Biometry for Premium IOLs 2015 Jack T. Holladay MD MSEE FACS Page 1 of 9 3/23/2015 JTH 1 The Promise of No Glasses or Contact Lenses ! Jack T. Holladay, MD, MSEE, FACS Clinical Professor of Ophthalmology Baylor College of Medicine Houston, Tx WWW.AAO.ORG 0 AMERICAN ACADEMY OF OPHTHALMOLOGY Financial Disclosure I have the following financial interests or relationships to disclose: Abbott Medical Optics: C; AcuFocus, Inc.: C,O; Alcon Laboratories, Inc.: C; ArcScan: C,O; Carl Zeiss Inc: C; Elenza: C,O; Oculus, Inc.: C; Visiometrics: C,O; Wavetec: C 3/23/2015 JTH 5 7 www.docholladay.com Handouts 3/23/2015 JTH 6 Requirements Centration Accurate Biometry – Optical (IOL Master or LenStar) Accurate K’s- Repeatable 4 th Generation Formula (WTW) Personalized Lens Constant Eliminate Corneal Astigmatism 3/23/2015 JTH 7 Multifocal IOL Optimal Location Cannot place on Pupil Center & Visual Axis (near P1) where axial ray is perpendicular to foveola. Optimal location is different for each patient and somewhere between Pupil Center & P1. 3/23/2015 JTH 8 Clinical Angle Kappa Pupil Center to Visual Axis NOSE
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Biometry for Premium IOLs 2015
Jack T. Holladay MD MSEE FACS Page 1 of 9
3/23/2015 JTH 1
The Promise of No Glasses
or Contact Lenses !
Jack T. Holladay, MD, MSEE, FACSClinical Professor of Ophthalmology
Baylor College of MedicineHouston, Tx WWW.AAO.ORG
0
AMERICAN ACADEMY OF OPHTHALMOLOGY
Financial Disclosure I have the following financial interests or relationships to disclose: Abbott Medical Optics: C;
AcuFocus, Inc.: C,O;
Alcon Laboratories, Inc.: C;
ArcScan: C,O;
Carl Zeiss Inc: C;
Elenza: C,O;
Oculus, Inc.: C;
Visiometrics: C,O;
Wavetec: C
3/23/2015 JTH 57
www.docholladay.com
Handouts
3/23/2015 JTH 6
Requirements Centration
Accurate Biometry – Optical
(IOL Master or LenStar)
Accurate K’s- Repeatable
4th Generation Formula (WTW)
Personalized Lens Constant
Eliminate Corneal Astigmatism
3/23/2015 JTH 7
Multifocal IOLOptimal Location
Cannot place on Pupil Center & Visual Axis (near P1) where axial ray is perpendicular to foveola.
Optimal location is different for each patient and somewhere between Pupil Center & P1.
3/23/2015 JTH 8
ClinicalAngle Kappa
Pupil Centerto Visual Axis
NOSE
Biometry for Premium IOLs 2015
Jack T. Holladay MD MSEE FACS Page 2 of 9
3/23/2015 JTH 9
Horizontal Angle & Alpha & Kappa
OCPC
VA
< α< Κ
3/23/2015 JTH 10
Good centration ,optimal
optical performance?
Decentration: halos Poor vision for farand near
Courtesy Paolo Vinciguerra M.D.
3/23/2015 JTH 11Diffraction Rings are perfectly concentric with patient’s pupil
Courtesy Paolo Vinciguerra M.D.
3/23/2015 JTH 12
3/23/2015 JTH 133/23/2015 Jack T. Holladay, MD, MSEE, FACS9 T S1 SS7 3/23/2015 JTH 143/23/2015 Jack T. Holladay, MD, MSEE, FACS
9 T S1 SS7
Biometry for Premium IOLs 2015
Jack T. Holladay MD MSEE FACS Page 3 of 9
Regression plot between the photic phenomenon of haloes (x axis) and the
kappa angle (y axis).
(R2 = 0.26, P = 0.029)
N = 37Zero = 25Non zero = 12
Regression plot between the photic phenomenon of glare (x axis) and the kappa
angle (y axis)
(R2 = 0.26, P = 0.033)
N = 37Zero = 30Non zero = 7
Horizontal Angle & Alpha & Kappa
OCPC
VA
< α< Κ
BEST CENTRATIONOF IOL
3/23/2015 JTH 18
Horizontal Angle & Alpha & Kappa
PCVA
< Κ
Angle Kappa on IOL Master, LenStar and penlight ~ 0.33 mm
If > 0.70 mm then concern!
●Karhanová M, Marešová K, Pluháček F, Mlčák P, Vláčil O, Sín M. Cesk Slov Oftalmol. The importance of angle kappa for centration of multifocal intraocular lenses. 2013 Jun;69(2):64-8. [Article in Czech]● G Prakash, DR Prakash, A Agarwal, DA Kumar, A Agarwal and S Jacob. Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation. Eye (2011) 25, 1187–1193
3/23/2015 JTH 193/23/2015 Jack T. Holladay, MD, MSEE, FACS
Ideal LocationLeft Eye
Between Pupil Center and Purkinje Image 1 (Vertex Normal Light Reflex)Slightly NASAL to Pupil Center (~ 0.15 mm) 3/23/2015 JTH 20
LENSTAR – HAAG-STREIT
Biometry for Premium IOLs 2015
Jack T. Holladay MD MSEE FACS Page 4 of 9
3/23/2015 JTH 21
IOL MASTER - ZEISS
3/23/2015 JTH 22
3/23/2015 JTH 23
Subtractfrom Ascanmeasured
Axial Length~ 0.8 mm
Zeiss - IOL Master - 2000Zaldivar-Holladay JCRS May 2000
3/23/2015 JTH 24
J Cataract Refract Surg 2011; 37:2018–2027
3/23/2015 JTH 25
Linear Regression to compensate for AVERAGE Index of Refraction in Long Eyes
Measured 36 34 mm
3/23/2015 JTH 26
Requirements
Accurate Biometry – IOL Master
Accurate K’s- Repeatable
4th Generation Formula (WTW)
Personalized Lens Constant
Eliminate Corneal Astigmatism
Biometry for Premium IOLs 2015
Jack T. Holladay MD MSEE FACS Page 5 of 9
3/23/2015 JTH 27
IOL Power Calculations Pentacam can measure FRONT &
BACK SURFACE POWER
Can Calculate: Equivalent K-Reading (EKR)
65% Mean, Peak & Average
NET POWER3/23/2015 JTH 28
EKR Reports Keratometry value but adjusts
for Back Surface Power from Normal (Current IOL Formulas)
If corneal front surface is 7.5 mm (45 D), but if back surface -0.3 D > normal: