EyeWorld India December 2021 Issue

CATARACT EWAP DECEMBER 2021 11 to streamline our process and improve our results. The most important objective is to optimize patients’ outcomes and satisfaction after surgery. We need to have a keen eye on every step of the patient’s clinical journey, from our preoperative assessment to our surgical procedure and postoperative recovery. The trend now is to streamline the process by bringing important clinical enhancements to the operating room,” he said, explaining that improved integration of the biometry reading with intraoperative aberrometry eliminates the need for manual data entry, reducing transcription errors, and can be paired with digital marking systems for precise and integrated IOL planning and execution. EWAP Editors’ note: Dr. Hoffer is Clinical Professor of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California, and receives royalties for the use of the trademark name Hoffer and assuring the accurate programming of his formulas from most optical biometer manufacturers. Dr. Loh practices at Loh Ophthalmology Associates Miami, Florida, and declared no relevant financial interests. Dr. Shammas is Clinical Professor of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, and has interests with Alcon and Oculus. Fam Han Bor, MD Senior Consultant & Head, Cataract and Anterior Segment Service The Eye Institute @ Tan Tock Seng Hospital 11, Jalan Tan Tock Seng famhb@singnet.com.sg B iometry is imperative in cataract surgery and accurate IOL power calculation is a requisite towards good surgical outcomes. With newer premium IOLs, the importance of getting the targeted refraction spot-on is critical. There are many factors in deciding on a new biometry machine. The following are what I consider some of the more important factors. Accurate and Consistent Measurements The three most important measurements in IOL power calculation are axial length, keratometry, and anterior chamber depth. These are accurately measured with most optical biometers. With improvement in technology, such as with the swept-source OCT, more parameters can be reliably measured with better accuracy. Newer formulas take advantage of these additional parameters to improve their outcomes. Barrett Universal II, EVO, Olsen, etc. allow more variables to be entered to fine-tune calculations. While most normal eyes should be fine with just three variables, atypical eyes would benefit from these additional parameters. Cataract Penetration Optical biometers have limited penetration in dense cataracts. Newer swept-source OCT technology has better penetration than the older optical systems. Optical biometry measurements, being more accurate than ultrasound, having better penetration with the swept-source OCT biometry benefits a wider variety of cataractous patients. In our practice, the swept-source OCT has reduced our need for ultrasound biometers from 19% to just 5%. That is a substantial improvement in penetration; an important consideration in acquiring an optical biometer. Integration, Ease of use and Workflow Ease of use is an important consideration for a busy clinic; it can enhance workflow and save considerable time. Being less operator dependent can ensure consistency of measurements. New technicians can familiarize themselves and be up to mark quickly. The availability of newer formulas installed in the biometry system would make workflow more efficient and reduce the risk of transcription errors with having to do calculations online. A connected biometry system is a bonus. It streamlines the workflow and allows surgeons to view the measurements, calculate the IOL powers, and make decisions from wherever they are: clinic, operating room, office, etc. A biometry system is primarily a measuring device. Hence, accurate and consistent measurements in as many eyes are the most important consideration. Ease of use ensures accurate measurement can be easily achieved. There may be other reasons but these are less important. Editors’ note: Dr. Fam declared no relevant financial interests. In the last six months with partial coherent interferometry (Zeiss IOLMaster 5.4), our usage of ultrasound (Alcon Ocuscan RXP) was necessary at 18.8%. After acquiring the denser penetrating SS-OCT (Zeiss IOLMaster 700), the usage of ultrasound dropped to just 5.0%. Source: Fam Han Bor, MD ASIA-PACIFIC PERSPECTIVES