Development of a new intraocular lens power calculation method based on lens position estimated with optical coherence tomography.

A new method is developed and validated for intraocular lens (IOL) power calculation based on paraxial ray tracing of the postoperative IOL positions, which are obtained with the use of anterior segment optical coherence tomography. Of the 474 eyes studied, 137 and 337 were grouped into training and validation sets, respectively. The positions of the implanted IOLs of the training datasets were characterized with multiple linear regression analyses one month after the operations. A new regression formula was developed to predict the postoperative anterior chamber depth with the use of the stepwise analysis results. In the validation dataset, postoperative refractive values were calculated according to the paraxial ray tracing of the cornea and lens based on the assumption of finite structural thicknesses with separate surface curvatures. The predicted refraction error was calculated as the difference of the expected postoperative refraction from the spherical-equivalent objective refraction values. The percentage error (within ±0.50 diopters) of the new formula was 84.3%. This was not significantly correlated to the axial length or keratometry. The developed formula yielded excellent postoperative refraction predictions and could be applicable to eyes with abnormal proportions, such as steep or flat corneal curvatures and short and long axial lengths.

Relationship between Crystalline Lens Thickness and Shape and the Identification of Anterior Ocular Segment Parameters for Predicting the Intraocular Lens Position after Cataract Surgery.

PURPOSE: This study was performed to investigate the relationships among crystalline lens shape, actual intraocular lens (IOL) position, and crystalline lens thickness (LT), as measured by anterior segment optical coherence tomography (AS-OCT), and to determine anterior ocular segment parameters that predict postoperative IOL position. METHODS: Seventy-nine eyes of 79 patients who underwent uneventful cataract surgery were enrolled. For crystalline lens preoperative anterior segment data, the LT, and anterior, equatorial, and posterior surface depths (ASD, ESD, and PSD, respectively) of crystalline lenses were quantitatively determined. For postoperative anterior segment data, the actual IOL position was quantified. Moreover, the following correlations were analyzed: LT with the ASD, ESD, PSD, and IOL position; IOL position with the ASD, ESD, and PSD; and refractive prediction error with the difference between the predicted postoperative anterior chamber depth (ACD) of the SRK/T formula and the IOL position, ASD, ESD, and PSD (each depth minus the predicted postoperative ACD of the SRK/T formula). RESULTS: The LT was significantly correlated with the ASD (r = -0.65) and PSD (r = 0.41), whereas it was not correlated with the ESD or IOL position. The IOL position was significantly correlated with the ASD (r = 0.67), ESD (r = 0.72), and PSD (r = 0.74). The refractive prediction error was significantly correlated with the difference between the predicted postoperative ACD of the SRK/T formula and the IOL position (r = 0.65), ASD (r = 0.46), ESD (r = 0.54), and PSD (r = 0.58). CONCLUSIONS: The ESD and PSD obtained using AS-OCT were highly correlated with the IOL position and significantly correlated with the refractive prediction error. These findings suggest that the ESD and PSD may enhance the accuracy of actual IOL position prediction.

Prediction of pupil size under binocular open-view settings using the new CASIA2 device.

PURPOSE: Pupillometry should be performed under conditions as close to natural viewing as possible. The present study aimed to determine whether pupil size in binocular open-view settings can be predicted based on pupil size measured using the CASIA2 device. METHODS: The present study included 61 participants (25 men and 36 women; mean age, 49 ± 15 years; age range, 22-69 years) with no history of ophthalmic disease other than refractive errors and cataract. We measured pupil size using the new CASIA2 device and a binocular open-view digital pupillometer (FP-10000II, TMI Co., Ltd., Saitama). Intra-class and inter-class reliabilities were evaluated by measuring pupil times three times with each device (two independent examiners) in 21 of the 61 participants. Reproducibility was analyzed using intra-class and inter-class correlation coefficients (ICCs). Regression formulae for calculating FP10000II pupil size based on CASIA2 pupil size were developed via simple linear regression analyses. RESULTS: Both devices exhibited high ICC values (> 0.80). The regression formulae for calculating the FP10000II pupil size for the distant and near views based on CASIA2 pupil size were y = 0.5702x + 0.4611 (determination coefficient, 0.67) and y = 0.502x + 0.445 (determination coefficient, 0.64), respectively. CONCLUSIONS: Pupil size under binocular open-view settings can be predicted based on simultaneous measurement of pupil size during evaluation of the anterior segment using the CASIA2 device. The calculated pupil size may represent a useful index for determining the most appropriate treatment strategy in candidates for cataract and refractive surgery.

Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism.

PURPOSE: To evaluate the long-term clinical outcomes and rotational stability of toric intraocular lenses (IOLs) to correct preexisting astigmatism in cataract patients. SETTING: Kitasato University Hospital, Kanagawa, Japan. DESIGN: Prospective observational study. METHODS: Phacoemulsification with implantation of a toric IOL (Acrysof IQ toric SN6AT) was performed in cataract patients with corneal astigmatism. The postoperative follow-up was up to 2 years. RESULTS: This study enrolled 378 eyes of 302 patients with a mean age of 63.4 years ± 16.9 (SD). The corrected distance visual acuity 3 months postoperatively was 20/25 or better in 94.7% of eyes. The mean refractive cylinder was -1.92 ± 1.45 diopters (D) preoperatively, -0.59 ± 0.62 D 3 months postoperatively (322 eyes), and -0.67 ± 0.90 D at 2 years (73 eyes). There were statistically significant differences between the preoperative and 3-month postoperative measurements (P<.001, Wilcoxon signed-rank test). The mean IOL misalignment was 4.1 ± 3.0 degrees 2 years postoperatively. The mean IOL rotation was 4.5 ± 4.9 degrees within 1 day postoperatively. The rotation was more than 20 degrees in 6 eyes, all of which had an axial length (AL) of more than 25.0 mm. All rotations occurred within 10 days postoperatively. CONCLUSIONS: Toric IOLs were effective in reducing preexisting corneal astigmatism and had overall good rotational stability. A large degree of IOL rotation might occur in eyes with a relatively long AL, especially during the early postoperative period. The 6 rotated IOLs were implanted to correct with-the-rule astigmatism. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.