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Another view on the benefits of intraoperative aberrometry

2020; Lippincott Williams & Wilkins; Volume: 46; Issue: 2 Linguagem: Inglês

10.1097/j.jcrs.0000000000000057

1873-4502

Johnny L. Gayton,

Glaucoma and retinal disorders

Several years ago, Dr. Warren Hill made 2 predictions. First, there is a tsunami of postrefractive surgery patients who need cataract surgery. Second, patient satisfaction largely depends on the uncorrected distance vision after cataract surgery. This led me to adopt intraoperative aberrometry (IOA), especially for postrefractive surgery patients. My experience with IOA peaked my interest in the results of a study by Solomon et al.1 on intraocular lens (IOL) power calculations. Modern diagnostic equipment and formulas have improved IOL power calculations; however, they are not without fault. A review of an article by Ianchulev et al.2 confirms the improved accuracy that many surgeons using IOA have experienced in postrefractive cases. He noted a 45.6% improvement in patients within ±0.50 diopters (D) predicted when IOA was used in postmyopic laser in situ keratomileusis patients. Those patients were excluded from the study by Solomon et al. Recently, I had a photorefractive keratectomy patient that IOA accurately recommended 2.00 D more than our calculations. IOA has also helped me avoid implanting a wrong IOL power because of a calculation error. In the study by Solomon et al., the Barrett Universal II3 formula was used for the non-IOA group, whereas the Holladay 24 formula was used for the IOA group. Our practice has been impressed with the accuracy of the Barrett formulas. Because IOA recommendations were not used to influence IOL power in the study by Solomon et al., it could be considered a comparison of formulas. In the toric IOL group, the Barrett II formula and the Barrett toric calculator were compared to the VERION system (Alcon Laboratories, Inc.). In the relaxing incision group, the Barrett II and the limbal relaxing incision calculator (Abbott Medical Optics, Inc.) were compared to the VERION. In the Solomon et al. study, 76% of patients had 1.50 D or less of cylinder and only 24% of patients had 2.00 D or more. This amount of cylinder might not show the true benefits of IOA. By contrast, a study by Woodcock et al.5 with 69.5% of patients having 1.50 D or more of astigmatism demonstrated 89.2% of eyes were within ±0.50 D using IOA, whereas the contralateral eyes in which IOA was not used had 76.6% within ±0.50 D. There are definitely times that preoperative measurements differ. In those cases, IOA helps me decide the power and axis of my toric IOL. I will also admit that turnover in my technical department sometimes results in inexperienced technicians performing measurements. Dr. Solomon has a brilliant colleague in charge of IOL power calculations; thus, his preoperative measurements are more consistent and accurate than mine. IOA is probably more helpful in a practice like mine, but I would suspect that is true in many other practices as well.