Evaluating the Predictability of Postoperative Target Refraction Using the Prototype of a New Intraoperative Aberrometer

Abstract

Despite all the progress in cataract and refractive lens surgery, refractive surprise is common in clinical practice. A significant postoperative refractive error is particularly annoying – and contributes to the patientʼs dissatisfaction with the procedure and the surgeon – when a multifocal IOL, an EDOF-IOL or a toric IOL has been implanted. The relatively new technology of intraoperative aberrometry offers the surgeon the option to intraoperatively measure the eye and its refraction, either directly after lens extraction and/or following IOL implantation. Currently, three different systems are available. In a number of studies, the technology has shown a better refractive predictability than preoperative biometry. Besides giving an evaluation of the prototype of a new intraoperative aberrometer, the I-O-W-A system, we also present our results on the influence of the kind of anaesthesia chosen and of two different IOL designs on the predictability of intraoperative aberrometry.

Fazitbox

Bereits bekannt:

• Die Echtzeit-Refraktionsmessung im Rahmen der Operation bietet einen deutlichen Vorteil in der Ergebnisoptimierung.

• Die intraoperative Aberrometrie, für die es zurzeit 2 unterschiedliche Geräte gibt, zeigt in den meisten Evaluationen eine deutlich geringere Abweichung von der Zielrefraktion als die präoperative Biometrie.

Neu beschrieben:

• In dieser Publikation soll die neue Methode der intraoperativen Aberrometrie anhand erster eigener klinischer Erfahrungen vorgestellt werden, wobei die Verbesserung der Erreichung von Zielrefraktion sowie Ermittlung von etwaigen Einflüssen auf die Messmethode untersucht wird.

• Unter den gängigen Anästhesieverfahren ist die topische Lokalanästhesie gegenüber der peribulbären Injektion für die intraoperative Aberrometrie vorzuziehen, da mit ihr nach unseren Untersuchungen eine höhere refraktive Genauigkeit erreicht wird.

• Durch zusätzliche IOL-typische Korrekturfaktoren kann die Vorhersagegenauigkeit erhöht werden.

Conclusion Box

Already known:

• Real-time refraction measurement during surgery offers a significant advantage in optimizing results.

• Intraoperative aberrometry, for which two different devices are currently available, shows a much smaller deviation from the target refraction than preoperative biometry in most evaluations.

Newly described:

• In this article we aim to present the new method of intraoperative aberrometry on the basis of our own initial clinical experience. To this purpose we investigated improvements in achieving target refraction, and we identified factors that have an influence on this measurement method.

• Among the common anesthetic methods, topical local anesthesia is preferable to peribulbar injection for intraoperative aberrometry because it achieves higher refractive accuracy according to our study results.

• Additional IOL-specific correction factors can increase prediction accuracy.

Key words

cataract - refractive surgery - anaesthesia (topical, peribulbar) - astigmatism - intraocular lens (IOL) - intraoperative aberrometry

Publication History

Received: 02 December 2021

Accepted: 19 December 2022

Accepted Manuscript online:
23 December 2022

Article published online:
15 November 2023

• References/Literatur

• 1 Lundström M, Dickmann M, Henry Y. et al. Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery. J Cataract Refract Surg 2018; 44: 447-452
• 2 Rabsilber TM, Jepsen C, Auffarth GU. et al. Intraocular lens power calculation: clinical comparison of 2 optical biometry devices. J Cataract Refract Surg 2010; 36: 230-234
• 3 Sahin A, Hamrah P. Clinically relevant biometry. Curr Opin Ophthalmol 2012; 23: 47-53
• 4 Melles RB, Holladay JT, Chang WJ. Accuracy of intraocular lens calculation formulas. Ophthalmology 2018; 125: 169-178
• 5 Hemmati HD, Gologorsky D, Pineda R. Intraoperative wavefront aberrometry in cataract surgery. Semin Ophthalmol 2012; 27: 100-106
• 6 Shammas HJ, Shammas MC, Jivrajka RV. et al. Effects on IOL power calculation and expected clinical outcomes of axial length measurements based on multiple vs. single refractive indices. Clin Ophthalmol 2020; 14: 1511-1519
• 7 Cooke DL, Cooke TL, Suheimat M. et al. Standardizing sum-of-segments axial length using refractive index models. Biomed Opt Express 2020; 11: 5860-5870
• 8 Savini G, Hoffer KJ, Carballo L. et al. Comparison of different methods to calculate the axial length measured by optical biometry. J Cataract Refract Surg 2022; 48: 685-689
• 9 Ianchulev T, Hoffer KJ, Yoo SH. et al. Intraoperative refractive biometry for predicting intraocular lens power calculation after prior myopic refractive surgery. Ophthalmology 2014; 121: 56-60
• 10 Krueger RR, Shea W, Zhou Y. et al. Intraoperative, real-time aberrometry during refractive cataract surgery with a sequentially shifting wavefront device. J Refract Surg 2013; 29: 630-635
• 11 Charman WN. Wavefront technology: past, present and future. Cont Lens Anterior Eye 2005; 28: 75-92
• 12 Blaylock JF, Hall BJ. Clinical Outcomes of monofocal toric IOLs using digital tracking and intraoperative aberrometry. Clin Ophthalmol 2021; 15: 3593-3600
• 13 Cionni RJ, Breen M, Hamilton C. et al. Retrospective analysis of an intraoperative aberrometry database: a study investigating absolute prediction in eyes implanted with low cylinder power toric intraocular lenses. Clin Ophthalmol 2019; 13: 1485-1492
• 14 Raufi N, James C, Kuo A. et al. Intraoperative aberrometry vs. modern preoperative formulas in predicting intraocular lens power. J Cataract Refract Surg 2020; 46: 857-861
• 15 Davison JA, Potvin R. Preoperative measurement vs. intraoperative aberrometry for the selection of intraocular lens sphere power in normal eyes. Clin Ophthalmol 2017; 11: 923-929
• 16 Stringham J, Pettey J, Olson RJ. Evaluation of variables affecting intraoperative aberrometry. J Cataract Refract Surg 2012; 38: 470-474