PURPOSE:To assess the agreement and repeatability of horizontal white-to-white (WTW) and horizontal sulcus-to-sulcus (STS) diameter measurements and use this data in combination with available literature to correct for inter-device bias in pre-operative implantable collamer lens (ICL) size selection. DESIGN: Inter-instrument reliability and bias assessment study. METHODS: A total of 107 eyes from 56 patients assessed for ICL implantation at our institution were included in the study. This was a consecutive series of all patients with suitable available data. The agreement and bias between WTW (measured with the Pentacam and BioGraph devices) and STS (measured with the HiScan device) were estimated. RESULTS: The mean spherical equivalent was -8.93D ± 5.69D. The BioGraph measures of WTW were wider than those taken with the Pentacam (bias= 0.26 mm, p<0.01), and both horizontal WTW measures were wider than the horizontal STS measures (bias >0.91 mm, p<0.01). The repeatability (Sr) of STS measured with the HiScan was 0.39 mm, which was significantly reduced (Sr=0.15 mm) when the average of two measures were used. Agreement between the horizontal WTW measures and horizontal STS estimates when bias was accounted for was г=0.54 with the Pentacam and г=0.64 with the BioGraph. CONCLUSIONS: Large inter-device bias was observed for WTW and STS measures. STS measures demonstrated poor repeatability, but the average of repeated measures significantly improved repeatability. In order to conform to the Federal Drug Administration's accepted guidelines for ICL sizing clinicians should be aware of and account for the inconsistencies between devices.3