiliation(s)
| | | | - David L Cooke
- Great Lakes Eye Care, 2848 Niles Road, Saint Joseph, MI, 49085, USA
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, 965 Wilson Rd, East Lansing, MI, 48824, USA
| | | | | | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Kirrberger Str. 100/22, 66424, Homburg, Germany
| | - Jascha A Wendelstein
- Institute of Experimental Ophthalmology, Saarland University, Kirrberger Str. 100/22, 66424, Homburg, Germany.
- Institut Für Refraktive Und Ophthalmo-Chirurgie (IROC), Stockerstrasse 37, CH-8002, Zurich, Switzerland.
- Department for Ophthalmology and Optometry, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
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Langenbucher A, Hoffmann P, Cayless A, Wendelstein J, Szentmáry N. Evaluation of corneal power from an AS-OCT thick lens model and ray tracing: reliability of the keratometer index. J Cataract Refract Surg 2024; 50:360-368. [PMID: 37962174 DOI: 10.1097/j.jcrs.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To investigate and compare different strategies of corneal power calculations using keratometry, paraxial thick lens calculations and ray tracing. SETTING Tertiary care center. DESIGN Retrospective single-center consecutive case series. METHODS Using a dataset with 9780 eyes of 9780 patients from a cataractous population the corneal front (Ra/Qa) and back (Rp/Qp) surface radius/asphericity, central corneal thickness (CCT), and entrance pupil size (PUP) were recorded using the Casia 2 tomographer. Beside keratometry with the Zeiss (PK Z ) and Javal (PK J ) keratometer index, a thick lens paraxial formula (PG) and ray tracing (PR) was implemented to extract corneal power for pupil sizes from 2 mm to 5 mm in steps of 1 mm and PUP. RESULTS With PUP PK Z /PK J overestimates the paraxial corneal power PG in around 97%/99% of cases and PR in around 80% to 85%/99%. PR is around 1/6 or 5/6 diopters (D) lower compared with PK Z or PK J . For a 2 mm pupil PR is around 0.20/0.91 D lower compared with PK Z /PK J and for a 5 mm pupil PR is comparable with PK Z (around 0.03 D lower) but around 0.70 to 0.75 D lower than PK J . CONCLUSIONS "True" values of corneal power are mostly required in lens power calculations before cataract surgery, and overestimation of corneal power could induce trend errors in refractive outcome with axial length and lens power if compensated with the effective lens position.
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Affiliation(s)
- Achim Langenbucher
- From the Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany (Langenbucher, Wendelstein); Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany (Hoffmann); School of Physical Sciences, The Open University, Milton Keynes, United Kingdom (Cayless); Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria (Wendelstein); Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany (Szentmáry); Department of Ophthalmology, Semmelweis-University, Budapest, Hungary (Szentmáry)
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Wendelstein JA, Hoffmann PC, Hoffer KJ, Langenbucher A, Findl O, Ruiss M, Bolz M, Riaz KM, Pantanelli SM, Debellemanière G, Gatinel D, Cooke DL, Galzignato A, Yeo TK, Seiler TG, Zinkernagel M, Savini G. Differences Between Keratometry and Total Keratometry Measurements in a Large Dataset Obtained With a Modern Swept Source Optical Coherence Tomography Biometer. Am J Ophthalmol 2024; 260:102-114. [PMID: 38092314 DOI: 10.1016/j.ajo.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE This study aimed to explore the concept of total keratometry (TK) by analyzing extensive international datasets representing diverse ethnic backgrounds. The primary objective was to quantify the disparities between traditional keratometry (K) and TK values in normal eyes and assess their impact on intraocular lens (IOL) power calculations using various formulas. DESIGN Retrospective multicenter intra-instrument reliability analysis. METHODS The study involved the analysis of biometry data collected from ten international centers across Europe, the United States, and Asia. Corneal power was expressed as equivalent power and astigmatic vector components for both K and TK values. The study assessed the influence of these differences on IOL power calculations using different formulas. The results were analyzed and plotted using Bland-Altman and double angle plots. RESULTS The study encompassed a total of 116,982 measurements from 57,862 right eyes and 59,120 left eyes. The analysis revealed a high level of agreement between K and TK values, with 93.98% of eyes exhibiting an absolute difference of 0.25 D or less. Astigmatism vector differences exceeding 0.25 D and 0.50 D were observed in 39.43% and 1.08% of eyes, respectively. CONCLUSIONS This large-scale study underscores the similarity between mean K and TK values in healthy eyes, with rare clinical implications for IOL power calculation. Noteworthy differences were observed in astigmatism values between K and TK. Future investigations should delve into the practicality of TK values for astigmatism correction and their implications for surgical outcomes.
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Affiliation(s)
- Jascha A Wendelstein
- From the Institut für Refraktive und Ophthalmo-Chirurgie (IROC) (J.A.W., T.G.S.), Zurich, Switzerland; Department for Ophthalmology and Optometry (J.A.W., M.B.), Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz (J.A.W., M.B.), Linz, Austria; Institute of Experimental Ophthalmology (J.A.W., A.L.), Saarland University, Homburg, Germany.
| | | | - Kenneth J Hoffer
- Stein Eye Institute (K.J.H.), University of California, Los Angeles, California, CA, USA; St. Mary's Eye Center (K.J.H.), Santa Monica, California, CA, USA
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology (J.A.W., A.L.), Saarland University, Homburg, Germany
| | - Oliver Findl
- Department of Ophthalmology (O.F., M.R.), Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), Vienna, Austria
| | - Manuel Ruiss
- Department of Ophthalmology (O.F., M.R.), Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), Vienna, Austria
| | - Matthias Bolz
- Department for Ophthalmology and Optometry (J.A.W., M.B.), Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz (J.A.W., M.B.), Linz, Austria
| | - Kamran M Riaz
- Dean A. McGee Eye Institute, University of Oklahoma (K.M.R.), Oklahoma City, OK, USA
| | - Seth M Pantanelli
- Department of Ophthalmology (S.M.P.), Penn State College of Medicine, Hershey, PA, USA
| | | | - Damien Gatinel
- Rothschild Foundation Hospital (G.D., D.G.), Department of Ophthalmology, Paris, France
| | - David L Cooke
- Great Lakes Eye Care (D.L.C.), Saint Joseph, MI, USA; Department of Neurology and Ophthalmology (D.L.C.), Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | | | - Tun Kuan Yeo
- Tan Tock Seng Hospital (T.K.Y.), Department of Ophthalmology, Singapore, Singapore
| | - Theo G Seiler
- From the Institut für Refraktive und Ophthalmo-Chirurgie (IROC) (J.A.W., T.G.S.), Zurich, Switzerland; Inselspital Bern (T.G.S., M.Z.), Universitätsklinik für Augenheilkunde, Bern, Switzerland; Klinik für Augenheilkunde (T.G.S.), Universitätsklinikum Düsseldorf, Duesseldorf, Germany
| | - Martin Zinkernagel
- Inselspital Bern (T.G.S., M.Z.), Universitätsklinik für Augenheilkunde, Bern, Switzerland
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Wendelstein J, Casazza M, Riaz KM, Fischinger I, Fuchs B, Bolz M, Seiler TG, Kohnen T, Langenbucher A. Characteristics of surgically induced astigmatism after standardized microincisional cataract surgery with a superior limbal incision. J Cataract Refract Surg 2023; 49:1025-1035. [PMID: 37532255 DOI: 10.1097/j.jcrs.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To determine (1) if measurements of surgically induced astigmatism (SIA) as measured by keratometry (K) and total keratometry (TK) differ (2) if SIA affects the magnitude and/or meridian of keratometric astigmatism (3) if SIA evolves over time. SETTING Tertiary care center. DESIGN Retrospective data analysis. METHODS A swept-source optical coherence tomography biometry dataset (IOLMaster700) consisting of 498 eyes (327 patients) from a tertiary care center was analyzed. For all eyes preoperative and postoperative biometric measurements at 1-month, 3-month, and 6-months postoperative visits were considered for vector analysis of SIA K and SIA TK . RESULTS Centroids in right and left eyes were 0.26 diopters (D) @5 degrees/0.31 D @1 degree for SIA K and 0.27 D @4 degrees/0.34 D @1 degree for SIA TK . Centroids for difference vectors K-TK in right and left eyes were 0.02 D @ 176 degrees/0.03 D @6 degrees. The mean SIA magnitudes in right and left eyes were 0.48 ± 0.41 D and 0.50 ± 0.37 D for SIA K and 0.53 ± 0.42 D and 0.54 ± 0.40 D for SIA TK . In eyes with ATR astigmatism, an increase in postoperative astigmatism magnitude was more common than a decrease. More than 30% of eyes showed changes in the meridian of more than 15 degrees. CONCLUSIONS Overall, we observed differences in K- and TK-derived SIA, and changes in SIA magnitude over time. For postsurgical interventions, postoperative astigmatism meridian values should be measured to base treatments. Astigmatism magnitude showed a tendency to decrease for steep-meridian incisions and to increase in flat-meridian incisions.
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Affiliation(s)
- Jascha Wendelstein
- From the Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Linz, Austria (Wendelstein, Casazza, Fischinger, Fuchs, Bolz); Johannes Kepler University Linz, Medical Faculty, Linz, Austria (Wendelstein, Casazza, Fischinger, Fuchs, Bolz); Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany (Wendelstein, Langenbucher); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Ophthalmology, Augentagesklinik Spreebogen Berlin, Berlin, Germany (Fischinger); Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland (Wendelstein, Seiler); Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Duesseldorf, Germany (Seiler); Universitätsklinik für Augenheilkunde, Inselspital Bern, Bern, Switzerland (Seiler); Department of Ophthalmology, Goethe University, Frankfurt, Germany (Kohnen)
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Langenbucher A, Eppig T, Cayless A, Gatzioufas Z, Wendelstein J, Hoffmann P, Szentmáry N. Simulation of Corneal imaging properties for near objects. Ophthalmic Physiol Opt 2021; 41:1152-1160. [PMID: 34418877 DOI: 10.1111/opo.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Using raytracing simulation to study the effect of corneal imaging metrics for different aperture sizes as a function of object distances with different schematic model eyes. METHODS This raytracing simulation determined the best focus (with the least root-mean-square (rms) ray scatter) and the best wavefront focus (with least rms wavefront error) for four schematic model eyes (Liou-Brennan (LBME), Atchison (ATCHME), Gullstrand (GULLME) and Navarro (NAVME)) with 4 aperture sizes (2-5 mm) and 30 object distances in a logscale from 10 cm to 10 m plus infinity. For each configuration, 10,000 rays were traced through the cornea, and the aperture stop was located at the lens front apex plane as described in the model eyes. The wavefront was decomposed into Zernike components to extract the spherical aberration term. RESULTS The focal distance with respect to the corneal front apex increases from around 31 mm for objects at infinity to around 40 mm for objects at 10 cm. The best (wavefront) focus was systematically closer to the cornea compared with the paraxial focus, and the overestimation of focal length with the paraxial focus was larger for large aperture sizes and small object distances. The rms ray scatter and wavefront error were both systematically larger with large aperture and small object sizes. At best focus the rms wavefront error was systematically larger, and the rms ray scatter was systematically smaller compared to the best wavefront focus. Spherical aberration varied more with GULLME than with LBME or NAVME, and increased strongly at smaller object distances. CONCLUSIONS The imaging properties of the cornea, especially spherical aberration, increase strongly as the object distance decreases. This effect should be considered, especially when considering aberration correcting lenses for near vision such as multifocal or enhanced depth of focus lenses.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Timo Eppig
- Department of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Jascha Wendelstein
- Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria
| | - Peter Hoffmann
- Augen- und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
| | - Nóra Szentmáry
- Dr Rolf M Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis-University, Budapest, Hungary
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