Intraoperative Wavefront Aberrometry Research Articles

Accuracy of intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in short and long eyes.

To compare the accuracy of intraoperative wavefront aberrometry using the ORA VLynk system with different biometry-based formulas in short and long eyes after cataract surgery. This prospective study considered 48 eyes with axial lengths of <22.1 mm and 48 eyes with axial lengths of >25.0 mm. All eyes were implanted with the monofocal AcrySof IQ IOL, the power being determined using the ORA VLynk. The postoperative spherical equivalent (SE) at 3 months was compared to that predicted preoperatively using the SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II, and Barrett True K formulas and intraoperatively using the ORA VLynk. Mean numerical and absolute errors and the percentage of eyes within ±0.50 D/1.00 D of their target were obtained. For long eyes, the mean absolute error values were 0.35, 0.52, 0.34, 0.30, 0.29, 0.27, and 0.24D for SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II, Barrett True K, and ORA VLynk, respectively (p < 0.001). These values were 0.55, 0.45, 0.49, 0.40, 0.44, 0.44 and 0.50 D for short eyes, respectively (p < 0.001). The proportions of long eyes within ±0.50 D of the target were 77.08, 50, 75, 85.42, 83.33, 79.17, and 87.50%, respectively; and 50, 66.67, 60.42, 66.67, 60.42, 60.42, and 58.33%, respectively, for short eyes. The ORA VLynk performs better than all biometry-based formulas in long eyes and, in short eyes, it is as effective as SRK/T, Haigis, Barrett Universal II, and Barrett true K, with the Hoffer Q and Holladay 2 being the most accurate; however, the differences between the calculation methods were small. Identifier DRKS000028106.

Accuracy of intraoperative aberrometry versus modern preoperative methods in post-myopic laser vision correction eyes undergoing cataract surgery with capsular tension ring placement

PurposeTo assess the accuracy of intraoperative wavefront aberrometry (IWA) versus modern intraocular lens formulas in post-myopic laser vision correction (LVC) patients undergoing cataract surgery with capsular tension ring placement.MethodsThis is a retrospective chart review conducted at an academic outpatient center. All post-myopic LVC eyes undergoing cataract surgery with IWA from a single surgeon from 05/2017 to 12/2019 were included. All patients received a capsular tension ring (CTR). Mean numerical error (MNE), median numerical error (MedNE), and percentages of prediction error within 0.50D, 0.75D, and 1.00D were calculated for the above formulas.ResultsTwenty-seven post-myopic LVC eyes from 18 patients were included. In post-myopic LVC, MNE with Optiwave Refractive Analysis (ORA), Barrett True K (BTK), Haigis, Haigis-L, Shammas, SRK/T, Hill-RBF v3.0, and W-K AL-adjusted Holladay 1 were + 0.224, − 0.094, + 0.193, − 0.231, − 0.372, + 1.013, + 0.860, and + 0.630 (F = 8.49, p < 0.001). MedNE were + 0.125, − 0.145, + 0.175, + 0.333, + 0.333, + 1.100, + 0.880, and + 0.765 (F = 7.89, p < 0.001), respectively. BTK provided improved accuracy in both MNE (p < 0.001) and MedNE (p = .033) when compared to ORA in pairwise analysis. If the ORA vs. BTK-suggested IOL power were routinely selected, 30% and 15% of eyes would have projected hyperopic outcomes, respectively (p = 0.09).ConclusionsOur study suggests that in post-myopic LVC eyes undergoing cataract surgery with CTRs, BTK performed more accurately than ORA with regard to accuracy and yielded a lower percentage of eyes with hyperopic outcomes. Haigis, Haigis-L, and Shammas yielded similar results to ORA with regard to accuracy and percentage of eyes with hyperopic outcomes. On average, Shammas and Haigis-L suggested IOLs that would yield outcomes more myopic than expected when compared to BTK.

Predictive accuracy of an intraoperative aberrometry device for a new monofocal intraocular lens.

To evaluate refractive outcomes for the Clareon monofocal intraocular lens (IOL) in terms of achieved target refraction for the ORA (ALCON) intraoperative wavefront aberrometry device and preoperative noncontact biometry. University Eye Clinic Maastricht, Maastricht University Medical Center+, the Netherlands. Prospective observational clinical trial. Patients with bilateral age-related cataracts undergoing phacoemulsification, either by delayed sequential surgery or on the same day, were included in the study. Exclusion criteria were an increased risk for refractive surprise or complicated surgery. Implanted IOL power was based on noncontact optical biometry data using the Barrett Universal II (BU-II) formula, optimized for the Clareon IOL. Postoperative subjective refraction was measured 4 to 6 weeks after surgery. Catquest-9SF questionnaires were completed preoperatively and 3 months after surgery. 100 eyes (51 patients) were included. The percentages of eyes within 1.0 diopters (D), 0.75 D, 0.50 D, and 0.25 D of target for ORA vs BU-II were 84% (84 eyes), 72% (72 eyes), 57% (57 eyes), and 21% (21 eyes) vs 97% (97 eyes), 88% (88 eyes), 77% (77 eyes), and 53% (53 eyes), respectively. Mean absolute prediction error was significantly higher for ORA vs preoperative biometry (P < .001). After global optimization, the prediction accuracy of ORA improved significantly (P < .001). Catquest-9SF questionnaires showed improved levels of ability at 3 months after surgery (P < .001). This study showed lower percentages of eyes within target refraction for ORA (prior to lens constant optimization) compared with the BU-II formula when implanting the Clareon IOL. However, prediction accuracy of ORA improved significantly after global optimization. Therefore, further intraoperative measurements, postoperative measurements, and optimization are needed to improve the ORA prediction for this IOL.

Prediction accuracy of intraoperative aberrometry compared with preoperative biometry formulae for intraocular lens power selection

ObjectiveTo compare the accuracy of intraoperative wavefront aberrometry to preoperative biometry formulae for predicting intraocular lens power. DesignRetrospective, consecutive case series. ParticipantsEyes undergoing cataract extraction with at least 1 month of follow-up after surgery at an ambulatory surgical centre in Toronto. MethodsConsecutive sample of 228 cataract extractions with monofocal, trifocal, or toric intraocular lens implantation from November 1, 2017, to December 31, 2019. The spherical equivalent was predicted preoperatively with Barrett Universal II, Hill-Radial Basis Function (RBF), SRK/T, Holladay I, Holladay II, Haigis, and HofferQ using biometry measurements and intraoperatively with wavefront aberrometry. The primary outcomes were mean prediction error and proportion of eyes with a spherical equivalent within 0.5 D of the refractive target at postoperative month 1. ResultsThe analysis included 159 eyes with 52% females and a mean age of 69.4 years. Formulae with the lowest mean prediction error were Hill-RBF (0.32 D ± 0.02 D), Barrett Universal II (0.32 D ± 0.02 D), intraoperative aberrometry (0.32 D ± 0.02 D), SRK/T (0.33 D ± 0.02 D), Holladay II (0.34 D ± 0.03 D), Holladay I (0.35 D ± 0.02 D), Haigis (0.37 D ± 0.02 D), and HofferQ (0.42 D ± 0.02 D). There were no statistically significant differences between intraoperative aberrometry and the preoperative formulae. Formulae with the highest proportion of eyes within 0.5 D of the refractive target were intraoperative aberrometry (82%), Barrett Universal II (81%), Hill-RBF (80%), SRK/T (77%), Holladay II (76%), Holladay I (75%), Haigis (71%), and HofferQ (70%). ConclusionsIntraoperative aberrometry and modern preoperative biometry formulae are equally effective at reaching the refractive target. In normal eyes, intraoperative aberrometry does not appear to provide any additional benefit to modern prediction formulae.

Repeatability of intraoperative Hartmann-Shack wavefront sensing in cataract surgery.

To evaluate the repeatability of aphakic intraoperative wavefront aberrometry and compare it with preoperative and postoperative aberrometry. Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. Prospective case series. Patients scheduled for cataract surgery were each measured 3 consecutive times using Hartmann-Shack wavefront sensing (HS-WFS) preoperatively, intraoperatively in aphakia, and 2 months postoperatively after intraocular lens implantation by a single examiner. Intraclass correlation coefficients (ICCs) of spherical equivalent (SE) values were evaluated for each timepoint. Intrasubject standard deviation (Sw) as repeatability (Sr) with corresponding repeatability limit () and mean SE differences with corresponding limits of agreement (LoA) were calculated for comparison. A high consistency of repeated measurements was found with ICCs above 0.9 for each of the 3 timepoints. Intraobserver repeatability (Sr) and repeatability limit (r) of intraoperative aberrometry SE measurements (30 eyes of 30 patients) were 0.34 diopters (D) and 0.95 D, respectively. The LoA for intraoperative aphakic SE across 3 consecutive measurements were -0.71 to +0.85 D. For comparison, Sr and r for phakic preoperative measurements in the cataractous state (30 eyes of 30 patients) and postoperative measurements in the pseudophakic state (24 eyes of 24 patients) were 0.33 D and 0.93 D and 0.23 D and 0.64 D, respectively. Similarly, the LoA for preoperative and postoperative SE measurements were -0.66 to +0.60 D and -0.27 to +0.45 D, respectively. HS-WFS test-retest reliability was high for all 3 timepoints, but the intraoperative setting resulted in a lower repeatability and broadened the agreement range.

Intraoperative wavefront aberrometry to determine planar endpoint for the repositioning of vaulted accommodative IOLs.

Accommodative intraocular lenses (IOLs) are suitable options for patients desiring less dependence on spectacles after cataract surgery. Accommodative IOLs do not require diffractive optics and, therefore, might be used in a wider range of patients who have mild comorbidities or wish to avoid photopsia associated with diffractive IOLs. However, a small percentage of patients have experienced vault, or capsular contraction syndrome (CCS), due to fibroblastic metaplasia of lens epithelial cells. Early detection of CCS might be managed with Nd:YAG capsulotomy; however, accommodative IOLs with significant CCS have required viscodissection of the fibrosis and placement of a capsular tension ring. A challenge with this maneuver is using the operating microscope to determine whether the accommodative IOL has returned to planar position. This article describes a new technique using serial intraoperative wavefront aberrometry measurements of lenticular astigmatism during accommodative IOL repositioning to determine a planar endpoint in the reduction of vault.

Alport Syndrome and Femtosecond Laser-assisted Cataract Surgery.

We report the surgical management of a patient with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS) and the Optiwave Refractive Analysis (ORA) system. A 38-year-old man with Alport syndrome presented to our department with visual loss due to anterior lenticonus in both eyes. Adjustments during bilateral FLACS were performed with the software's calipers to manually delineate the anterior capsulotomy. Multifocal toric intraocular lenses (IOLs) were selected and placed in the posterior chamber with the aid of intraoperative aberrometry. The intended postoperative positioning parameters for the IOL as well as the planned visual acuity and refraction were achieved. The implementation of FLACS and intraoperative wavefront aberrometry is a safe and useful surgical approach for the management of cataract in challenging cases such as patients with anterior lenticonus due to Alport syndrome.

Optiwave Refractive Analysis (ORA)

In the current era, there is increasing demand for optimal refractive outcomes following cataract surgery. Optical methods have been identified as a gold standard for Intraocular lens (IOL) power calculation but there is always a scope of improvement. Intraoperative wavefront aberrometry with devices such as Optiwave refractive analysis (ORA) calculates IOL power on the basis of lower order aberrations intraoperatively. This provides an alternate method for IOL calculation.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in axial myopia

To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis function (RBF) formula with other formulas based on preoperative biometry in predicting residual refractive error after cataract surgery in eyes with axial myopia. Private practice, Harrisburg, Pennsylvania, USA. Retrospective consecutive case series. Eyes with an axial length (AL) greater than 25.0mm had cataract extraction with intraocular lens implantation. For each eye, the 1-center Wang-Koch AL-optimized Holladay 1formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using theSRK/T, Holladay 1 and 2, Barrett Universal II, and Hill-RBF formulas and intraoperatively using wavefront aberrometry. The postoperative refraction was compared with the preoperative and intraoperative predictions. The study comprised 37 patients (51 eyes). The mean numerical errors ± standard error associated with using the SRK/T, Holladay 1, AL-optimized Holladay 1, Holladay 2, Barrett Universal II, and Hill-RBFformulas and intraoperative wavefront aberrometry were 0.20±0.06 diopters (D), 0.33±0.06 D, -0.02±0.06 D, 0.24±0.06 D, 0.19±0.06 D, 0.22±0.06 D, and 0.056±0.06D, respectively (P<.001). The proportion of patients within ±0.5 D of the predicted error was 74.5%, 62.8%, 82.4%, 79.1%, 73.9%, 76.7%, and 80.4%, respectively (P=.090). Hyperopic outcomes occurred in 70.6%, 76.5%, 49.0%, 74.4%, 76.1%, 74.4%, and 45.1% of the eyes, respectively (P=.007). Intraoperative wavefront aberrometry was better than all formulas based on preoperative biometry and as effective as the AL-optimized Holladay 1 formula in predicting residual refractive error and reducing hyperopic outcomes. The Hill-RBF formula's performance was similar to that of the fourth-generation formulas.

Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation.

Purpose:To compare the outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens (IOL) power calculation in eyes undergoing cataract surgery with monofocal IOL implantation.Methods:Preoperative data were obtained with the IOLMaster. Intraoperative aphakic measurements and IOL power calculations were obtained in some patients with the optiwave refractive analysis (ORA) system. Analysis was performed to determine the accuracy of monofocal IOL power prediction and postoperative manifest refraction at 1 month of the ORA versus IOLMaster.Results:Two hundred and ninety-five eyes reviewed, 61 had only preoperative IOLMaster measurements and 234 had both IOLMaster and ORA measurements. Of these 234 eyes, 6 were excluded, 107 had the same recommended IOL power by ORA and IOLMaster. Sixty-four percent of these eyes were within ±0.5D. 95 eyes had IOL power implantation based on ORA instead of IOLMaster. Seventy percent of these eyes were within ±0.5D of target refraction. 26 eyes had IOL power chosen based on IOLMaster predictions instead of ORA. Sixty-five percent were within ±0.5D. In the group with IOLMaster without ORA measurements, 80% of eyes were within ±0.5D of target refraction. The absolute error was statistically smaller in those eyes where the ORA and IOLMaster recommended the same IOL power based on preoperative target refraction compared to instances in which IOL selection was based on ORA or IOLMaster alone. Neither prediction errors were statistically different between the ORA and IOLMaster alone.Conclusion:Intraoperative wavefront aberrometry with the ORA system provides postoperative refractive results comparable to conventional biometry with the IOLMaster for monofocal IOL selection.

Intraoperative aberrometry-based aphakia refraction in patients with cataract: status and options

AimTo explore the application of intraoperative wavefront aberrometry (IWA) for aphakia-based biometry using three existing formulae derived from autorefractive retinoscopy and introducing new improved formulae.MethodsIn 74 patients undergoing cataract surgery,...

Visual and Refractive Outcomes of a Toric Presbyopia-Correcting Intraocular Lens.

Purpose. To evaluate outcomes in astigmatic patients implanted with the Trulign (Bausch + Lomb) toric presbyopia-correcting intraocular lens (IOL) during cataract surgery in a clinical practice setting. Methods. Retrospective study in 40 eyes (31 patients) that underwent cataract extraction and IOL implantation in a procedure using intraoperative wavefront aberrometry guidance (ORA system). Endpoints included uncorrected visual acuity (VA), reduction in refractive cylinder, accuracy to target, axis orientation, and safety. Results. At postoperative month 1, refractive cylinder was ≤0.50 D in 97.5% of eyes (≤1.00 D in 100%), uncorrected distance VA was 20/25 or better in 95%, uncorrected intermediate VA was 20/25 or better in 95%, and uncorrected near VA was 20/40 (J3 equivalent) or better in 92.5%. Manifest refraction spherical equivalent was within 1.00 D of target in 95% of eyes and within 0.50 D in 82.5%. Lens rotation was <5° and best-corrected VA was 20/25 or better in all eyes. Conclusion. The IOL effectively reduced refractive cylinder and provided excellent uncorrected distance and intermediate vision and functional near vision. Refractive predictability and rotational stability were exceptional. Implantation of this toric presbyopia-correcting IOL using ORA intraoperative aberrometry provides excellent refractive and visual outcomes in a standard of care setting.

First clinical results on the feasibility, quality and reproducibility of aberrometry-based intraoperative refraction during cataract surgery

ObjectiveTo provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract.DesignIWA refraction was recorded at 7 defined measurement...

Effect of intraoperative aberrometry on the rate of postoperative enhancement: Retrospective study

To determine whether the use of intraoperative wavefront aberrometry reduces the frequency of postoperative laser enhancements over the rate in cases in which aberrometry was not used. Private surgical center and private practice, Eugene, Oregon, USA. This was a retrospective case-control chart review of patients who chose to have correction of preexisting corneal astigmatism by limbal relaxing incisions (LRIs) at the time of cataract surgery or refractive lens exchange. In the aberrometry group, an ORange wavefront aberrometer was used intraoperatively to measure total ocular refractive cylinder after intraocular lens implantation and to guide LRI enhancement. A group in which the aberrometer was not used served as the control. The control group had 37 eyes and the aberrometry group, 30 eyes. The excimer laser enhancement rate was 3.3% in the aberrometry group and 16.2% in the control group. The mean postoperative cylinder was 0.48 diopter (D) in the control group and 0.37 D in the aberrometry group. Residual cylindrical refractive error, not sphere, determined the patients' decision to have enhancement. The use of intraoperative wavefront aberrometry to measure and enhance the effect of LRIs produced a nonsignificant trend that led to a 5.7-fold reduction in the odds ratio of subsequent excimer laser enhancement.