Comparison of the Accuracy of Intraoperative Aberrometry in Intraocular Lens Implantation Between Myopic Eyes with Emmetropia and Myopia Targets

Abstract

Purpose To compare the accuracy of intraoperative aberrometry (IA) for predicting postoperative refraction between eyes with emmetropia and myopia targets. Patients and Methods This retrospective analysis included patients with axial myopia (axial length ≥ 25.0 mm) who underwent uncomplicated phacoemulsification cataract surgery with IA to achieve emmetropia (plano to −0.5 D) or intentional myopia (−2.5 D to −5.0 D). Preoperative ocular biometry was performed in all eyes using an IOLMaster. Refractive prediction errors in IA were compared between eyes with emmetropia and myopia targets. Refractive prediction errors in IA for both groups were also compared with those predicted by intraocular lens power calculation formulas including the SRK/T, Holladay 1, Hoffer Q, Holladay 2, Haigis, and Barrett Universal II formulas. Results Thirty-nine eyes of 39 patients with a target of emmetropia and 22 eyes of 22 patients with a target of intentional myopia were included in the final analysis. The mean numerical error was significantly different from zero (myopic trend) in myopia-targeted eyes (−0.37 ± 0.54 D, one-sample t -test, P = 0.004, 95% confidence interval: −0.61 to −0.14), while it was close to zero in emmetropia-targeted eyes. The mean absolute error was significantly smaller in emmetropia-targeted eyes (0.28 ± 0.27 D) than in myopia-targeted eyes (0.51 ± 0.41 D, P = 0.01). IA was revealed as the most accurate method for predicting postoperative refraction in eyes with emmetropia target, whereas Barrett Universal II formula was found to be the most accurate for eyes with myopia target. Conclusion In patients with axial myopia, the performance of IA was altered when targeting intentional myopia compared with emmetropia. Myopic shift in the refractive outcome should be considered when IA is used to target myopia.

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

“…More recently, the superiority of IWA has been challenged by next-generation formulas such as BTK, Haigis, AL-adjusted Holladay 1, and Hill-RBF. Previous studies conducted in normal eyes by Sakai et al and Geenwood et al each compared IWA with these formulas and suggest use of these preoperative formula produces results equal to or superior to IWA [12,13]. However, further research has been needed to compare the accuracy of outcomes between these formulas and IWA in post-refractive eyes.…”

“…Some have demonstrated IWA to be superior to BTK [7], but the difference is small and other studies suggest the results are similar between the two [8][9][10][11]. Although previous studies have evaluated other next generation formulas such as Haigis and AL-adjusted Holladay 1 compared to IWA in normal eyes [12,13], few have compared these additional formulas in the setting of post LVC eyes [14], and none have included Hill-Radial Basis Function Version 3.0 (Hill-RBF v3.0) in their analysis. Even further, there have been no studies comparing IWA to any of these formulas in cases with capsular tension rings, which have demonstrated lower variance in refractive outcomes than in contralateral eyes without a CTR [15].…”

Intraoperative aberrometry: an update on applications and outcomes

“…& ]. In contrast, there are numerous studies that instead focus on either routine/typical non-post-refractive surgery cases alone [6,9,10 ,11, 14,30-32,33 & ,34-38] or on subsets of atypical patients [29,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]. This trend in publications may be at least in part a reflection that in the real world, many cataract surgeons utilize intraoperative aberrometry selectively rather than broadly.…”

“…However, within each of these groups, there was no statistically significant difference between the mean prediction error for intraoperative aberrometry versus preoperative calculations [33 ▪ ]. An additional consideration when using intraoperative aberrometry in patients with axial myopia is that it appears to be more accurate for emmetropic target refraction than for intentional myopia (−2.5 D to −5.0D) based on a study by Sakai et al [40].…”

“…Moreover, in studies with broad cohorts, overall outcomes are generally not reported, and instead the focus is on subsets of patients [20 ▪▪ ,28 ▪ ]. In contrast, there are numerous studies that instead focus on either routine/typical non-post-refractive surgery cases alone [6,9,10 ▪ ,11,14,30–32,33 ▪ ,34–38] or on subsets of atypical patients [29,39–52]. This trend in publications may be at least in part a reflection that in the real world, many cataract surgeons utilize intraoperative aberrometry selectively rather than broadly.…”