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Elaine M Tran, Kevin S Tang, Allison J Chen, Michael L Chen, David R Rivera, Jorge J Rivera, Paul B Greenberg; Assessing cataract surgery outcomes with toric intraocular lenses in a teaching hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6477.
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© ARVO (1962-2015); The Authors (2016-present)
Past studies of resident-performed cataract surgery using toric intraocular lenses (IOL) have been small and none have evaluated the relative performance of biometric formulae. The purpose of this study was to benchmark the outcomes of cataract surgery using toric IOLs in a teaching hospital and compare the accuracy of two biometric formulae for toric IOL power calculation.
Our study subjects were patients who received cataract surgery with toric IOLs at a Veterans Affairs Medical Center from November 2013 to May 2018. We included only one eye from each study subject. The postoperative follow-up period was 3 weeks to 4 months. The Holladay 2 formula and Barrett toric IOL formula were used to predict the postoperative refraction for each cataract surgery. The main outcome measures were best-corrected visual acuity (BCVA) and the difference in cylinder between the preoperative and postoperative manifest refractions. The accuracy of each biometric formula was also assessed using the mean absolute error (MAE) and the percentage of eyes with a prediction error of +/- 0.25D, +/- 0.50D, and +/- 1.00D. Subgroup analyses of MAE were conducted for short (axial length [AL]<22.0 mm), medium (AL=22.0-25.0 mm), and long (AL>25.0 mm) eyes.
Out of 326 total charts reviewed, 43 patients were excluded based on the study criteria. We included 283 patients in the study; 88% (248/283) of cases were performed by resident surgeons. The median postoperative BCVA was 20/20 and 92% (259/283) of patients had a postoperative BCVA of 20/25 or better. There was no statistically significant difference in MAE between the Holladay 2 and Barrett toric formulae for the entire AL range (p=0.21), as well as the short AL group (p=0.94), medium AL group (p=0.49), and long AL group (p=0.08). For all AL groups, the Barrett toric formula had lower MAE than the Holladay 2 formula. The MAE was highest in the short AL group for both formulae.
The refractive outcomes were comparable to those in other teaching hospitals and non-teaching hospitals. The Barrett toric formula and Holladay 2 formula had similar prediction error outcomes across all ALs.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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