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Romero-Valero D, Martínez-Toldos JJ, Alió JL. Method to guide toric intraocular lens realignment based on vectorial analysis of astigmatism. J Cataract Refract Surg 2024; 50:538-539. [PMID: 38651700 DOI: 10.1097/j.jcrs.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/09/2023] [Indexed: 04/25/2024]
Affiliation(s)
- Daniel Romero-Valero
- From the Department of Opthalmology, General University Hospital of Elche, Elche, Spain (Romero-Valero, Martínez-Toldos); VISSUM Ophthalmological Institut of Alicante, Alicante, Spain (Alió)
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Barber KM, O’Connor S, Mackinder P, Chih A, Jones B. Rotational stability and refractive outcomes of the DFT/DATx15 toric, extended depth of focus intraocular lens. Int Ophthalmol 2023; 43:2737-2747. [PMID: 36894823 PMCID: PMC10371906 DOI: 10.1007/s10792-023-02673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To quantitatively assess postoperative rotational stability and visual acuity with the DFT/DATx15 extended depth of focus (EDOF) toric intraocular lens (IOL). METHODS In this prospective case series, thirty-five patients with a calculated IOL power between + 15.0 D and + 25.0 D, corneal astigmatism between 0.75 D and 2.25 D, and no significant ocular pathology underwent cataract surgery. Primary outcome was rotational stability of the IOL at 1 month post-operatively. Secondary outcomes included residual refractive astigmatism, absolute residual astigmatism prediction error, and monocular distance and intermediate visual acuities. RESULTS Mean absolute postoperative IOL rotation was 1.1 ± 0.2 degrees, with no rotation of more than 3 degrees at the final visit. Monocular mean best spectacle-corrected distance visual acuity (BSCDVA) improved from logMAR 0.27 ± 0.030 to 0.078 ± 0.017 (P < .001). Monocular uncorrected distance visual acuity (UCDVA) improved from 0.93 ± 0.096 to 0.18 ± 0.022 (P < .001). Best spectacle-corrected intermediate visual acuity (DSCIVA) was 0.17 ± 0.025, and uncorrected intermediate visual acuity (UCIVA) was 0.27 ± 0.040. Residual regular astigmatic refractive error was 0.21 ± 0.047 D. CONCLUSIONS The toric DFT/DATx15 EDOF lens showed excellent rotational stability and effective and predictable correction of astigmatism. Its refractive outcomes and safety profile were similar to those identified in prior studies of the non-toric DFT/DAT015 EDOF IOL. A small difference in monocular BSCDVA, of uncertain clinical significance, was found when comparing these outcomes with prior DFT/DAT015 data. The trial was retrospectively registered on November 5, 2021 (TRN NCT05119127).
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Affiliation(s)
- Kevin M. Barber
- Central Florida Eye Specialists, 968 International Parkway, Lake Mary, FL 32746 USA
| | - Sara O’Connor
- Central Florida Eye Specialists, 968 International Parkway, Lake Mary, FL 32746 USA
| | - Philip Mackinder
- Central Florida Eye Specialists, 968 International Parkway, Lake Mary, FL 32746 USA
| | - Andreea Chih
- Central Florida Eye Specialists, 968 International Parkway, Lake Mary, FL 32746 USA
| | - Brian Jones
- Central Florida Eye Specialists, 968 International Parkway, Lake Mary, FL 32746 USA
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Kaufman AR, Pineda R. Intraoperative aberrometry: an update on applications and outcomes. Curr Opin Ophthalmol 2023; 34:48-57. [PMID: 36484210 DOI: 10.1097/icu.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Aaron R Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Liu W, Yang L, Liu J. The Impact of Posterior Corneal Astigmatism on Surgically Induced Astigmatism in Cataract Surgery. Int J Gen Med 2022; 15:8417-8425. [PMID: 36465271 PMCID: PMC9718375 DOI: 10.2147/ijgm.s382774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 11/05/2023] Open
Abstract
PURPOSE This study aimed to evaluate the changes in posterior corneal astigmatism after cataract surgery and provide a theoretical basis to accurately evaluate the total corneal astigmatism (TA) to be corrected before toric intraocular lens (IOL) implantation. PATIENTS AND METHODS Sixty-two patients (89 eyes) who underwent phacoemulsification combined with toric IOL implantation (AcrySof IQ Toric SN6AT2-T9) at Shanxi Eye Hospital between January 2017 and September 2018 were enrolled. Surgically induced astigmatism of the posterior cornea (SIAPA) was analysed using vector analysis during pentacam examination. RESULTS The vector variances of keratometric astigmatism (KA), TA, and posterior corneal astigmatism (PA) preoperatively and postoperatively in the "with-the-rule (WTR) astigmatism" group and "overall patient" group were statistically significant (P < 0.05). A statistically significant difference was observed between surgically induced KA (SIAKA) and surgically induced astigmatism of the total cornea (SIATA) for all patients, including those with WTR astigmatism. For all patients, SIAKA was less than SIATA by 0.05 ± 0.21 D, and for patients with WTR astigmatism, SIAKA was less than SIATA by 0.09 ± 0.22 D. For patients in the "against-the-rule (ATR) astigmatism" group, there were no statistically significant differences between SIAKA and SIATA, although SIAKA was greater than SIATA by 0.03 ± 0.18 D. When PA ≤0.4 D or KA ≤2.0 D, SIAPA can be ignored. However, when PA >0.4 D or KA >2.0 D, ignoring SIAPA caused by cataract surgery incision will cause SIAKA in patients with WTR astigmatism to underestimate SIATA, while SIAKA in patients with ATR astigmatism will cause an overestimation of SIATA. CONCLUSION SIA on the posterior corneal astigmatism may have a significant role on more precise planning of toric IOL implantation, especially in cases with higher preoperative anterior or posterior corneal astigmatism.
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Affiliation(s)
- Wenjie Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Lichun Yang
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Jiewei Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
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Llorens-Quintana C, Lee DJ, Pavlatos E, Chamberlain W, Huang D, Li Y. Measuring corneal astigmatism using OCT in keratoconus. J Cataract Refract Surg 2022; 48:1285-1291. [PMID: 35616503 PMCID: PMC10414777 DOI: 10.1097/j.jcrs.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To measure net corneal astigmatism using optical coherence tomography (OCT) (Avanti) in individuals with keratoconus and compare the repeatability and accuracy with those obtained using Scheimpflug imaging (Pentacam HR). SETTING Casey Eye Institute, Portland, Oregon. DESIGN Prospective cross-sectional observational study. METHODS Net corneal astigmatism was calculated in keratoconic and normal eyes using OCT and Scheimpflug imaging with 4 settings-pupil or vertex centration settings with a 3 or 4 mm circular analytical zone. Corneal elevation maps were obtained from OCT images and fitted with the Zernike polynomials to obtain net corneal astigmatism. Manifest refraction astigmatism was used to evaluate the accuracy of net corneal astigmatism measurements. The coefficient of repeatability from 2 repeated measures was calculated. RESULTS 46 eyes with manifest or subclinical keratoconus and 52 normal control eyes were analyzed. For OCT measurements in keratoconus, better accuracy was achieved with pupil centration and 3 mm analytical zone; however, better repeatability was achieved with vertex centration and 4 mm analytical zone (coefficient of repeatability = 0.53 diopters, the Fligner-Killeen test with Bonferroni adjustment P < .0017). Agreement with manifest refraction was significantly better with OCT compared with that using Pentacam HR (generalized mixed-effect model with Bonferroni adjustment P < .00625). No statistically significant difference was found between instruments or settings in control eyes. CONCLUSIONS OCT was able to measure net corneal astigmatism with better accuracy and precision in keratoconic eyes than the Pentacam HR. Measurements may be more accurate using pupil centration and a smaller analytical zone in patients with keratoconus.
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Llorens-Quintana C, Pavlatos E, Thaware O, Gupta S, Gradin D, Romfh D, Li Y, Huang D. Accuracy of OCT-derived net corneal astigmatism measurement. J Cataract Refract Surg 2022; 48:267-274. [PMID: 34326282 PMCID: PMC8792105 DOI: 10.1097/j.jcrs.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/21/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the repeatability and accuracy of corneal astigmatism measurement with a spectral-domain optical coherence tomography (OCT) system (Avanti, Optovue) and compare them with Scheimpflug imaging (Pentacam HR, Oculus) and swept-source optical biometry (IOLMaster 700, Carl Zeiss Meditec AG). SETTING Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. DESIGN Prospective cross-sectional observational study. METHODS 60 pseudophakic eyes with monofocal nontoric intraocular lens that previously had refractive surgery were analyzed. To assess accuracy, simulated keratometry (SimK) and net corneal astigmatism, obtained from each device, were compared with subjective manifest refraction astigmatism. Repeatability for corneal astigmatism was assessed for OCT and Pentacam HR by the coefficient of repeatability from 3 repeated measures. RESULTS Compared with manifest refraction, SimK readings produced with-the-rule astigmatic bias that was reduced for net astigmatism for the 3 devices. Except for OCT net astigmatism, all instruments significantly overestimated the magnitude of the astigmatism (linear mixed-effects model [LMM], P < .05). OCT net astigmatism showed the highest accuracy for manifest astigmatism prediction with the smaller 95% confidence ellipse for the mean difference vector. OCT net mean absolute difference was 0.57 diopters (D), significantly smaller than that of the other modalities (LMM, P < .05). Net corneal astigmatism measured with OCT showed the best repeatability (coefficient of repeatability = 0.29 D). CONCLUSIONS OCT has the capability to measure net corneal astigmatism with higher precision and accuracy than Pentacam HR Scheimpflug imaging and IOLMaster 700 swept-source optical biometry in postrefractive subjects.
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Affiliation(s)
- Clara Llorens-Quintana
- From the Casey Eye Institute and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
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Abulafia A, Rein AP, Weill Y, Zadok D, Mourits MP, Lapid-Gortzak R. Comparison of corneal surgically induced astigmatism calculations based on keratometry measurements made by 2 biometric devices. J Cataract Refract Surg 2021; 47:1542-1547. [PMID: 33974371 DOI: 10.1097/j.jcrs.0000000000000671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare calculated corneal surgically induced astigmatism (SIA) by means of anterior-based keratometry (K) and total keratometry (TK) measurements made by 2 biometric devices. SETTING Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN Retrospective, consecutive case series. METHODS The medical records of patients who had undergone cataract surgery through a 2.4 mm temporal clear corneal incision by a single surgeon between March 2018 and November 2020 were retrospectively reviewed. Patients for whom there were preoperative and postoperative K measurements assessed by 2 biometric devices, optical low-coherence reflectometry (OLCR) (Lenstar LS900, Haag-Streit, software v. eye suite i/9.1.0.0) and swept-source optical coherence tomography (SS-OCT) (IOLMaster700, Carl Zeiss Meditec AG, software v. 1.80.6.60340), were identified. Corneal SIA (mean vector value) was calculated by vector analysis for 3 groups: SS-OCT(K), SS-OCT(TK), and OLCR(K). Bivariate analyses were applied for comparisons. RESULTS 147 eyes of 123 patients (73 right eyes and 74 left eyes) were enrolled in the study. The right eye corneal SIA values were 0.09 diopters (D) @ 136 degrees, 0.09 D @ 141 degrees, and 0.07 D @ 123 degrees for the SS-OCT(K), SS-OCT(TK), and OLCR, respectively. The corresponding left eye corneal SIA values were 0.13 D @ 120 degrees, 0.11 D @ 123 degrees, and 0.08 D @ 120 degrees. There were no statistically significant differences between the mean vector value and variance of the corneal SIA for the right (P = .78 and P = .65) and the left (P = .75 and P = .37) eyes of the 3 groups. CONCLUSIONS Corneal SIA values were low (0.07 to 0.13 D) and similar for the SS-OCT and the OLCR biometric devices with standard K measurements. TK measurements yielded similar corneal SIA values compared with anterior corneal-based measurements.
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Affiliation(s)
- Adi Abulafia
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel (Abulafia, Rein, Weill, Zadok); Department of Ophthalmology, Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands (Mourits, Lapid-Gortzak)
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Chang SW, Wu WL. Age affects intraocular lens attributes preference in cataract surgery. Taiwan J Ophthalmol 2021; 11:280-286. [PMID: 34703744 PMCID: PMC8493983 DOI: 10.4103/tjo.tjo_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/15/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aim of this study is to analyze the effects of age on intraocular lens (IOL) attributes preference. MATERIALS AND METHODS We enrolled 4213 eyes that underwent smooth phacoemulsification and IOL implantation between January 2005 and June 2018. Patients were subdivided into six groups according to their ages, i.e.,≤40, 41-50, 51-60, 61-70, 71-80, and ≥ 81 years old. The difference in preference of IOL attributes regarding age, gender, and year of surgery was analyzed separately. The analyzed IOL attributes included asphericity, astigmatism-correction, presbyopia-correction, and blue-blocking function. RESULTS The patients averaged 68.3 ± 11.6 years old at the time of surgery. There was no significant difference in age between males and females. There were 1980 patients (47.0%) selected aspheric IOL, 822 patients (19.5%) selected multifocal (MF) IOL, 93 patients (2.2%) selected toric IOL, and 859 patients (20.4%) selected blue-blocking IOL. Adoption of aspheric and MF IOL increased significantly during the study (P < 0.001 for both attributes). There were more young patients selected aspheric and MF IOL (P < 0.001 for both), and the change in the trend of adoption over the years was also most significant in the young group (P < 0.001 for both). The proportion of patients that selected blue-blocking IOL decreased significantly after 2011 (P < 0.001). There was no gender preference in aspheric, MF, and toric IOL selection. However, there were more male patients selected blue-blocking IOL (P = 0.018). CONCLUSION The adoption of IOLs with emerging technologies increased significantly over the years. Younger adults tended to adopt advanced technology IOL more than the older ones.
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Affiliation(s)
- Shu-Wen Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Lin Wu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taipei, Taiwan
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Georgiev S, Hirnschall N, Fişuş AD, Ruiss M, Hienert J, Leisser C, Findl O. Repeatability of intraoperative Hartmann-Shack wavefront sensing in cataract surgery. J Cataract Refract Surg 2021; 47:902-906. [PMID: 33315741 DOI: 10.1097/j.jcrs.0000000000000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the repeatability of aphakic intraoperative wavefront aberrometry and compare it with preoperative and postoperative aberrometry. SETTING Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. DESIGN Prospective case series. METHODS Patients scheduled for cataract surgery were each measured 3 consecutive times using Hartmann-Shack wavefront sensing (HS-WFS) preoperatively, intraoperatively in aphakia, and 2 months postoperatively after intraocular lens implantation by a single examiner. Intraclass correlation coefficients (ICCs) of spherical equivalent (SE) values were evaluated for each timepoint. Intrasubject standard deviation (Sw) as repeatability (Sr) with corresponding repeatability limit () and mean SE differences with corresponding limits of agreement (LoA) were calculated for comparison. RESULTS A high consistency of repeated measurements was found with ICCs above 0.9 for each of the 3 timepoints. Intraobserver repeatability (Sr) and repeatability limit (r) of intraoperative aberrometry SE measurements (30 eyes of 30 patients) were 0.34 diopters (D) and 0.95 D, respectively. The LoA for intraoperative aphakic SE across 3 consecutive measurements were -0.71 to +0.85 D. For comparison, Sr and r for phakic preoperative measurements in the cataractous state (30 eyes of 30 patients) and postoperative measurements in the pseudophakic state (24 eyes of 24 patients) were 0.33 D and 0.93 D and 0.23 D and 0.64 D, respectively. Similarly, the LoA for preoperative and postoperative SE measurements were -0.66 to +0.60 D and -0.27 to +0.45 D, respectively. CONCLUSIONS HS-WFS test-retest reliability was high for all 3 timepoints, but the intraoperative setting resulted in a lower repeatability and broadened the agreement range.
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Affiliation(s)
- Stefan Georgiev
- From the VIROS-Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Lu LW, Rocha-de-Lossada C, Rachwani-Anil R, Flikier S, Flikier D. The role of posterior corneal power in 21st century biometry: A review. J Fr Ophtalmol 2021; 44:1052-1058. [PMID: 34148699 DOI: 10.1016/j.jfo.2020.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE Intraocular lens (IOL) calculation and biometry have evolved significantly in recent decades. However, present outcomes are still suboptimal. Our objective is to summarize the results reported in the literature with regard to a new variable, the value of the relationship between anterior and posterior corneal curvature in the biometric calculation of IOL power. METHODS We have created a narrative revision of the existing evidence regarding the posterior to anterior corneal curvature ratio in IOL calculation. RESULTS The corneal posterior/anterior ratio (P/A ratio), also called Gullstrand ratio, has a standard deviation of 2.4% in normal people, hence causing a possible IOL power miscalculation error of up to 0.75 diopters (D). This error is magnified in pathological corneas or in those with previous refractive surgery. Including the P/A ratio in the IOL formula reduces errors in the calculation of IOL power. CONCLUSIONS Measurement of the posterior corneal surface should be recommended prior to IOL calculation, given the demonstrated results regarding the P/A ratio for IOL power calculation. Regarding toric IOL calculation, we suggest incorporation of all internal astigmatic vectors, for instance, posterior corneal surface, IOL tilt induced toricity, and retinal astigmatism. All of these factors may improve surgical outcomes.
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Affiliation(s)
- L W Lu
- Arizona State University, Tempe, Arizona, USA; Cayetano Heredia University School of Medicine, Department of Ophthalmology, San Martín de Porres, Peru
| | - C Rocha-de-Lossada
- Department of Ophthalmology (QVision), Vithas Almería, Spain; University Hospital Virgen de las Nieves, Granada, Spain; Ceuta Medical Center, Spain
| | - R Rachwani-Anil
- Hospital Regional Universitario de Málaga, Ophthalmology Department, Málaga, Spain.
| | - S Flikier
- Instituto de Cirugía Ocular, San José, Costa Rica
| | - D Flikier
- Instituto de Cirugía Ocular, San José, Costa Rica
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Langenbucher A, Schrecker J, Schwemm M, Eppig T, Schröder S, Szentmáry N. [Monte Carlo simulation of biometric effect sizes and their influence on the translational ratio of corneal astigmatism in the cylinders of toric intraocular lenses]. Ophthalmologe 2021; 118:569-577. [PMID: 32767100 PMCID: PMC8187219 DOI: 10.1007/s00347-020-01199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hintergrund und Zielsetzung Torische Kapselsacklinsen bieten heutzutage eine zuverlässige Option der permanenten Korrektur eines Hornhautastigmatismus. Zur Ermittlung der für den gewünschten Ausgleich erforderlichen Linsenstärke kann der Operateur entweder auf die in seinem Biometriegerät implementierten Berechnungsmodi oder auf den vom Linsenhersteller angebotenen Kalkulationsservice zurückgreifen. In vielen Fällen wird dabei allerdings keine klassische Linsenberechnung aus biometrischen Daten durchgeführt, sondern nur mit einer vereinfachten Abschätzung gearbeitet, die den Hornhautastigmatismus in den Torus der tIOL übersetzt. Dieses dann zumeist als durchschnittlicher Standardwert genutzte Übersetzungsverhältnis kann jedoch eine erhebliche Schwankungsbreite aufweisen, sodass im ungünstigsten Fall eine Unterkorrektur des refraktiven Zylinders um bis zu 12,5 % oder eine Überkorrektur um bis zu 17 % resultieren kann. Ziel dieser Studie war es aufzuzeigen, welche biometrischen Einflussgrößen das Verhältnis zwischen dem zu korrigierenden Hornhautastigmatismus und dem für dessen Vollkorrektur notwendigen Torus einer Kapselsacklinse bestimmen. Methoden Aus der WEB-Plattform IOLCon wurden 16.744 Datensätze extrahiert, und anhand der präoperativen biometrischen Größen und dem postoperativen sphärischen Äquivalent wurde zunächst die axiale Position der Kapselsacklinse formelunabhängig abgeleitet. Anschließend wurde, basierend auf der Propagation sphärozylindrischer Vergenzen, der entsprechende Brechwert einer emmetropisierenden Kapselsacklinse ermittelt. Das Übersetzungsverhältnis als Quotient aus dem Torus der Linse und dem Hornhautastigmatismus wurde mit einer Monte-Carlo-Simulation auf seine potenziellen Einflussgrößen hin untersucht. Ergebnisse Die Monte-Carlo-Simulation zeigt, dass nicht von einem konstanten Übersetzungsverhältnis ausgegangen werden kann. Für die hier zugrunde gelegten klinischen Fälle ergibt sich ein mittleres Übersetzungsverhältnis von 1,3938 ± 0,0595 (Median 1,3921) mit einer Spannweite von 1,2131 bis 1,5974. Den größten Einfluss hat hierbei die axiale Position der Kapselsacklinse – je weiter posterior sich diese befindet, desto höher ist das Übersetzungsverhältnis. Aufgrund der Korrelation der axialen Linsenposition mit der Augenlänge kann die Augenlänge als indirekte Einflussgröße gewertet werden. Der Äquivalentbrechwert sowie der Astigmatismus der Hornhaut besitzen keinen nennenswerten Effekt auf das Übersetzungsverhältnis. Diskussion In einer ganzen Reihe von Berechnungsmodulen wird die Kalkulation des Torus der Kapselsacklinse dahingehend vereinfacht, dass dieser mittels eines einfachen konstanten Umrechnungsfaktors aus dem gemessenen Hornhautastigmatismus abgeleitet wird. Die vorliegende Studie zeigt jedoch, dass diese Vereinfachung zu deutlich fehlerhaften Ergebnissen führen kann. Dementsprechend wird eine individuelle Berechnung des Torus der IOL aus gemessenen biometrischen Größen (z. B. mittels Vergenzpropagation, Matrizen oder mittels Full-aperture-Raytracing) empfohlen.
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Affiliation(s)
- Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland.
| | - Jens Schrecker
- Klinik für Augenheilkunde, Rudolf-Virchow-Klinikum, Glauchau, Deutschland
| | - Michael Schwemm
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - Timo Eppig
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - S Schröder
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Kirrberger Str., Gebäude 22, 66421, Homburg, Deutschland.,Klinik für Augenheilkunde, Semmelweis-Universität, Mária u. 39, 1085, Budapest, Ungarn
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Kommineni UB, Mohamed A, Vaddavalli PK, Reddy JC. Comparison of total keratometry with corneal power measured by optical low-coherence reflectometry and placido-dual Scheimpflug system. Eur J Ophthalmol 2021; 32:1496-1503. [PMID: 34053330 DOI: 10.1177/11206721211020633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the total keratometry (TK) and astigmatism measurements in eyes with cataract using automated keratometry of swept-source optical coherence tomography (ss-OCT), optical low-coherence reflectometry (OLCR), simulated keratometry (SimK), and total corneal power (TCP) of combined placido-dual Scheimpflug imaging system. SETTING The study was conducted at LV Prasad Eye Institute, Hyderabad, India. DESIGN Retrospective evaluation of electronic medical records of patients who were evaluated for cataract surgery. METHODS Twenty-eight eyes of 28 patients were included in the study. All patients evaluated for cataract surgery underwent corneal power measurements using three devices: ssOCT, OLCR, and combined placido-dual Scheimpflug imaging were included in the study. Vector analysis was performed to evaluate corneal astigmatism and Bland-Altman analysis was conducted to evaluate the limits of agreement of similar parameters among devices. RESULTS The mean TK was statistically significantly different from the keratometry obtained from optical biometers and values measured by the Scheimpflug imaging system. The magnitude of mean difference was greater between TK and TCP (0.75 ± 0.25) compared to other variables. The mean difference in astigmatism between TK, ss-OCT-K (0.09 ± 0.12, p = 0.48), OCLR-K (0.10 ± 0.48, p = 0.91), and TCP (0.09 ± 0.47, p = 0.31) was not statistically significant but was statistically significant between TK and SimK values (0.23D ± 0.49D). The axis of orientation (<20°) of astigmatism was comparable (100%, 28 eyes) between two keratometry variables measured by ss-OCT. CONCLUSION There appears to be a greater correlation of automated keratometry, and TK values obtained from ss-OCT compared to other variables studied. The measurements from TK, Simk, and TCP cannot be used interchangeably.
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Affiliation(s)
- Usha Bhanu Kommineni
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Department of Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Pravin K Vaddavalli
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Jagadesh C Reddy
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Kramer BA, Hardten DR, Berdahl JP. Rotation Characteristics of Three Toric Monofocal Intraocular Lenses. Clin Ophthalmol 2020; 14:4379-4384. [PMID: 33364742 DOI: 10.2147/opth.s285818] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the rotational stability of the three monofocal toric intraocular lenses (IOLs) via data from an online toric IOL back-calculator. Methods A retrospective data review of an online toric IOL back-calculator, which allows users to input preoperative toric planning information, postoperative lens orientation, and subjective refraction. Inputted data were used to determine the optimal orientation of the toric IOL to minimize residual refractive astigmatism. Aggregate data from 3/11/2019 to 3/10/2020 were extracted and validated. Only data with ≥0.5D of residual refractive astigmatism were used in the study. Pre-operative intended IOL orientation and post-operative IOL orientation were used to calculate IOL rotation. Results After validation, 5397 entries were determined to represent patient eyes, of which 3238 represented the three monofocal IOLs evaluated. The rate of rotation for AcrySof, TECNIS, and enVista Toric IOLs was 72.7%, 83.4%, and 83.0%, respectively, and location only significantly impacted TECNIS IOLs. The magnitude of rotation for rotated IOLs was similar for all models and was significantly more for IOLs initially placed in the oblique axis. All IOL models tended to rotate in a counterclockwise direction (53.2%, 73.0%, 69.7%, respectively; p<0.05), and the tendency was greater for IOLs initially located horizontally. Conclusion The AcrySof IQ Toric IOL was more rotationally stable than both the TECNIS and enVista Toric IOLs; there was no significant difference in rotational stability of the latter two.
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Affiliation(s)
- Brent A Kramer
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
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Gundersen KG, Potvin R. Comparing Visual Acuity, Low Contrast Acuity and Refractive Error After Implantation of a Low Cylinder Power Toric Intraocular Lens or a Non-Toric Intraocular Lens. Clin Ophthalmol 2020; 14:3661-3666. [PMID: 33154626 PMCID: PMC7608696 DOI: 10.2147/opth.s281178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare uncorrected and best-corrected visual acuity, low contrast acuity, residual refraction and ocular biometry after low cylinder power toric intraocular lens (IOL) or non-toric IOL implantation. Patients and Methods This was a non-interventional comparative study of visual outcomes after uncomplicated cataract or refractive lens exchange surgery with either a low cylinder (Low_Cyl) or non-toric (Non_Toric) IOL of similar design implanted (AcrySof® T2 IQ Toric IOL and AcrySof® IQ IOL). Subjects in both groups had to have been eligible for the low cylinder IOL based on biometry. They had to have uncorrected distance visual acuity (UDVA) of 20/32 (0.2 logMAR) or better at the time of their single diagnostic study visit. Clinical evaluation included the manifest refraction, visual acuity (VA), low contrast VA and ocular biometry. Results A total of 94 eyes were enrolled, 51 Low_Cyl and 43 Non_Toric. The mean manifest refractive cylinder was statistically significantly lower (~0.25 D) in the Low_Toric group (p < 0.01) and significantly more eyes had 0.25 D or less of refractive cylinder in that group (p = 0.03). The orientation of the preoperative anterior corneal astigmatism was a significant cofactor, with the difference between groups more evident when astigmatism was against the rule. Uncorrected high contrast visual acuity was statistically significantly better in the Low_Toric group (p = 0.02) as was the percentage of eyes with 20/20 visual acuity (p = 0.05). Uncorrected low contrast visual acuity was not statistically significantly different in mesopic or photopic conditions. Conclusion The low cylinder power toric IOL provided better uncorrected visual acuity and lower residual refractive cylinder than a similar non-toric IOL after cataract surgery.
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Kane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology 2020; 128:e94-e114. [PMID: 32798526 DOI: 10.1016/j.ophtha.2020.08.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022] Open
Abstract
The refractive outcome of cataract surgery is influenced by the choice of intraocular lens (IOL) power formula and the accuracy of the various devices used to measure the eye (including intraoperative aberrometry [IA]). This review aimed to cover the breadth of literature over the previous 10 years, focusing on 3 main questions: (1) What IOL power formulas currently are available and which is the most accurate? (2) What biometry devices are available, do the measurements they obtain differ from one another, and will this cause a clinically significant change in IOL power selection? and (3) Does IA improve refractive outcomes? A literature review was performed by searching the PubMed database for articles on each of these topics that identified 1313 articles, of which 166 were included in the review. For IOL power formulas, the Kane formula was the most accurate formula over the entire axial length (AL) spectrum and in both the short eye (AL, ≤22.0 mm) and long eye (AL, ≥26.0 mm) subgroups. Other formulas that performed well in the short-eye subgroup were the Olsen (4-factor), Haigis, and Hill-radial basis function (RBF) 1.0. In the long-eye group, the other formulas that performed well included the Barrett Universal II (BUII), Olsen (4-factor), or Holladay 1 with Wang-Koch adjustment. All biometry devices delivered highly reproducible measurements, and most comparative studies showed little difference in the average measures for all the biometric variables between devices. The differences seen resulted in minimal clinically significant effects on IOL power selection. The main difference found between devices was the ability to measure successfully through dense cataracts, with swept-source OCT-based machines performing better than partial coherence interferometry and optical low-coherence reflectometry devices. Intraoperative aberrometry generally improved outcomes for spherical and toric IOLs in eyes both with and without prior refractive surgery when the BUII and Hill-RBF, Barrett toric calculator, or Barrett True-K formulas were not used. When they were used, IA did not result in better outcomes.
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Affiliation(s)
- Jack X Kane
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - David F Chang
- University of California, San Francisco, San Francisco, California
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Davison JA, Makari S, Potvin R. Clinically relevant differences in the selection of toric intraocular lens power in normal eyes: preoperative measurement vs intraoperative aberrometry. Clin Ophthalmol 2019; 13:913-920. [PMID: 31239634 PMCID: PMC6551590 DOI: 10.2147/opth.s205352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose: To assess the value of intraoperative aberrometry (IA) in determining toric intraocular lens (IOL) power in eyes with no previous ocular surgery. Patients and methods: This was a retrospective data review at one US clinical site of eyes that underwent uncomplicated cataract surgery with toric IOL implantation where standard preoperative and IA measurements were available. Calculated IOL sphere and cylinder powers and orientation were compared based on the measurement method and the postoperative refraction, using both actual and simulated (back-calculated) results. Comparisons were between the surgeon’s preoperative calculations, IA measurements, the actual IOL implanted and results from the Barrett toric calculator. Results: There was no significant difference (p>0.7) in the number of eyes expected to have, or having, a spherical equivalent refraction within 0.50D of the target between Actual (92%), IA (93%) or Preoperative calculation results (86%). The percentage of eyes with expected residual refractive astigmatism ≤0.50D was significantly higher for the IA vs Preoperative calculations (75% vs 53%, p<0.01). There was no significant difference in expected results between the Actual, IA and Barrett toric calculations (p>0.65). Conclusion: Modern IOL calculations for sphere produced results comparable to those achieved with IA. The value of IA in determining IOL cylinder power and orientation was more evident when comparing expected results between IA and a preoperative method based on measured total corneal astigmatism than when comparing to expected results from the Barrett toric calculator.
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Holladay JT. Improved Accuracy With a Vergence-Based Online Toric Intraocular Lens Back-calculator. J Refract Surg 2018; 34:639. [PMID: 30199571 DOI: 10.3928/1081597x-20180723-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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