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Farzanfar A, Lockett-Ruiz V, Navarro R, Koppen C, Rozema JJ. The influence of variations in ocular biometric and optical parameters on differences in refractive error. Ophthalmic Physiol Opt 2024; 44:1000-1009. [PMID: 38666416 DOI: 10.1111/opo.13318] [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: 09/23/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE To present a paraxial method to estimate the influence of variations in ocular biometry on changes in refractive error (S) at a population level and apply this method to literature data. METHODS Error propagation was applied to two methods of eye modelling, referred to as the simple method and the matrix method. The simple method defines S as the difference between the axial power and the whole-eye power, while the matrix method uses more accurate ray transfer matrices. These methods were applied to literature data, containing the mean ocular biometry data from the SyntEyes model, as well as populations of premature infants with or without retinopathy, full-term infants, school children and healthy and diabetic adults. RESULTS Applying these equations to 1000 SyntEyes showed that changes in axial length provided the most important contribution to the variations in refractive error (57%-64%), followed by lens power/gradient index power (16%-31%) and the anterior corneal radius of curvature (10%-13%). All other components of the eye contributed <4%. For young children, the largest contributions were made by variations in axial length, lens and corneal power for the simple method (67%, 23% and 8%, respectively) and by variations in axial length, gradient lens power and anterior corneal curvature for the matrix method (55%, 21% and 14%, respectively). During myopisation, the influence of variations in axial length increased from 54.5% to 73.4%, while changes in corneal power decreased from 9.82% to 6.32%. Similarly, for the other data sets, the largest contribution was related to axial length. CONCLUSIONS This analysis confirms that the changes in ocular refraction were mostly associated with variations in axial length, lens and corneal power. The relative contributions of the latter two varied, depending on the particular population.
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Affiliation(s)
- Arezoo Farzanfar
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Veronica Lockett-Ruiz
- INMA, Consejo Superior de Investigaciones Científicas & Universidad de Zaragoza, Zaragoza, Spain
| | - Rafael Navarro
- INMA, Consejo Superior de Investigaciones Científicas & Universidad de Zaragoza, Zaragoza, Spain
| | - Carina Koppen
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Jos J Rozema
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Langenbucher A, Szentmáry N, Cayless A, Bolz M, Hoffmann P, Wendelstein J. Prediction of spectacle refraction uncertainties with discrete IOL power steps and manufacturing tolerances according to ISO using a Monte Carlo model. Br J Ophthalmol 2024; 108:793-800. [PMID: 37495264 PMCID: PMC11137444 DOI: 10.1136/bjo-2023-323921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The purpose of this study was to develop a concept for predicting the effects of both discrete intraocular lens (IOL) power steps (PS) and power labelling tolerances (LT) on the uncertainty of the refractive outcome (REFU). DESIGN Retrospective non-randomised cross-sectional Monte Carlo simulation study. METHODS We evaluated a dataset containing 16 669 IOLMaster 700 preoperative biometric measurements. The PS and the delivery range of two modern IOLs (Bausch and Lomb enVista and Alcon SA60AT) were considered for this Monte Carlo simulation. The uncertainties from PS or LT were assumed to be normally distributed according to ±½ the IOL PS or the ISO 11979 LT. REFU was recorded and analysed for all simulations. RESULTS With both lenses the REFU from discrete PS ranged from 0.11 to 0.12 dpt. Due to the larger PS for low/high power lenses with the enVista/SA60AT, REFU is more dominant in initially myopic/hyperopic eyes. REFU from LT ranged from 0.18 to 0.19 dpt for both lenses. Since LT increases stepwise with IOL power, REFU is more prevalent in initially hyperopic eyes requiring high IOL power values, and for lenses with a wide delivery range towards higher powers. CONCLUSIONS Since surgeons and patients are typically aware of the effect of discrete PS on REFU, these might be tolerated in cataract surgery. However, REFU resulting from LT is inevitable while the true measured IOL power is not reported on the package, leading to background noise in postoperative achieved refraction.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University Hospital and Faculty of Medicine, Homburg, Germany
- Department of Ophthalmology, Semmelweis University of Medicine, Budapest, Hungary
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - Matthias Bolz
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria
| | - Peter Hoffmann
- Augen-und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
| | - Jascha Wendelstein
- Department of Experimental Ophthalmology, Saarland University, Homburg, Germany
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
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Feng R, Wang M, Tao S, Liang F, Liu X, He C, Fan S. Refractive stability and timing of spectacle prescription following cataract surgery in myopic eyes. Ophthalmic Physiol Opt 2024; 44:576-583. [PMID: 38351864 DOI: 10.1111/opo.13285] [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: 07/31/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE To investigate the post-operative refractive stabilisation time and provide evidence for the optimal timing of a spectacle prescription in myopic post-cataract surgery patients. METHODS A total of 116 consecutive myopic cataract patients were recruited from the Zhongshan Ophthalmic Center in this prospective study. Post-operative subjective refraction was assessed after 1 week and 1 month (4-6 weeks), with the interval for the new spectacle acquisition being recorded. Visual Function Index-14 (VF-14) questionnaires were used to assess the vision-related quality of life. RESULTS There was no significant difference in spherical (p = 0.33), cylindrical (p = 0.65) or spherical equivalent refractions (p = 0.45) obtained 1 week and 1 month post-operatively, indicating that subjects achieved refractive stability within 1 week. In subgroups having differing age and axial lengths, there were also no significant differences between the 1 week and 1 month findings. The spherical equivalent refractive shift between 1 week and 1 month was significantly correlated with the post-operative prediction error (R = 0.35; p < 0.001). Only five (4.3%) out of 116 patients obtained new spectacles 1 week post-surgery. The VF-14 values improved from 85.77 ± 7.24 to 90.45 ± 5.39 after acquiring new spectacles (p < 0.01). CONCLUSIONS The stabilisation of subjective refraction occurred within 1 week in myopic cataract patients. Shortening the interval before prescribing a new spectacle prescription is recommended for myopic patients following cataract surgery to improve their vision-related quality of life.
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Affiliation(s)
- Rui Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingwei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Shuya Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Feiyan Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Xialin Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Chang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | - Shuxin Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
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Shen X, Chen Z, Jia W, Wang Y, Chen T, Sun Y, Jiang Y. Influencing factors of effective lens position in patients with Marfan syndrome and ectopia lentis. Br J Ophthalmol 2024:bjo-2023-325017. [PMID: 38604620 DOI: 10.1136/bjo-2023-325017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
AIMS The aim of this study was to analyse the effective lens position (ELP) in patients with Marfan syndrome (MFS) and ectopia lentis (EL). METHODS Patients with MFS undergoing lens removal and primary intraocular lens (IOL) implantation were enrolled in the study. The back-calculated ELP was obtained with the vergence formula and compared with the theoretical ELPs. The back-calculated ELP and ELP error were evaluated among demographic and biometric parameters, including axial length (AL), corneal curvature radius (CCR) and white-to-white (WTW). RESULTS A total of 292 eyes from 200 patients were included. The back-calculated ELP was lower in patients undergoing scleral-fixated IOL than those receiving in-the-bag IOL implantation (4.54 (IQR 3.65-5.20) mm vs 4.98 (IQR 4.56-5.67) mm, p<0.001). The theoretical ELP of the SRK/T formula exhibited the highest accuracy, with no difference from the back-calculated ELP in patients undergoing in-the-bag IOL implantation (5.11 (IQR 4.83-5.65) mm vs 4.98 (IQR 4.56-5.67) mm, p=0.209). The ELP errors demonstrated significant correlations with refraction prediction error (PE): a 1 mm ELP error led to PE of 2.42D (AL<22 mm), 1.47D (22 mm≤AL<26 mm) and 0.54D (AL≥26 mm). Multivariate analysis revealed significant correlations of ELP with AL (b=0.43, p<0.001), CCR (b=-0.85, p<0.001) and WTW (b=0.41, p=0.004). CONCLUSION This study provides novel insights into the origin of PE in patients with MFS and EL and potentially refines existing formulas.
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Affiliation(s)
- Xin Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zexu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - WanNan Jia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yalei Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Tianhui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yongxiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
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Marques JH, Baptista PM, Ribeiro B, Menéres P, Beirão JM. Intraocular lens power calculation: angle κ and ocular biomechanics. J Cataract Refract Surg 2024; 50:345-351. [PMID: 37962186 DOI: 10.1097/j.jcrs.0000000000001362] [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: 12/12/2022] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To study the effect of ocular biomechanics on the prediction error of intraocular lens (IOL) power calculation. SETTING Centro Hospitalar Universitário do Porto, Porto, Portugal. DESIGN Prospective longitudinal study. METHODS This study included 67 subjects. Before cataract surgery subjects underwent biometry with IOLMaster 700 and biomechanical analysis with Corvis Scheimpflug technology. The targeted spherical equivalent was calculated with SRK-T and Barrett Universal II. Associations between prediction error (PE), absolute prediction error (AE), and biometric and biomechanical parameters were performed with stepwise multivariate linear correlation analysis. RESULTS Using the SRKT formula, there was association between PE and Corvis Biomechanical Index (CBI, B = -0.531, P = .011) and between AE and the horizontal offset between the center of the pupil and the visual axis (angle κ, B = -0.274, P = .007). Considering the Barret Universal II formula, PE was independently associated with anterior chamber depth ( B = -0.279, P = .021) and CBI ( B = -0.520, P = .013) and AE was associated with angle κ ( B = -0.370, P = .007). CONCLUSIONS A large angle κ may reduce the predictability of IOL power calculation. Ocular biomechanics likely influence the refractive outcomes after IOL implantation. This study showed that eyes with softer corneal biomechanics had more myopic PE. This may relate to anteriorization of the effective lens position. Dynamic measurements may be the way to progress into future formulas.
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Affiliation(s)
- João Heitor Marques
- From the Serviço de Oftalmologia, Centro Hospitalar Universitário do Porto, Porto, Portugal (Marques, Baptista, Ribeiro, Menéres, Beirão); Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal (Baptista, Menéres, Beirão)
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Paredes B, Mora J, Martín MD, Larrosa A, Piñero DP. Short-term clinical results with a trifocal diffractive toric intraocular lens using an optimized preoperative and intraoperative protocol. Eur J Ophthalmol 2024; 34:146-153. [PMID: 37093755 DOI: 10.1177/11206721231171427] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. METHODS Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. RESULTS A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. CONCLUSIONS The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.
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Affiliation(s)
| | | | | | | | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Lei CS, Lin X, Ning R, Yu J, Huang X, Li K, Wang Y, Savini G, Schiano-Lomoriello D, Zhou X, Huang J. Repeatability and Interobserver Reproducibility of a Swept-Source Optical Coherence Tomography for Measurements of Anterior, Posterior, and Total Corneal Power. Ophthalmol Ther 2023; 12:3263-3279. [PMID: 37787889 PMCID: PMC10640522 DOI: 10.1007/s40123-023-00815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the intraobserver repeatability and interobserver reproducibility of corneal power measurements obtained with a swept-source optical coherence tomographer (CASIA 2, Tomey, Japan) in healthy subjects. METHODS A total of 67 right eyes from 67 healthy subjects were enrolled. Two experienced observers measured each eye three times consecutively with the CASIA 2. Corneal power values were recorded as simulated keratometry, anterior, posterior, and total corneal power. Parameters were flattest keratometry (Kf), steepest keratometry (Ks), mean keratometry (Km), astigmatism magnitude, astigmatism power vectors J0 and J45. Intraobserver repeatability and interobserver reproducibility of the CASIA 2 were assessed by the within-subject standard deviation (Sw), test-retest repeatability (TRT), coefficients of variation (CoV), and intraclass correlation coefficients (ICCs). Double-angle plots were used for astigmatism vector analysis. RESULTS The CASIA 2 had high repeatability for all corneal power values, with Sw values ≤ 0.17 diopters (D), TRT ≤ 0.46 D, and ICCs ranging from 0.866 to 0.998. Interobserver reproducibility was also high, showing all Sw values ≤ 0.10 D, TRT ≤ 0.27 D, and ICCs ≥ 0.944. The reproducibility of the average of three consecutive measurements (Sw 0.01-0.10 D, TRT 0.03-0.27 D, ICC 0.944-0.998) was higher than the reproducibility of single measurements (Sw 0.01-0.17 D, TRT 0.03-0.47 D, ICC 0.867-0.996). CONCLUSIONS The CASIA 2 showed high intraobserver repeatability and interobserver reproducibility for anterior, posterior, and total corneal power measurements in 6.0-mm diameter area. In addition, we suggest that using the average of three consecutive measurements can improve reproducibility between observers, compared to single measurements only.
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Affiliation(s)
- Chak Seng Lei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xuanqiao Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ning
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jinjin Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaomin Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Kexin Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yiran Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | | | | | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, No. 19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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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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Zheng J, He L, Zhong J. Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:225. [PMID: 37773468 DOI: 10.1007/s10103-023-03893-0] [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: 07/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. METHODS Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. RESULTS Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were - 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I2 = 7%) and - 0.09 (95% CI = - 0.18 to 0.00, P = 0.04, I2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = - 0.01 to 0.11, P = 0.09, I2 = 70%). CONCLUSIONS FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.
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Affiliation(s)
- Jiang Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Lun He
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523129, China.
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Diao C, Lan Q, Liao J, Lu P, Zhou Z, Li L, Zeng S, Yao G, Huang W, Chen Q, Lv J, Tang F, Li M, Xu F. Influence of decentration of plate-haptic toric intraocular lens on postoperative visual quality. BMC Ophthalmol 2023; 23:332. [PMID: 37474888 PMCID: PMC10360333 DOI: 10.1186/s12886-023-03061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND To evaluate the influence of decentration of plate-haptic toric intraocular lens (IOLs) on visual quality. METHODS This study enrolled 78 eyes of 78 patients. Patients in group A were implanted with toric IOLs, and patients in group B were implanted with monofocal IOLs. All patients were divided into group A1 and B1 (decentration below 0.3 mm) and group A2 and B2 (decentration above 0.3 mm). The uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), modulation transfer function cutoff (MTF cutoff), objective scatter index (OSI), strehl ratio (SR), optical interference and patients' satisfaction were measured in different pupils at three months postoperatively. The associations between decentration and visual quality were analyzed by Spearman correlation. RESULTS There were no significant differences in UDVA, BCVA, MTF cutoff, OSI, SR, optical interference and patients' satisfaction among subgroups. The differences in decentration between groups A and B were not statistically significant. In group A2, the total higher order aberrations (tHOAs) at pupil sizes of 3 mm (P = 0.046), 5 mm (P = 0.014), spherical aberrations at pupil sizes of 3 mm (P = 0.011), 4 mm (P = 0.014), 5 mm (P = 0.000), secondary astigmatism at pupil sizes of 3 mm (P = 0.002), 4 mm (P = 0.005) were higher than in group B2. Compared to group A1, group A2 had higher spherical aberrations at pupil sizes of 4 mm (P = 0.042), 5 mm (P = 0.001), 6 mm (P = 0.038), secondary astigmatism at pupil sizes of 3 mm (P = 0.013), 4 mm (P = 0.005), 6 mm (P = 0.013). Group B2 has higher coma and secondary astigmatism than group B1 at 6-mm pupil (P = 0.014, P = 0.045). Significant positive correlations were found between spherical aberrations and the decentration of group A1 and A2 at 6-mm pupils. CONCLUSION The decentration above 0.3 mm negatively affected visual quality due to increased tHOAs, spherical aberrations, coma and secondary astigmatism aberrations, the influence become larger with increasing pupil diameter. And toric IOLs are more affected by decentration than monofocal IOLs.
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Affiliation(s)
- Chunli Diao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Qianqian Lan
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jing Liao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Peng Lu
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Zhou Zhou
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Lanjian Li
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Siming Zeng
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Gang Yao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Wei Huang
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Qi Chen
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jian Lv
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Fen Tang
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Min Li
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Fan Xu
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China.
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Jiang Y, Shen Y, Chen X, Niu L, Li B, Cheng M, Lei Y, Xu Y, Wang C, Zhou X, Wang X. Artificial intelligence-based refractive error prediction and EVO-implantable collamer lens power calculation for myopia correction. EYE AND VISION (LONDON, ENGLAND) 2023; 10:22. [PMID: 37121995 PMCID: PMC10150472 DOI: 10.1186/s40662-023-00338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/16/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Implantable collamer lens (ICL) has been widely accepted for its excellent visual outcomes for myopia correction. It is a new challenge in phakic IOL power calculation, especially for those with low and moderate myopia. This study aimed to establish a novel stacking machine learning (ML) model for predicting postoperative refraction errors and calculating EVO-ICL lens power. METHODS We enrolled 2767 eyes of 1678 patients (age: 27.5 ± 6.33 years, 18-54 years) who underwent non-toric (NT)-ICL or toric-ICL (TICL) implantation during 2014 to 2021. The postoperative spherical equivalent (SE) and sphere were predicted using stacking ML models [support vector regression (SVR), LASSO, random forest, and XGBoost] and training based on ocular dimensional parameters from NT-ICL and TICL cases, respectively. The accuracy of the stacking ML models was compared with that of the modified vergence formula (MVF) based on the mean absolute error (MAE), median absolute error (MedAE), and percentages of eyes within ± 0.25, ± 0.50, and ± 0.75 diopters (D) and Bland-Altman analyses. In addition, the recommended spheric lens power was calculated with 0.25 D intervals and targeting emmetropia. RESULTS After NT-ICL implantation, the random forest model demonstrated the lowest MAE (0.339 D) for predicting SE. Contrarily, the SVR model showed the lowest MAE (0.386 D) for predicting the sphere. After TICL implantation, the XGBoost model showed the lowest MAE for predicting both SE (0.325 D) and sphere (0.308 D). Compared with MVF, ML models had numerically lower values of standard deviation, MAE, and MedAE and comparable percentages of eyes within ± 0.25 D, ± 0.50 D, and ± 0.75 D prediction errors. The difference between MVF and ML models was larger in eyes with low-to-moderate myopia (preoperative SE > - 6.00 D). Our final optimal stacking ML models showed strong agreement between the predictive values of MVF by Bland-Altman plots. CONCLUSION With various ocular dimensional parameters, ML models demonstrate comparable accuracy than existing MVF models and potential advantages in low-to-moderate myopia, and thus provide a novel nomogram for postoperative refractive error prediction and lens power calculation.
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Affiliation(s)
- Yinjie Jiang
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xun Chen
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lingling Niu
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Boliang Li
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Mingrui Cheng
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yadi Lei
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yilin Xu
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Chongyang Wang
- Research and Development Department, Shanghai MediWorks Precision Instruments Company Limited, Shanghai, China
| | - Xingtao Zhou
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Ear Nose and Throat Hospital, Fudan University, No. 19 BaoQing Road, XuHui District, Shanghai, 200031, China.
- National Health Commission Key Lab of Myopia, Fudan University, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Rémignon CH, Levron A, Agard E, Douma I, El-Chehab H, Brunet O, Sejournet L, Billant J, Dot C. Impact of Total Corneal Astigmatism Estimated With the Abulafia-Koch Formula Versus Measured With a SS-OCT Biometer on the Refractive Outcomes of a Toric Intraocular Lens in Cataract Surgery. J Refract Surg 2023; 39:171-179. [PMID: 36892238 DOI: 10.3928/1081597x-20230103-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCAABU) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCATK) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation. METHODS Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCAABU (estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCATK (measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCAABU. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCAABU or TCATK). The cylinder power and the axis of the posterior chamber IOL were compared. RESULTS The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCAABU and 0.35 D at 148° with TCATK (P(x) < .001; P(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCAABU and 0.50 ± 0.37 D with TCATK (P < .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCAABU versus 50% of eyes with TCATK. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases. CONCLUSIONS Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCAABU was used compared to TCATK measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup. [J Refract Surg. 2023;39(3):171-179.].
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Bu S, Jiang Y, Gao Y, Bai X, Chen X, Zhang H, Tian F. The impact of posterior corneal astigmatism on the surgical planning of toric multifocal intraocular lens implantation. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:39-46. [PMID: 37846431 PMCID: PMC10577858 DOI: 10.1016/j.aopr.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 08/21/2022] [Indexed: 10/18/2023]
Abstract
Purpose To investigate the influence of posterior corneal astigmatism on the prediction accuracy of toric multifocal intraocular lens (IOL) calculation. Methods The keratometric astigmatism measured by Lenstar LS 900 (KCAL), keratometric astigmatism (KCAP) and total corneal astigmatism (TCA) measured by Scheimpflug camera (Pentacam HR) were documented and analyzed accordingly. Three deduction models using different parameters were compared. Model 1: KCAL + keratometric corneal surgically induced astigmatism (KCSIA, 0.30 D @ 50°); Model 2: KCAP + KCSIA); Model 3: TCA + total CSIA (TCSIA, 0.23 D @ 50°). The prediction errors of each model as the difference vector between the actual and the intended residual astigmatism were compared. Results Seventy-six eyes implanted with toric multifocal IOLs were included in this study. The vector differences of the actual KCSIA and TCSIA were statistically significant in the total sample and against-the-rule (ATR) subgroup (both P < 0.05). Model 1 deduced the smallest mean values of prediction error, while that of Model 3 were smaller than that of Model 2, both in the total sample and the ATR subgroups (all P < 0.05). Meanwhile, in the total sample and ATR subgroups, the centroid vector magnitudes of Model 3 were smaller than that of Model 1 (0.31 ± 0.76 D and 0.39 ± 0.76 D). Conclusions The calculation of toric multifocal IOL should be individualized especially in the ATR eyes for the impact of PCA on the estimation of the preoperative corneal astigmatism and the CSIA.
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Affiliation(s)
| | | | - Yichen Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 300384, Tianjin, China
| | - Xiaomei Bai
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 300384, Tianjin, China
| | - Xiteng Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 300384, Tianjin, China
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Liang J, Liu H, Zhou S, Zhou L, Qian Z, Jiang L, Chen X. Intraocular lens constant optimization in toric intraocular lens calculation using keratometry and total corneal power. Eur J Ophthalmol 2023; 33:230-238. [PMID: 35656766 DOI: 10.1177/11206721221106136] [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: 01/11/2023]
Abstract
PURPOSE To evaluate intraocular lens (IOL) constant optimization in toric IOL calculation with keratometry (K) and total corneal refractive power (TCRP). METHODS Predicted spherical equivalent (SE) and residual astigmatism (RA) with K and TCRP were retrospectively calculated using the Haigis, Holladay 1, and SRK/T formulae and optimized IOL constants. The results of the Barrett calculator and the Abulafia-Koch formula with K were also calculated. The median absolute error in SE (MedAE-SE), mean absolute error in RA (MAE-RA), and centroid error (CE) were analyzed. RESULTS Seventy-nine eyes of 71 patients implanted with toric IOLs were included. With K, there were no significant differences between the results before and after constant optimization using all the formulae. With TCRP, constant optimization significantly reduced MedAE-SE; however, significantly increased MAE-RA and CE using the Holladay 1 and SRK/T formulae. MedAE-SE, MAE-RA, and CE using the Haigis formula did not show significant differences. The difference in the predicted RA before and after constant optimization increased with IOL toricity. The MedAE-SE predicted by TCRP was significantly higher than that predicted by K despite constant optimization. The MAE-RA and CE predicted by TCRP were significantly lower than those predicted by K without posterior corneal astigmatism optimization; however, were not significantly different from those predicted by the Barrett and Abulafia-Koch formulae. CONCLUSIONS Constant optimization is recommended when using the TCRP in toric IOL calculations, particularly for patients with large astigmatism. However, TCRP did not yield more accurate results than optimized K in toric IOL calculations despite constant optimization.
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Affiliation(s)
- Jianheng Liang
- Aier School of Ophthalmology, 506624Central South University, Changsha, Hunan Province, China
| | - Hui Liu
- Aier School of Ophthalmology, 506624Central South University, Changsha, Hunan Province, China
| | - Suowang Zhou
- Aier School of Ophthalmology, 506624Central South University, Changsha, Hunan Province, China
| | - Lijing Zhou
- Aier School of Ophthalmology, 506624Central South University, Changsha, Hunan Province, China
| | - Zhuyun Qian
- GIANTMED medical diagnostics Lab, Beijing, China
| | - Lihong Jiang
- Department of Ophthalmology, Zhabei Central Hospital, Shanghai, China
| | - Xu Chen
- Aier School of Ophthalmology, 506624Central South University, Changsha, Hunan Province, China.,Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
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Feldhaus L, Mayer WJ, Dirisamer M, Kassumeh S, Shajari M, Priglinger SG, Luft N. Comparison of Visual and Refractive Outcome between Two Methods of Corneal Marking for Toric Implantable Collamer Lenses (TICL) in Phakic Eyes. Curr Eye Res 2022; 48:357-364. [PMID: 36524538 DOI: 10.1080/02713683.2022.2159981] [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: 12/23/2022]
Abstract
PURPOSE To compare the efficacy of digital-assisted reference marking for toric implantable collamer lenses (Callisto Eye System) with manual marking technique using a slit lamp markeur. METHODS This study included patients that underwent implantation of a toric implantable collamer lens (EVO Visian toric ICL, Staar Surgical). Patients were included if they had a myopia above -3 diopters (D) and regular corneal astigmatism of 0.75 diopters or higher. Between both groups a 1:2 matching regarding similar preoperative level of myopia and astigmatism was performed. Visual and refractive outcomes were evaluated. Vector analysis was performed to evaluate total astigmatic changes. RESULTS This study comprised 57 eyes of 57 patients with 19 eyes in the digital group and 38 eyes in the manual marking group. Postoperatively there were no statistically significant differences between both groups in UDVA (p = 0.467), spherical equivalent (SE) (p = 0.864), sphere (p = 0.761) and cylinder (p = 0.878). Vector analysis showed a slightly more accurate postoperative refractive astigmatism in the manual group (0.26 D at 107° ± 0.50 D) compared to the digital marking group (0.31 D at 107° ± 0.45 D), nevertheless with no statistically significant differences between both groups. CONCLUSIONS A digital tracking approach for toric ICL alignment was an efficient and safe method for toric marking with similar results regarding visual and refractive outcomes compared to a conventional corneal marking method. Nevertheless, image-guided surgery helped to streamline the workflow in refractive ICL surgery.
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Affiliation(s)
- Lukas Feldhaus
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dirisamer
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Mehdi Shajari
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | | | - Nikolaus Luft
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
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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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Osawa R, Sano M, Yuguchi T, Kaiya T, Oshika T. Effects of Modified Haptics on Surgical Outcomes and Rotational Stability of Toric Intraocular Lens Implantation. J Refract Surg 2022; 38:648-653. [PMID: 36214346 DOI: 10.3928/1081597x-20220715-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE To assess the rotational stability of a new toric intraocular lens (IOL), TECNIS toric II (toric II), which is a modified version of the TECNIS toric IOL (toric I) with frosted haptics (Johnson & Johnson). METHODS A total of 101 eyes of 101 patients who had been treated with phacoemulsification and toric IOL implantation were included. Before and 1 day, 1 week, and 1 month after surgery, uncorrected (UDVA) and corrected (CDVA) distance visual acuity were measured. Preoperative corneal astigmatism and postoperative manifest refractive astigmatism at 1 day and 1 month were analyzed. At 1 day and 1 month postoperatively, the amount of IOL axis misalignment from the intended orientation, tilt, and decentration were measured using anterior segment optical coherence tomography. RESULTS Fifty-one eyes received the toric I IOL and 50 eyes received the toric II IOL. Toric I IOLs showed a significantly larger amount of axis misalignment than toric II IOLs at both 1 day (9.6 ± 7.6° vs 5.4 ± 4.8°, P = .003) and 1 month (9.1 ± 7.8° vs. 4.7 ± 4.2°, P = .003) postoperatively.The proportion of eyes with misalignment greater than 10° was significantly larger with toric I than toric II IOLs (P < .001). There were no significant differences between IOLs in the amount of residual astigmatism, UDVA, CDVA, and amount of tilt and decentration at 1 day and 1 month postoperatively. CONCLUSIONS The TECNIS toric II IOL with frosted haptics has significantly improved rotational stability compared to its previous model. [J Refract Surg. 2022;38(10):648-653.].
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Ding N, Wang X, Song X. Digital versus slit-beam marking for toric intraocular lenses in cataract surgery. BMC Ophthalmol 2022; 22:323. [PMID: 35897093 PMCID: PMC9326429 DOI: 10.1186/s12886-022-02548-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] [Received: 04/04/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the visual outcomes of digital and slit-beam manual marking for toric intraocular lenses (IOL) in cataract surgery. Setting Single-center, Beijing Tongren Hospital, China. Design Retrospective study. Methods All patients with cataracts and regular corneal astigmatism greater than 0.75 diopters (D) underwent cataract surgery and astigmatism correction between June 2019 and June 2020. To mark the target axis of the toric IOL and the location of the incision, intraoperative digital marking was used by Callisto eye image-guided system in one group, while preoperative manual slit-beam marking was used in the other group. Uncorrected and best-corrected spectacle visual acuity, refraction, toric IOL axis, total higher order aberrations, coma, spherical aberration, and trefoil were evaluated at 1, 4, and 12 weeks postoperatively. Results Seventy-two eyes of 58 patients were included. At 3 months after surgery, the mean residual refractive cylinder was 0.42 ± 0.45D in the digital group and 0.39 ± 0.40D in the manual group (P = 0.844). There were no significant differences between groups in spherical equivalent refraction, uncorrected and best-corrected spectacle visual acuity, or the parameters of vector analysis. All toric IOL alignment errors were within 10° of the intended axis, and among them, about 42% of eyes in the digital group and 61% of eyes in the manual group had a rotation of 0–2° (P = 0.038). Trefoil in the manual group decreased postoperatively compared with the digital group (P = 0.012). Other aberration analyses did not reveal any statistical differences between groups. Conclusions Accurate slit-beam manual marking and digital image-guided marking are equally effective for toric IOL alignment.
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Affiliation(s)
- Ning Ding
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, No.1 Dongjiaomin lane, Dongcheng District, Beijing, 100730, China
| | - Xiaozhen Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, No.1 Dongjiaomin lane, Dongcheng District, Beijing, 100730, China
| | - Xudong Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, No.1 Dongjiaomin lane, Dongcheng District, Beijing, 100730, China.
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Lukewich MK, Murtaza F, Somani S, Tam ES, Chiu HH. Comparison of Barrett Toric Calculations Using Measured and Predicted Posterior Corneal Astigmatism in Cataract Surgery Patients. Clin Ophthalmol 2022; 16:1739-1751. [PMID: 35673350 PMCID: PMC9167600 DOI: 10.2147/opth.s351011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark K Lukewich
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sohel Somani
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Eric S Tam
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Correspondence: Hannah H Chiu, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +1 416 292-0330, Fax +1 416 292-0331, Email
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Miháltz K, Szegedi S, Steininger J, Vécsei-Marlovits PV. The relationship between patient satisfaction and visual and optical outcome after bilateral implantation of an extended depth of focus multifocal intraocular lens. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100043. [PMID: 37846221 PMCID: PMC10577816 DOI: 10.1016/j.aopr.2022.100043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2023]
Abstract
Purpose To evaluate patient satisfaction after implantation of the Tecnis Symfony multifocal intraocular lens (MIOL). Methods 120 eyes of 60 subjects with senile cataract were bilaterally implanted with the Tecnis Symfony IOL. Follow-up examination was performed 6 months postoperatively. Main outcome measures included uncorrected and corrected distance and near visual acuity, manifest refraction, and visual quality metrics. According to their subjective symptoms patient were divided in two groups: satisfied and unsatisfied. Results Uncorrected intermediate (0.15 ± 0.11 vs 0.18 ± 0.01, P = 0.04) and near (0.26 ± 0.12 vs 0.31 ± 0.11, P = 0.04) (UIVA, UNVA) log MAR visual acuity was significantly better, cylindrical error less (0.31 ± 0.36 vs 0.67 ± 0.29, P = 0.05), axial length (AL) smaller (23.68 ± 1.3 vs 24.22 ± 1.6, P = 0.05), Strehl ratio higher (0.08 ± 0.08 vs 0.05 ± 0.04, P = 0.03) and mesopic pupil larger (4.3 ± 1.1 vs 3.7 ± 1.05, P = 0.01) among satisfied patients.Residual cylinder, Strehl ratio, halos, mesopic pupil diameter and UNVA were significant predictors of patient satisfaction. Uncorrected distance visual acuity, higher order Strehl ratio and pupil diameter were significant predictors of halos. Near visual acuity significantly correlated (P = 0.018, R = 0.22) with axial length. Conclusions Uncorrected cylindrical error, poor reading quality, larger pupil and halos seem to be the most disturbing factors for patients implanted with the Tecnis Symfony IOL.
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Affiliation(s)
- Kata Miháltz
- Department of Ophthalmology, Clinic Hietzing, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and QM in Cataract Surgery, Vienna, Austria
| | - Stephan Szegedi
- Department of Ophthalmology, Clinic Hietzing, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and QM in Cataract Surgery, Vienna, Austria
| | - Jolanda Steininger
- Department of Ophthalmology, Clinic Hietzing, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and QM in Cataract Surgery, Vienna, Austria
| | - Pia Veronika Vécsei-Marlovits
- Department of Ophthalmology, Clinic Hietzing, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and QM in Cataract Surgery, Vienna, Austria
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21
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Scantling-Birch Y, Naveed H, Mukhija R, Nanavaty MA. A Review of Smartphone Apps Used for Toric Intraocular Lens Calculation and Alignment. Vision (Basel) 2022; 6:vision6010013. [PMID: 35225972 PMCID: PMC8883946 DOI: 10.3390/vision6010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022] Open
Abstract
Smartphone apps are becoming increasingly popular in ophthalmology, one specific area of their application being toric intraocular lens (IOL) surgery for astigmatism correction. Our objective was to identify, review and objectively score smartphone apps applicable to toric IOL calculation and/or axis alignment. This review was divided into three phases. A review was conducted on four major app databases (phase I): National Health Service (NHS) Apps Library, Google Play Store, Apple App Store and Amazon Appstore. A systematic literature review (phase II) was conducted to identify studies for included apps in phase I of our study. Keywords used in both searches included: “toric lens”, “toric IOL”, “refraction”, “astigmatism”, “ophthalmology”, “eye calculator”, “ophthalmology calculator” and “refractive calculator”. Included apps were objectively scored (phase III) by three independent reviewers using the mobile app rating scale (MARS), a validated tool that ranks the quality of mobile health apps using a calculated mean app quality (MAQ) score. Phase I of our study screened 2428 smartphone apps, of which six apps for toric IOL calculation and four apps for axis marking were eligible and were selected for quantitative analysis. Phase II of our study screened 477 studies from PubMed, Medline and Google Scholar. Three studies validating two apps (toriCAM, iToric Patwardhan) in a clinical setting as adjunct tools for preoperative axis marking were identified. Phase III ranked Toric Calculator for iPhone (Apple iOS, MAQ 4.13; average MAQ 3.34 ± 0.54) as the highest-scoring toric IOL calculator, and iToric Patwardhan (Android OS, MAQ 4.13; average MAQ 3.41 ± 0.44) was the highest-scoring axis marker in our study. Our review identified and objectively scored ten smartphone apps available for toric IOL surgery adjuncts. Toric Calculator for iPhone and iToric Patwardhan were the highest-scoring toric IOL calculator and axis marker, respectively. Current literature, though limited, suggests that axis marking smartphone apps can achieve similar levels of misalignment reduction when compared to digital systems.
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Affiliation(s)
- Yarrow Scantling-Birch
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BF, UK; (Y.S.-B.); (R.M.)
| | - Hasan Naveed
- Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone ME16 9QQ, UK;
- Brighton and Sussex Medical School, University of Sussex, Falmer Campus, Brighton BN1 9PX, UK
| | - Ritika Mukhija
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BF, UK; (Y.S.-B.); (R.M.)
| | - Mayank A. Nanavaty
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BF, UK; (Y.S.-B.); (R.M.)
- Brighton and Sussex Medical School, University of Sussex, Falmer Campus, Brighton BN1 9PX, UK
- Correspondence:
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22
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Langenbucher A, Szentmáry N, Cayless A, Wendelstein J, Hoffmann P. Prediction of the axial lens position after cataract surgery using deep learning algorithms and multilinear regression. Acta Ophthalmol 2022; 100:e1378-e1384. [PMID: 35128815 DOI: 10.1111/aos.15108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/23/2021] [Accepted: 01/20/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prediction of anatomical axial intraocular lens position (ALP) is one of the major challenges in cataract surgery. The purpose of this study was to develop and test prediction algorithms for ALP based on deep learning strategies. METHODS We evaluated a large data set of 1345 biometric measurements from the IOLMaster 700 before and after cataract surgery. The target parameter was the intraocular lens (IOL) equator plane at half the distance between anterior and posterior apex. The relevant input parameters from preoperative biometry were extracted using a principal component analysis. A selection of neural network algorithms was tested using a 5-fold cross-validation procedure to avoid overfitting. The results were then compared with a traditional multilinear regression in terms of root mean squared prediction error (RMSE). RESULTS Corneal radius of curvature, axial length, anterior chamber depth, corneal thickness, lens thickness and patient age were identified as effective predictive parameters, whereas pupil size, horizontal corneal diameter and Chang-Waring chord did not enhance the model. From the tested algorithms, the Gaussian prediction regression and the Support Vector Machine algorithms performed best (RMSE = 0.2805 and 0.2731 mm), outperforming the multilinear prediction model (0.3379 mm). The mean absolute prediction error yielded 0.1998, 0.1948 and 0.2415 mm for the respective models. CONCLUSION Modern prediction techniques may have the potential to outperform traditional multilinear regression techniques as they can deal easily with nonlinearities between input and output parameters. However, in all cases a cross-validation is mandatory to avoid overfitting and misinterpretation of the results.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology Saarland University Homburg/Saar 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
| | - Alan Cayless
- School of Physical Sciences The Open University Milton Keynes UK
| | - Jascha Wendelstein
- Department of Ophthalmology Johannes Kepler University Linz Linz Austria
| | - Peter Hoffmann
- Augen‐ und Laserklinik Castrop‐Rauxel Castrop‐Rauxel Germany
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Wendelstein JA, Hoffmann PC, Mariacher S, Wingert T, Hirnschall N, Findl O, Bolz M. Precision and refractive predictability of a new nomogram for femtosecond laser-assisted corneal arcuate incisions. Acta Ophthalmol 2021; 99:e1297-e1306. [PMID: 33629542 PMCID: PMC9540120 DOI: 10.1111/aos.14837] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Validating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium- and Bowman-penetrating femtosecond laser-assisted arcuate incisions. METHODOLOGY Prospective, interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser-assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity. RESULTS The study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was -0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D. CONCLUSION The Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism.
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Affiliation(s)
- Jascha A. Wendelstein
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | | | - Siegfried Mariacher
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Tina Wingert
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Nino Hirnschall
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Oliver Findl
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Matthias Bolz
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
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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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Langenbucher A, Szentmáry N, Cayless A, Weisensee J, Wendelstein J, Hoffmann P. The Castrop formula for calculation of toric intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2021; 259:3321-3331. [PMID: 34236474 PMCID: PMC8523386 DOI: 10.1007/s00417-021-05287-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To explain the concept behind the Castrop toric lens (tIOL) power calculation formula and demonstrate its application in clinical examples. Methods The Castrop vergence formula is based on a pseudophakic model eye with four refractive surfaces and three formula constants. All four surfaces (spectacle correction, corneal front and back surface, and toric lens implant) are expressed as spherocylindrical vergences. With tomographic data for the corneal front and back surface, these data are considered to define the thick lens model for the cornea exactly. With front surface data only, the back surface is defined from the front surface and a fixed ratio of radii and corneal thickness as preset. Spectacle correction can be predicted with an inverse calculation. Results Three clinical examples are presented to show the applicability of this calculation concept. In the 1st example, we derived the tIOL power for a spherocylindrical target refraction and corneal tomography data of corneal front and back surface. In the 2nd example, we calculated the tIOL power with keratometric data from corneal front surface measurements, and considered a surgically induced astigmatism and a correction for the corneal back surface astigmatism. In the 3rd example, we predicted the spherocylindrical power of spectacle refraction after implantation of any toric lens with an inverse calculation. Conclusions The Castrop formula for toric lenses is a generalization of the Castrop formula based on spherocylindrical vergences. The application in clinical studies is needed to prove the potential of this new concept.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, Kirrberger Str 100 Bldg. 22, 66424, Homburg/Saar, 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
| | - Alan Cayless
- School of Physical Sciences, The Open University, Milton Keynes, UK
| | - Johannes Weisensee
- Department of Experimental Ophthalmology, Saarland University, Kirrberger Str 100 Bldg. 22, 66424, Homburg/Saar, Germany
| | - Jascha Wendelstein
- Department of Ophthalmology, Johannes Kepler University Linz, Linz, Austria
| | - Peter Hoffmann
- Augen-und Laserklinik Castrop-Rauxel, Castrop-Rauxel, Germany
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Fernández J, Rodríguez-Vallejo M, Rocha-de-Lossada C, Hueso E, Piñero D. Toric Intraocular Lens Calculation Considering Anterior Surgically Induced Astigmatism and Posterior Corneal Astigmatism. Curr Eye Res 2021; 47:25-31. [PMID: 34166169 DOI: 10.1080/02713683.2021.1948064] [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: 10/21/2022]
Abstract
Purpose: To evaluate the prediction error (PE) after applying the Abulafia-Koch formula in an online calculator with and without consideration of anterior corneal surgically induced astigmatism (SIACornea).Methods: SIACornea models were calculated with a historical database of 204 right eyes (REs) from a single surgeon, either for manual (2.2 mm) or femtosecond (2.5 mm) temporal clear corneal incisions. PE was assessed in 58 REs operated by the same surgeon with a monofocal toric IOL and calculated, considering the PCA estimation in an online calculator with the combination of each one of the following SIACornea calculation approaches: (A) considering only significant centroids after stratification, (B) all centroids after stratification and (C) a single centroid without stratification.Results: The consideration of all centroids resulted in an underestimation of SIACornea in cases of preoperative against-the-rule astigmatism (ATR-A) and an overestimation in with-the-rule astigmatism (WTR-A). After stratification, SIACornea was only significant in preoperative ATR and oblique astigmatism cases for femtosecond incisions. PE considering PCA only was 0.03@160º. The combination with SIACornea resulted in a WTR-A surprise in preoperative ATR-A and WTR-A, however only being significant for preoperative ATR-A in calculation approaches B (0.29@84º) and C (0.21@80º). SIACornea addition to PCA estimation only reduced the centroid for oblique preoperative astigmatism.Conclusions: Surgeons should consider the calculation of the SIACornea after stratification by astigmatism type when using the same incision location (i.e. temporal). However, SIACornea derived from the anterior corneal surface should not be combined with PCA estimation for IOL power calculations.
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Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision), VITHAS Hospital, Almería, Spain
| | | | - Carlos Rocha-de-Lossada
- Department of Ophthalmology (Qvision), VITHAS Hospital, Almería, Spain.,Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Elisa Hueso
- Department of Ophthalmology (Qvision), VITHAS Hospital, Almería, Spain
| | - David Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.,Department of Ophthalmology (OFTALMAR), Vithas Medimar International Hospital, Alicante, Spain
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Gundersen KG, Potvin R. Clinical Results After Precision Pulse Capsulotomy. Clin Ophthalmol 2020; 14:4533-4540. [PMID: 33402816 PMCID: PMC7778437 DOI: 10.2147/opth.s293819] [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: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To compare residual refractive error and complication rates between eyes undergoing a manual capsulotomy and those receiving a precision pulse capsulotomy using an automated device. Patients and Methods This study was a non-interventional two-arm retrospective chart review of clinical results after bilateral cataract surgery or refractive lens exchange (RLE) surgery with a monofocal toric intraocular lens (IOL) or a trifocal IOL where a manual capsulorhexis (Manual) or automated precision pulse capsulotomy (PPC) was performed. Results Exams from 243 eyes (122 PPC, 121 Manual) from 124 patients were reviewed; about 75% of which had a trifocal IOL implanted. There was no statistically significant difference in the MRSE with either IOL type, or overall. The overall percentage of eyes with residual refractive cylinder ≤ 0.50 D was significantly higher in the PPC group (89% vs. 79% in the manual group, p = 0.03), primarily driven by results with the toric IOL. Best corrected distance visual acuity was not statistically significantly different by group. Capsulotomy-related complications were lower in the PPC group relative to the manual group (4.1% vs. 6.6%), but this result was not statistically significant (p = 0.38). Conclusion Significantly more eyes had refractive cylinder ≤0.50 D in the PPC group. For all other measures, the automated PPC device produced clinical results equivalent to those achieved with a manual capsulorhexis.
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