June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Modeling of the Lower Limits of IOL Prediction Error Resultant from Instrument Precision
Author Affiliations & Notes
  • Yu-Cherng Chang
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, Florida, United States
  • Florence Cabot
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Bianca Maceo Heilman
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, Florida, United States
  • Larissa Meza
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, Florida, United States
  • Marco Ruggeri
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, Florida, United States
  • Arthur Ho
    Brien Holden Vision Institute Limited, Sydney, New South Wales, Australia
  • Sonia Yoo
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Jean-Marie A Parel
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Brien Holden Vision Institute Limited, Sydney, New South Wales, Australia
  • Fabrice Manns
    Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
    Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, Florida, United States
  • Footnotes
    Commercial Relationships   Yu-Cherng Chang, None; Florence Cabot, None; Bianca Maceo Heilman, None; Larissa Meza, None; Marco Ruggeri, 8,425,037 (P); Arthur Ho, None; Sonia Yoo, None; Jean-Marie Parel, 8,425,037 (P); Fabrice Manns, 8,425,037 (P)
  • Footnotes
    Support  National Eye Institute Grants 1F30EY027162, 2R01EY14225, P30EY14801; Florida Lions Eye Bank and the Beauty of Sight Foundation; Drs KR Olsen and ME Hildebrandt; Drs R Urs and A Furtado; the Henri and Flore Lesieur Foundation; an unrestricted grant from Research to Prevent Blindness; Wallace H. Coulter Foundation
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 592. doi:
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    • Get Citation

      Yu-Cherng Chang, Florence Cabot, Bianca Maceo Heilman, Larissa Meza, Marco Ruggeri, Arthur Ho, Sonia Yoo, Jean-Marie A Parel, Fabrice Manns; Modeling of the Lower Limits of IOL Prediction Error Resultant from Instrument Precision. Invest. Ophthalmol. Vis. Sci. 2020;61(7):592.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : As IOL calculation formulas improve, prediction error approaches a fundamental limit defined by IOL manufacturing tolerance and precision of biometry instruments. In this study, we characterize the contribution of instrument precision to IOL prediction error.

Methods : Fifty-one eyes of 35 subjects (age: 70.9 ± 10.1 years, SEQ: -0.40 ± 0.62 D) who underwent cataract surgery and IOL implantation at Bascom Palmer Eye Institute were included. Individualized eye models were created from post-operative intraocular distances (central corneal thickness (CCT), anterior chamber depth (ACD), vitreous chamber depth (VCD), and IOL thickness (tIOL)) measured with a custom-built extended-depth OCT system (Ruggeri et al, Biomed Opt Exp 2012), and post-operative anterior (Rant cornea) and posterior (Rpost cornea) corneal curvatures measured with an anterior segment biometry system (Pentacam). The IOL was modeled as a symmetric biconvex thick lens. Post-operative refraction was calculated using backwards ray tracing. To simulate measurement variability, random Gaussian-distributed noise was added to eye model parameters based on the repeatability values derived from experimental data: 15, 100, 2, 12, 24, 5 µm for Rant cornea, Rpost cornea, tIOL, VCD, ACD, and CCT, respectively. Post-operative spherical equivalent refraction was estimated over 1000 simulation trials for each subject.

Results : The effect of single biometric parameters on post-operative refraction is depicted in Figure 1. Results from the Monte Carlo simulation are shown in Figure 2. An average variability (95% CI) of 0.27 ± 0.04 D across all subjects was determined.

Conclusions : Instrument repeatability contributes 0.25 to 0.30 D of error to IOL power calculation, representing a fundamental limit independent of IOL calculation formulas.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure 1. Change in estimated post-operative refraction after shifting values for single biometric parameters across a set range; analyses for each subject are shown in different colors.

Figure 1. Change in estimated post-operative refraction after shifting values for single biometric parameters across a set range; analyses for each subject are shown in different colors.

 

Figure 2. Monte Carlo simulation of uncertainty in post-operative refraction due to Gaussian-distributed noise. Plot shows results from 1000 iterations for each of the 51 eyes with error bars representing mean and 95% CI.

Figure 2. Monte Carlo simulation of uncertainty in post-operative refraction due to Gaussian-distributed noise. Plot shows results from 1000 iterations for each of the 51 eyes with error bars representing mean and 95% CI.

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