Optical biometry is the current standard for intraocular lens (IOL) power calculations in clinical practice. Optical biometry is a highly accurate non-invasive automated method for measuring the anatomical characteristics of the eye. Accurate measurements are critical for determining the correct power of an IOL before it is implanted during cataract surgery.
Before implantation the correct lens power needs to be determined. The process of measuring the various anatomical characteristics of the eye that are needed for IOL power calculation is called ocular biometry. Optical biometry, also known as ophthalmic biometry, using partial coherence interferometry has become the gold standard in ocular biometry as it is highly accurate, easy to perform, non-invasive and comfortable for the patient. The accuracy of optical biometry, and in particular the IOLMaster® from ZEISS, has been extensively confirmed across a wide range of scientific studies.
The use of optical biometry is a valuable tool when planning cataract surgery, resulting in optimization of patient outcomes.
Ocular biometry involves anatomical measurements of the eye, including the axial length (AL), keratometry and anterior chamber depth (ACD) and includes anterior segment biometry, for which only the front third of the eye is measured. These biometric measurements are crucial for the selection of the correct IOL power in order to achieve the desired refractive outcome after cataract surgery.1 Therefore, ocular biometry is an essential step before cataract surgery. There are currently two procedures available: ultrasound and optical biometry. Due to certain disadvantages of ultrasound biometry, optical biometry has become procedure of choice in ocular biometry.
Ultrasound biometry is an invasive procedure that requires direct contact with the cornea and the use of anesthetics, both of which can be uncomfortable for the patient.2 Moreover, this measurement method requires significant training for the examiner in order to avoid errors due to excessive compression of the ultrasound probe on the cornea. Ultrasound biometry also requires adjustment of the ultrasound speed when different media and/or optical conditions are present, e.g. pseudophakic eyes and silicone oil.3
In September 1999, the first automated non-invasive optical biometry device became available for clinicians – the IOLMaster from Carl Zeiss Meditec. The ZEISS IOLMaster operates as a modified Michelson interferometer and uses infrared laser light (wavelength 780 nm) to provide repeatable and precise measurements of the AL,4 curvature of the anterior corneal surface,5 ACD,6 and the horizontal visible iris diameter (white-to-white diameter, WTW).7
The technique underlying ZEISS IOLMaster biometry is partial coherence interferometry: A signal is produced as a result of the interference between the light reflected by the tear film and that reflected by the retinal pigmentary epithelium. Several studies comparing the ZEISS IOLMaster device to contact and/or ultrasonographic techniques have demonstrated repeatability and accuracy of measurements (Connors et al 2002, Sheng et al 2004).8 9
One reason for this accuracy is the reduced dependence of the biometric measurement on the examiner's experience, as only the alignment of the device to the patient´s eye is required while the rest of the process is automated.
The only limitation of optical biometers has been the inability to measure AL and ACD in eyes with densely opacified media. In the ZEISS IOLMaster 500 this can be overcome by connecting it to an ultrasound probe that can provide AL measurements in those eyes with very dense corneal leukomas and/or cataracts.10 Additionally, other values can be entered manually. Thus, almost any type of eye can be measured with this combined technology. Moreover, with the newly available ZEISS IOLMaster 700, featuring SWEPT Source OCT measurement, it has been shown that necessary ultrasound cases could be reduced by 92%, achieving a cataract penetration rate of 99%. 11
Accurate biometry measurements and IOL calculations can be performed quickly and easily.