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Biometry - Final

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30 views52 pages

Biometry - Final

Uploaded by

Sujon Paul
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CHAIRMAN- Prof.

JALAL AHMED
Director cum Professor, NIO&H

MODERATOR-DR. MD. GHULAM RASUL


ASSISTANT PROFESSOR,
DEPARTMENT OF OPHTHALMOLOGY, NIO&H

PRESENTER-DR. MD. MASUD RANA


DO Resident, NIO&H
BIOMETRY
It is the process by which the IOL power is
measured before doing cataract surgery.
Components of IOL power
calculations

 Biometry
 Formulas
 Clinical variables
Components of Biometry

 Axial length
 Corneal power
 IOL position
Factors for obtaining accurate
measurement
A. Ultrasound Axial B. Corneal Power
Length
A-scan ultrasound instrument Instrumentation

Real time Oscilloscope screen Contact lens wear

Immersion technique Astigmatism

Experienced Technician Previous refractive surgery

Appropriate ultrasound velocities Corneal transplant eyes


& B-scan Backup
Axial length can be measured by:

• 1. A- Scan biometry
-Applanation A-Scan
-Immersion A-Scan
• 2. IOL Master
A-Scan Biometry

Measurement of Axial eye length by ultrasound.

Average length of normal eye 23.06 mm

Majority 22.0 to 24.5 mm.


Error caused by 1 mm corneal
compression
Average eye---2.5D
Long eye---1.75D
Short eye---3.75D
Instrument settings
 Calibration Check
 Gates
 Gain
 Sound Velocity
Applanation A- Scan
Potential sources of error with
contact method
Corneal compression
 Fluid excess
 Misalignment of sound beam
 Inappropriate eye type
Immersion Technique
Potential sources error with
immersion method

Air bubble within fluid


Inappropriate eye type
Zeiss IOL Master

-Axial length
-ACD
-Corneal Power
-IOL power Calculation
Hoffer-Q, SRK/T, Holladay 1, Haigis
Zeiss IOL Master
Keratometry
Keratometry is the measurement of curvature of
the anterior surface of cornea.
It is done by --- Manual
--- Topography
--- Autokeratometer
--- IOL Master
Procedure of Keratometry
1. Instrument adjustment
2. Patient adjustment
3. Focusing of mire
4. Measurement of corneal curvature
Relationship between the Radius
of curvature and the Diopteric
power of cornea
D=( n-1)/r
r= (1.3375-1)/D m
=(337.5-1)/D mm
Here D= Diopteric power of the cornea
n= Index of refraction the cornea
r= Radius of cornea in meters
Measurement of postoperative
corneal power
K= Kpreop + Rpreop – Rpo

Here,
K= Effective corneal power
R= Refractive error
preop= preoperative
po= postoperative
Contact Lens Method
K= B + P + RCL – RNoCL

Here,
B= base curve
CL= contact lens
P= power of cl
R= refractive error
NoCL= bare refraction
Corneal Topography Method
According to Melony
K= 1.1141*Kt – 5.5

Here,
Kt is postoperative topography central
K
Shammas No History Method
K= 1.14*Kpo – 6.8

Here,

K= predicted corneal power


Kpo= the average corneal power obtained
with keratometry after corneal refractive
surgery.
Sources of error in Keratometry
Improper calibration
Faulty position of the patient
Accommodative fluctuation by examiner
Localized corneal distortion
Excessive teaing
Abnormal lid posion
Improper focusing of the corneal image
Bag Vs Sulcus Power
IOL Power for in Correction for
bag insertion sulcus
placement
+ 5.00 to + 0.00
9.00
+9.50 to -0.50
+17.00
+17.50 to + -1.00
28.00
+28.50 to -1.50
IOL Power Formula
Theoretical
Regression
Refractive
Theoretical Formula

These formulas contain many assumptions


including values of post-operative ACD,
refractive index of cornea & ocular
humors, retinal thickness.
Regression Formula

Actual post operative refractive results of


many lens implantations are used to
predict IOL power.
Refractive Formulas

IOL power calculation without determination


of axial length.
Basic Theoretical Formulas
Colenbrander’s formula
P=1336/(L-C-0.05)-1336/(1336/K)-C-0.05
Fyodorov’s formula
P=(1336-LK)/(L-C)(1-CK/1336)
Binkhorst formula
P=1336(4R-L)/(L-C)(4R-C)
Modified Theoretical formulas
Hoffer’s formula
P=1336/(L-C-0.05)-1336/(K+E)-C-0.05
Shamma’s fudged formula
P=1336/{L-0.1(L-23)-C-0.05}-1/(1.0125/K)-
(C+0.05)/1336
Binkhorst formula
P=1336(4R-L)/(L-C)(4R-C)
Generation of IOL formula
1st generation
Fyodorov,Colenbrander,Hoffer,SRK l
2nd generation
Binkhorst ,SRK ll
3rd generation
Holladay l, Hoffer-Q, SRK/T
4th generation
Holladay 2, Haigis
IOL formula 1st generation
Most are based on regression formula
developed by Sander, Retzlaff and Kraff-
known as SRK formula.

Formula, P= A - 2.5(L) - 0.9(K)


IOL formula 2nd generation
SRK ll

A l = A+ 3 AL < 20 mm
A l = A+ 2 AL 20 – 21
A l = A+ l AL 21 – 22
A l = A AL 22 – 24.5
A l = A – 0.5 AL >24.5
IOL formula 3rd generation
Third generation formulas—

SRK/T -very long eyes > 26 mm


Holladay -long eyes 24 – 26 mm
Hoffer Q -short eyes < 22 mm
SRK/T
It is a nonlinear theoretical optical
formula emperically optimized for
postoperative ACD,Retinal
thickness,corneal refractive index.
It combines advantages of
theoretical and regression formulas
IOL formula 4th generation
Holladay 2
Haigis formula-
d= ao + (a1 * ACD) + (a2 * AL)
Here,
ACD is the measured anterior chamber depth
AL is the axial length of the eye
The a0, a1 and a2 constants are set by optimizing
a set of surgeon and IOL specific outcome for a
wide range of ALs and ACDs.
SRK/T formula----- uses “ A-constant”
Holladay 1 formula- uses “Surgeon
Factor”
Holladay 2 formula– uses “ACD”
Hoffer Q Formula----uses “ACD”
Formula choice
AL < 19 mm (<0.1%) Holladay
AL 19-22 mm (8%) Holladay 2,
Hoffer-Q
AL 22-24.5 mm (72%) SRK II,Hoffer-
Q,Holladay I
AL 24.5-26mm (15%) Hololaday I,
Hoffer –Q
AL >26mm (15%) SRK/T
BIOMETRY IN SPECIAL CONDITIONS
Biometry in Aphakic eye
 According to Sean lanchulev formula—
 P= 2.02×AR+(A-118.4)
Here
 P = Emmetropic IOL power
 AR = Automated Refraction
 A = IOL A constant
APHAKIC Eye cont..

According to Mackool
P= 1.75×AR+ (A- 118.84)
Phakic Eye with a Phakic IOL
ALCORRECTED= AL1555 + (C*T)
Here,
AL1555= the measured AL of the eye at the
sound velocity of 1555
C= the material specific correction factor of
+0.42 for PMMA, -0.59 for silicone, +0.11
for collamer and +0.23 for acrylic
T= the central thickness of the phakic IOL
Biometry in Pseudophakic Eye
• Lowering the gain
• Velocity change
Biometry after keratorefractive
surgery
Feiz method:
For myopic LASIK cornea:
P= PTARG-0.595×RC- 0.231
Feiz method example calculations
Myopic eye
--SRK-T calculates 16.0 D IOL
--Change in Rx= -6.0 D
“- 0.595×(-6)- 0.231” = +3.34
P= 16.0 +3.34 =19.34 D
Feiz method contd..
For Hyperopic LASIK cornea
P= PTARG-0.862×RC+0.751
Example…
Hoffer Q calculate 22.0 D
Change in Rx= +3.0 D
-0.862×(+3)+ 0.751= -1.84
P= 22.0- 1.84= 20.16 D
Paediatric Biometry and IOL Power
calculation
In the first year of life the AL increases very fast. An
under correction has been recommended depending
upon the child’s age.

<2 years……20% under correction


2-5 years…... 10% under correction
5-8 years…… 5% under correction
Sources of error
• Error in measuring AL
-Staphyloma
-Contact applanation
-Technician inexperience
-Silicone oil filled eye
Incorrect measurement of the
corneal power
• Previous corneal refractive surgery
• Irregular calibration of instrument
• Wrong IR is set in IOL Master
THANK YOU

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