Comparison of Intraocular Lens Calculation Formulas Measured by Immersion-Type A-Scan Ultrasound and Partial Coherence Interferometry

Il Suk Yun; Aram Park; Shin Young Choi; Hong Seok Yang

doi:10.3341/jkos.2016.57.6.905

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Yun, Park, Choi, and Yang: Comparison of Intraocular Lens Calculation Formulas Measured by Immersion-Type A-Scan Ultrasound and Partial Coherence Interferometry

Original Article

J Korean Ophthalmol Soc 2016;57(6):905-916.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.905

Comparison of Intraocular Lens Calculation Formulas Measured by Immersion-Type A-Scan Ultrasound and Partial Coherence Interferometry

Il Suk Yun, MD, Aram Park, MD, Shin Young Choi, MD, Hong Seok Yang, MD, PhD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Hong Seok Yang, MD, PhD Department of Ophthalmology, Ajou University Hospital, #164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: 82-31-219-5256, Fax: 82-31-219-5259 E-mail: yhs0816@ajou.ac.kr

Received 4 February 2016 Revised 2 April 2016 Accepted 9 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the accuracy of intraocular lens (IOL) formulas according to axial length, anterior chamber depth, and mean corneal curvature when performing biometry with an immersion type A-scan with mannual keratomery and an IOL Master^®.

Methods

Retrospective medical chart reviews were carried out for 82 eyes of 65 patients who underwent cataract surgery performed by a single surgeon. Biometry was performed using IOL Master^®, mannual keratometry, and immersion type A-scan ultrasound in sequence. Prediction diopter was obtained using Sanders-Retzlaff-Kraff/Theoretical (SRK-T) and Holladay 1 formulas calculated with the biometric value measured by mannual keratomery and A-scan, and using SRK-T and, Holladay 2 formulas with IOL Master^®. The final refractive outcome was determined as manifested refraction at least 7 weeks after the surgery, and it was compared with the preoperative prediction dipoter (D) of the IOL formulas.

Results

Mean axial length and mean keratomtric measurements as determined by A-scan with mannual keratomery showed significant statistical differences from those of IOL Master^®. However, there was no difference in postoperative mean absolute error between biometric measurements, or among formulas according to axial length, anterior chamber depth, or mean corneal curvature. However, the percentage of actual refraction within ±0.50 D of the intended refraction was dirrerent among the four formalas according to axial length, anterior chamber dept, mean corneal curvature.

Conclusions

Biometry measurement using the immersion-type A-scan with mannual keratomery is as accurate as that using IOL Master^® for predicting the postoperative refractive state of cataract surgery. However, it is suggested that the best IOL formula be chosen according to axial length, anterior chamber depth, and mean corneal curvature.

Keywords: Immersion-type A-scan ultrasound, Intraocular lens formula, Manual Keratometry, Partial coherence interferometry

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Figure 1.

Mean numerical error in subgroup. Prediction errors of intraocular lens (IOL) calculation formulas according to the axial length (A), anterior chamber depth (B), mean corneal curvature (C). A/T = Sanders-Retzlaff-Kraff/Theoretical (SRK-T) (A-scan); A/H1 = Holladay 1 (A-scan); M/T = SRK-T (IOL Master®); M/H2 = Holladay 2 (IOL Master®).

Figure 2.

Correlation between final spherical equivalent and intraocular lens (IOL) calculation formulas according to the axial length. (A) There are statically significant correlation between the IOL calculation formulas and the axial length in Sanders-Retzlaff-Kraff/Theoretical (SRK-T) (A-scan) formulas (p < 0.05). (B-D) No statically significant correlation between the IOL calculation formulas and the axial length in Holladay 1 (A-scan), SRK-T (IOL Master®) and Holladay 2 (IOL Master®) formulas. SE = spherical equivalent; A/T = SRK-T (A-scan); A/H1 = Holladay 1 (A-scan); D = diopter; M/T = SRK-T (IOL Master®); M/H2 = Holladay 2 (IOL Master®).

Figure 3.

Correlation between final spherical equivalent and intraocular lens (IOL) calculation formulas according to the anterior chamber depth. (A-D)There are no statically significant correlation between the IOL calculation formulas and the anterior chamber depth in all formulas. SE = spherical equivalent; A/T = Sanders-Retzlaff-Kraff/Theoretical (SRK-T) (A-scan); A/H1 = Holladay 1 (A-scan); D = diopter; M/T = SRK-T (IOL Master®); M/H2 = Holladay 2 (IOL Master®).

Figure 4.

Correlation between final spherical equivalent and intraocular lens (IOL) calculation formulas according to the mean corneal curvature. (A, C) There are statically significant correlation between the IOL calculation formulas and the anterior chamber depth in Sanders-Retzlaff-Kraff/Theoretical (SRK-T) (A-scan) and SRK-T (IOL Master®) formulas (p < 0.05). (B, D) No statically significant correlation between the IOL calculation formulas and the anterior chamber depth in Holladay 1 (A-scan) and Holladay 2 (IOL Master®) formulas. SE = spherical equivalent; A/T = SRK-T (A-scan); A/H1 = Holladay 1 (A-scan); D = diopter; M/T = SRK-T (IOL Master®); M/H2 = Holladay 2 (IOL Master®).

Table 1.

Demographics and biometry measurements of each group according to the axial length

	A₁ ^*	B₁ ^†	C₁ ^‡	Total
No. of eyes	35	32	15	82
Age (years)	67.6 ± 6.8	68.5 ± 9.1	62.8 ± 13.1	67.1 ± 9.2
Sex (M/F)	10/25	22/10	7/8	39/43
Lens (enVista™/isert)	21/14	17/15	8/7	46/36
Axial length (mm)
A-scan	22.78 ± 0.31	23.91 ± 0.41	26.18 ± 1.41	23.84 ± 1.39
IOL Master®	22.87 ± 0.30	24.01 ± 0.41	26.34 ± 1.37	23.95 ± 1.41
Difference (mm)	0.09 ± 0.08	0.10 ± 0.08	0.16 ± 0.15	0.11 ± 0.10
Keratometry (D)
Manual K	44.92 ± 1.30	43.23 ± 1.10	43.23 ± 1.10	44.24 ± 1.58
IOL Master®	45.20 ± 1.29	43.31 ± 1.13	43.31 ± 1.13	44.37 ± 1.65
Difference (D)	0.28 ± 0.42	0.07 ± 0.28	0.13 ± 0.18	0.17 ± 0.34
Anterior chamber depth (mm)	3.00 ± 0.35	3.30 ± 0.43	3.54 ± 0.32	3.22 ± 0.43

Values are presented as mean ± SD unless otherwise indicated.

^* Group A₁: axial length < 23.5 mm

^† Group B₁: axial length ≥ 23.5, < 25.0 mm

^‡ Group C₁: axial length ≥ 25.0 mm.

Table 2.

Comparison of mean absolute prediction errors among various intraocular lens (IOL) power calculation formulas

Group	Eyes	Mean absolute error (diopter)
Group	Eyes	A-scan		IOL Master®
		SRK-T	Holladay 1	SRK-T	Holladay 2
enVista™	46	0.38 ± 0.26 (0.01–1.02)	0.34 ± 0.28 (0.01–1.14)	0.30 ± 0.24 (0.01–1.22)	0.34 ± 0.24 (0.01–0.67)
isert250	36	0.43 ± 0.35 (0.02–1.47)	0.39 ± 0.31 (0.00–1.14)	0.37 ± 0.31 (0.01–1.32)	0.40 ± 0.31 (0.00–1.15)
^* p-value		0.9	0.4	0.34	0.75
Total	82	0.40 ± 0.30 (0.01–1.47)	0.36 ± 0.29 (0.00–1.14)	0.33 ± 0.27 (0.00–1.32)	0.36 ± 0.27 (0.00–1.15)

Values are presented as mean ± SD (range) unless otherwise indicated.

SRK-T = Sanders-Retzlaff-Kraff/Theoretical.

^* Mann-Whitney U-test.

Table 3.

Comparison of mean absolute prediction errors among various intraocular lens (IOL) power calculation formulas according to axial length, anterior chamber depth, mean corneal curvature

Group	No. of eyes	Mean absolute error (diopter)				p-value^*
		A-scan		IOL Master®
		SRK-T	Holladay 1	SRK-T	Holladay 2
A₁	35	0.40 ± 0.30 (0.01–1.08)	0.40 ± 0.29 (0.03–1.14)	0.31 ± 0.27 (0.01–1.22)	0.32 ± 0.27 (0.00–1.10)	0.06
B₁	32	0.36 ± 0.28 (0.02–0.97)	0.35 ± 0.30 (0.01–0.99)	0.34 ± 0.24 (0.03–1.15)	0.41 ± 0.27 (0.00–1.15)	0.56
C₁	15	0.49 ± 0.38 (0.07–1.47)	0.30 ± 0.30 (0.00–1.14)	0.35 ± 0.35 (0.02–1.32)	0.38 ± 0.28 (0.02–1.05)	0.19
p-value^†		0.50	0.28	0.66	0.21
A₂	8	0.36 ± 0.24 (0.05–0.70)	0.30 ± 0.28 (0.04–0.91)	0.25 ± 0.17 (0.01–0.41)	0.33 ± 0.28 (0.05–1.01)	0.53
B₂	52	0.38 ± 0.32 (0.01–1.47)	0.38 ± 0.30 (0.01–1.14)	0.34 ± 0.30 (0.01–1.32)	0.38 ± 0.29 (0.00–1.15)	0.06
C₂	22	0.48 ± 0.28 (0.03–1.02)	0.34 ± 0.29 (0.00–1.14)	0.35 ± 0.27 (0.03–1.15)	0.35 ± 0.25 (0.02–0.83)	0.44
p-value^†		0.21	0.79	0.70	0.66
A₃	11	0.30 ± 0.20 (0.13–0.68)	0.37 ± 0.23 (0.03–0.77)	0.30 ± 0.19 (0.03–0.62)	0.35 ± 0.32 (0.00–1.01)	0.67
B₃	44	0.37 ± 0.28 (0.01–0.99)	0.33 ± 0.30 (0.00–1.04)	0.30 ± 0.24 (0.01–1.15)	0.37 ± 0.29 (0.01–1.15)	0.35
C₃	27	0.50 ± 0.35 (0.07–1.47)	0.40 ± 0.32 (0.03–1.14)	0.38 ± 0.34 (0.03–1.32)	0.38 ± 0.24 (0.00–1.04)	0.06
p-value^†		0.15	0.6	0.69	0.68

Values are presented as mean ± SD (range) unless otherwise indicated.

SRK-T = Sanders-Retzlaff-Kraff/Theoretical; A₁ = Group A₁, axial length < 23.5 mm; B₁ = Group B₁, axial length ≥ 23.5, < 25.0 mm; C₁ = Group C₁, axial length ≥ 25.0 mm; A₂ = Group A₂, anterior chamber depth < 2.5 mm; B₂ = Group B₂, anterior chamber depth ≥ 2.5 mm <3.5 mm; C₂ = Group C₂, anterior chamber depth ≥ 3.5 mm; A₃ = Group A₃, mean corneal curvature < 42.5 D; B₃ = Group B₃, Group

A₃, mean corneal curvature ≥ 42.5 D, <45.0 D; C₃ = Group C₃, mean corneal curvature ≥ 45.0 D.

^* Friedman test

^† Kruskal Wallis test.

Table 4.

Percentage of eyes by absolute prediction error

Formula	Eyes (%)
Formula	<0.5 D	<1.0 D	<1.5 D
SRK-T (A-scan)
enVista™	65.2	97.8	100
isert250	63.9	94.4	100
Total	64.6	96.3	100
Holladay 1 (A-scan)
enVista™	67.4	95.7	100
isert250	63.9	94.4	100
Total	65.9	95.1	100
SRK-T (IOL Master®)
enVista™	78.9	97.8	100
isert250	72.2	94.4	100
Total	75.6	96.3	100
Holladay 2 (IOL Master®)
enVista™	78.3	97.8	100
isert250	69.4	88.9	100
Total	74.4	93.9	100

SRK-T = Sanders-Retzlaff-Kraff/Theoretical; D = diopter.

Table 5.

Percentage of eyes by absolute prediction error according to axial length, anterior chamber depth, mean corneal curvature

		Dipoter	A-scan		IOL Master®
		Dipoter	SRK-T	Holladay 1	SRK-T	Holladay 2
AL (mm)	<23.50	<0.5 D	65.7	65.7	74.3	82.9
		<1.0 D	94.3	91.4	97.1	94.3
	≥23.50, <25.00	<0.5 D	68.8	62.5	78.1	62.5
		<1.0 D	100	100	96.9	93.8
	≥25.00	<0.5 D	53.3	73.3	73.3	80.0
		<1.0 D	93.3	93.3	93.3	93.3
ACD (mm)	<2.50	<0.5 D	75	62.5	87.5	87.5
		<1.0 D	100	100	100	100
	≥2.50, <3.50	<0.5 D	71.2	65.4	75	71.2
		<1.0 D	94.2	94.2	96.2	92.3
	≥3.50	<0.5 D	45.5	68.2	72.7	77.3
		<1.0 D	95.5	95.5	95.5	100
K (D)	<42.5	<0.5 D	81.8	63.6	81.8	72.7
		<1.0 D	100	100	100	90.9
	≥42.5, <45	<0.5 D	65.9	65.9	84.1	72.7
		<1.0 D	100	97.7	97.7	93.2
	≥45	<0.5 D	55.6	66.7	59.3	77.8
		<1.0 D	88.9	88.9	92.6	96.3

SRK-T = Sanders-Retzlaff-Kraff/Theoretical; AL = axial length; ACD = anterior chamber depth; K = corneal curvature.

Table 6.

Multiple logistic regression analysis of intraocular lens (IOL) formulas

Group	A/T	A/H1	M/T	M/H2
Age
Odds ratio	1.04	1	1.01	1.02
95% CI	0.98–1.10	0.95–1.06	0.95–1.08	0.96–1.08
p-value	0.19	0.95	0.67	0.44
Lens
isert vs. enVista™ (ref)
Odds ratio	1.48	1.15	1.67	1.67
95% CI	0.54–4.05	0.44–2.97	0.57–4.90	0.59–4.68
p-value	0.45	0.78	0.35	0.21
Axial length
Odds ratio	1.15	0.82	1.67	0.99
95% CI	0.77–1.72	0.53–1.24	0.57–4.94	0.65–1.53
p-value	0.49	0.81	0.86	0.99
Anterior chamber depth
Odds ratio	4.12	1.34	2.21	1.29
95% CI	1.19–14.24	0.35–5.19	0.46–10.64	0.32–5.14
p-value	0.02^*	0.66	0.32	0.71
Keratometry
Odds ratio	1.37	0.52	1.42	0.87
95% CI	0.99–1.88	0.64–1.25	1.01–2.01	0.61–1.23
p-value	0.06	0.89	0.04^*	0.42

A/T = SRK-T (A-scan); A/H1 = Holladay 1 (A-scan); M/T = SRK-T (IOL Master®); M/H2 = Holladay 2 (IOL Master®); CI = confidence interval; ref = reference value.

^* p < 0.05.

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