Dense cataract visualization and precise measurement

Clinical Challenge

Visualization and precise measurement

A dense cataract is, by its very nature, difficult to penetrate. This makes pre-op cataract evaluation a challenge. Both precise biometric measurement as well as screening for macular pathologies are key to avoid refractive surprises.1,2,3

64-year-old female with a dense white intumescent cataract; Image courtesy Mario de La Torre, M.D., Peru

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Trilogy: Treating dense cataracts – when routine becomes a challenge

Clinical solution

Utilizing anterior OCT for biometric measurements and posterior OCT for macular pathology screening.

The occurrence of a dense cataract is most often identified in the slit lamp examination, where the view to the fundus may be impeded.
Detecting macular pathologies that could affect surgery and outcomes is especially important. Posterior OCT has become the gold standard here and supports informed decision-making on IOL selection for the patient. 3,4

Furthermore, accurate axial length measurement is critical for the IOL power calculation, a key step to achieving the targeted refraction.2 But as dense cataracts are difficult to penetrate precise measurement can be challenging for optical biometers.

Anterior swept source OCT devices can overcome this issue. In a recent study, ss-OCT technology was shown to significantly increase the proportion of successful axis eye length measurements compared to PCI technology.5

Screening out retinal pathologies in cataract surgery

David Chang, MD, Robert Osher, MD and William Wiley, MD

ZEISS Solution

ZEISS OCT technologies for precise biometric measurements and reliable retina screening

Using the ZEISS IOLMaster 700 with up to 99% cataract penetration rate6 and identifying retinal pathologies with the CIRRUS 6000, the performance OCT, for workflow efficiency in the cataract practice.

ZEISS IOLMaster 700

The ZEISS IOLMaster 700 is designed to optimize workflow efficiency, even when handling dense cataracts, thanks to:

  • Up to 99% cataract penetration rate, which reduces the need for ultrasound by 92%
  • A measurement time of <45 seconds for both eyes7
  • The unique Fixation Check to identify macular pathologies in your routine workflow8


VERACITY Surgical from ZEISS integrates electronic health record data and diagnostic pre-op measurements to enable a seamless, efficient surgical planning workflow solution.

Peer Insights

Clinical experiences with ZEISS technologies

Dense cataract workflow challenges


Lens fragmentation of a dense cataract requires a lot more phaco energy to emulsify the hard nucleus. More energy increases the risk of damage to corneal endothelial cells, which, in turn, can cause post-operative complications.2,9


After the removal of a dense cataract, patients expect to quickly and permanently regain perfect vision. However, post-operative complications like inflammation and edema can be more common after hard cataract surgery, and, longer term, issues like dislocated IOLs or dysphotopsias may occur.10,11

Webinar trilogy: Treating dense cataracts – when routine becomes a challenge

Dr. Don Pek, Dr. Ruth Lapid-Gortzak, Dr. Nino Hirnschall, Dr. Sartaj Grewal & Dr. Franco Spedale

March 2021

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  • 1 S.Garg, Surgeons meet challenges of removing rock-hard cataracts, Ocular Surgery News 2018,
  • 2 U. Devgan, Dense brunescent cataracts present surgical challenges, Ocular Surgery News 2011,
  • 3 Brissette A. OCT is indispensable for pre-op cataract evaluation. Available from:
  • 4 Hirnschall N et al. Macular disease detection with a swept-source optical coherence tomography-based biometry device in patients scheduled for cataract surgery. J Cataract Refract Surg. 2016 Apr;42(4):530-6.
  • 5 Hirnschall N et al. Enhanced Penetration for Axial Length Measurement of Eyes with Dense Cataracts Using Swept Source Optical Coherence Tomography: A Consecutive Observational Study. Ophthalmol Ther 2018;7:119-124.
  • 6 R. Varsits, N. Hirnschall, B. Doeller, O. Findl; Increasing the number of successful axial eye length measurements using swept-source optical coherence tomography technology compared to conventional optical biometry; presented at ESCSR 2016.
  • 7 Depending on eye condition and experience of the operator.
  • 8 The ZEISS IOLMaster 700 is clearly not intended to be used for diagnostics. Findings need to be verified and pathologies diagnosed with a dedicated retina OCT.
  • 9 M. Colvard, Phacoemulsification of the rock hard cataract, Eyeworld 2012,
  • 10
  • 11 R. J. Olson, MD, Salt Lake City, Review of Ophtalmology, PUBLISHED15 JANUARY 2005 Demystifying Dysphotopsia.