Development of an Implantable Collamer Lens Sizing Model: A Retrospective Study Using ANTERION Swept-Source Optical Coherence Tomography and a Literature Review

Abstract

Background Optimal sizing for phakic intraocular lens (EVO ICL with KS-AquaPort) implantation plays an important role in preventing postoperative complications. We aimed to formulate optimal lens sizing using ocular biometric parameters measured by the Heidelberg anterior segment optical coherence tomography (AS-OCT) device. Methods We retrospectively analyzed 892 eyes of 471 healthy subjects treated with intraocular collamer lens (ICL) and assigned them to development (80%) and validation (20%) sets. We built vault prediction models using the development set via classic linear regression methods, partial least squares, and least absolute shrinkage and selection operator (LASSO) regression techniques. We evaluated prediction abilities based on the Bayesian information criterion (BIC) to select the best prediction model. The performance was measured using Pearson’s correlation coefficients and the mean squared error (MAE) between the achieved and predicted vaults. Results Measurements of aqueous depth (AQD), anterior chamber volume, anterior chamber angle (ACA) distance, spur-to-spur distance, crystalline lens thickness (LT), and white-to-white distance from ANTERION were highly associated with the ICL vault. The LASSO model using the AQD, ACA distance, and LT showed the best BIC results for postoperative ICL vault prediction. In the validation dataset, the LASSO model showed the strongest correlation (r = 0.582, P < 0.001) and the lowest MAE (104.5 µm). Conclusions This is the first study to develop a postoperative ICL vault prediction and lens sizing model based on ANTERION. As the measurements from ANTERION and other AS-OCT are not interchangeable, ANTERION can be used for optimal ICL sizing using our formula.