Time Utilization and Refractive Prediction Enhancement Associated with Intraoperative Aberrometry Use During Cataract Surgery

Abstract

Purpose: To evaluate the time cost of intraoperative aberrometry (IA), to compare IA prediction error to the prediction error associated with conventional formulas using preoperative calculations (PC) and evaluate when IA provides clinically relevant benefit. Methods: This is a retrospective study of eyes that underwent cataract phacoemulsification surgery with IA at an academic eye center. IA versus PC prediction error were compared amongst various preoperative and intraoperative characteristics. Additionally, a dichotomous variable indicating clinically relevant benefit of IA, where IA absolute prediction error was less than 0.5D and PC absolute prediction error greater than 0.5D, was associated with clinical factors. Results: Five hundred eyes of 341 patients were included in the analysis. The quantitative difference between mean absolute prediction errors for IA versus PC was between 0.0D and 0.03D in most subgroups. For the 11.0% of eyes that had clinically relevant benefit to IA, the multivariable model identified the following strongest predictors: prior myopic corneal refractive surgery (Odds ratio (OR) 3.9, p<0.01 for myopic LASIK/PRK, OR 5.5, p=0.01 for radial keratotomy), toric or multifocal/EDOF lens implantation (OR 2.7, p=0.03 for toric monofocal lenses, OR 3.1, p=0.01 for EDOF/multifocal lenses), and short and long axial lengths (p<0.01). On average, IA implementation added 3.0 minutes to surgery (p<0.01). Conclusion: For greatest likelihood of a clinically meaningful improvement in outcomes despite increased surgical time, surgeons and patients should consider using IA for eyes with extremes in axial length, eyes with prior myopic corneal refractive surgery, or when implanting lenses with toric or extended-depth-of-focus/multifocal properties.

Refractive Accuracy of Barrett True-K vs Intraoperative Aberrometry for IOL Power Calculation in Post-Corneal Refractive Surgery Eyes

“…In post-corneal refractive surgery eyes, measurement inaccuracies pose additional challenges for ophthalmologists attempting to calculate IOL power. 24,25 Intraoperative aberrometry may help to reduce errors in IOL power calculation, especially in those with extremes in axial length or prior refractive surgery 26,28 by measuring the eye's refractive power in the aphakic state, thus accounting for both the anterior and posterior curvature and refractive index of the cornea. 22 The precision and quality of the intraoperative wavefront aberrometry measurements, however, may be affected by its lower repeatability, 24 the need to optimize IOP, hydration and wound integrity, the presence of bubbles in the visual axis, globe distortion due to eyelid speculum pressure, and patient cooperation.…”

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

“…The use of IA is expected to improve the refractive outcome of patients with axial myopia. 3 , 10 Previous reports on IA accuracy mainly focused on achieving emmetropia, although intentional myopia is another common choice for patients with axial myopia. In this study, we aimed to investigate the influence of intentional myopia on the refractive prediction of IA.…”

Intraoperative aberrometry: an update on applications and outcomes

“…They also reported that the percentage of patients within ±0.5D of target was 56% for intraoperative aberrometry and 47% for Barrett-True K ( P = 0.289) [28 ▪ ]. Other studies with smaller numbers of post-hyperopic ablation patients have shown a similar mean absolute error of approximately 0.5D without significant difference from preoperative calculations [20 ▪▪ ,29,45]. Intraoperative aberrometry may be more accurate in post-hyperopic ablation cases with short axial length in comparison to those with intermediate or long axial length [28 ▪ ].…”

“…In the multivariate regression model by Christopher et al [20 ▪▪ ] for eyes with greatest potential benefit of intraoperative aberrometry, post-radial keratotomy eyes had an odds ratio of 5.5 for intraoperative aberrometry to have prediction error less than 0.5D when preoperative calculations would have a prediction error greater than 0.5D. This was the highest odds ratio of the examined variables, and would suggest that intraoperative aberrometry might be particularly advantageous in post-radial keratotomy eyes [20 ▪▪ ]. However, other recent studies have instead found that intraoperative aberrometry has similar refractive outcomes to preoperative calculations [28 ▪ ,29,43,44].…”

“…Modi [26 ▪ ] found that the time for a single aphakic intraoperative aberrometry capture was 51 s, the time for a single pseudophakic capture was 71 s, and the total time to perform pseudophakic intraoperative aberrometry for toric IOL positioning (based on a median of three pseudophakic measurements) was 3 min and 45 s [26 ▪ ]. Christopher et al [20 ▪▪ ] performed an analysis of intraoperative aberrometry use by two surgeons, and found that the length of cataract surgery was on average 3 min longer when intraoperative aberrometry was utilized than when it was not [20 ▪▪ ]. Time to perform intraoperative aberrometry likely varies based on numerous variables including surgeon-related and facility-related factors.…”