AL SCAN SEMINAR

Nidek Optical Biometer – AL Scan

What can be measured?

• AL: Axial Length
• KM: Keratometry
• ACD: Anterior Chamber Depth
• CCT: Central Corneal Thickness
• WTW / PS: Corneal and Pupil Diameter

What can be done?

• IOL Calculation
• IOL Constant Optimization
• Printout and sent Data to IOL Station

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Part 1

AL SCAN FEATURES
 AL-Scan Features

• Easy and Fast operation

• Composed Waveform Axial
Length
• Double Ring Keratometry
• Scheimpflug Imaging
• Built-in Ultrasound
• Toric IOL Assist Function
• Linked to IOL Station, OPD-
Scan III, CEM 530
Measurement Options
 Measurement Screen

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 Video

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 Double Mire Ring Keratometry

Reliable Keratometry Data using 2 Mire Rings.

Nidek AL-Scan Zeiss IOL Master

360 points x 2 rings only 6 points

2.4 mm and 3.3 mm 2.4 mm

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 Scheimpflug Imaging

Measuring Central Corneal Thickness and

Anterior Chamber Depth

CCT
ACD

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 Built-in Ultra Sound (Optional)

-A-Scan and Pachymetry

-One unit for all patients
-Integrated Database for Optical and US Biometry

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 Eye Type Setting

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 US Measurement

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 Toric Assist Function

Selecting scleral vessel as reference landmark for toric IOL

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 Output to PC and Printout

LAN USB/LAN

Printout

Jpeg and XML file

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 Jpeg file

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 XML file

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 Print Manager

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 New IOL-Station

AL-Scan OPD-ScanIII CEM-530

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 Nidek Instruments for Cataract Surgery

US - 4000

OPD Scan III AL-Scan CEM 530 US - Biometry

Aberrometer and Topography Optical Biometer Endothelial Cell Microcope

CV 7000 / CV 30000

Nidek IOL
Aktis
IOL Station
Calculation & SIMULATION
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 AL-Scan – key points

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 Part 2

OPTICAL BIOMETER MARKED

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 Optical Biometer Market

HAAG-STREIT
•Total market volume for Europe
INTERNATIONAL
- 770 units / year
•Global market volume
- 2,800 units / year
•Our target within 3 years
TOMEY
- 20% market share
- 500 units / year

Carl Zeiss Meditec

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 Zeiss IOL Master 500

 Leader and 'Gold Standard'

 huge ULIB database for optimized IOL constants
 Haigis L and Phakic IOL support

 very small Display, no touch screen

 external keyboard necessary
 no Auto-Alignment (only Auto-Shot), requires refocusing
 6 point keratometry
 US biometry only external

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 IOL Master vs. AL Scan

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 Alcon/HS Lenstar 900

 'all in one' OCT measurement

 optical measurement of lens thickness
 slim design
 ACD in pseudophakic eyes

 completely manual alignment

 lower reproducibility
 difficulties to measure dense cataract
 external PC and monitor needed

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 Alcon/HS Lenstar 900

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 Tomey OA-1000

 Auto alignment and auto shot

 Dense cataract mode
 Ray Tracing Software (Okulix)

 smaller screen
 no K values!
 only external US biometry
 no WTW measurement
 no toric IOL support

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 Competitive Product Comparison
NIDEK Zeiss Haag Streit Tomey
AL-Scan IOL Master 500 LS-900 OA-1000 Advance
Axial Length (AL) Measurement Range:
14 - 40mm 14 - 39mm 14 - 32mm 14 - 40mm
Measurability:
95% or more 95% 85% 85%
A-mode Ultrasound (AL) Available to be built-in by option Optional external device N/A Optional external device
Additional 10k € (list price) Additional 5k €(list price)
Corneal Shape (KM) Principle: Double mire ring Bright point method Bright point method N/A
(High accuracy with 360 points) (6 points) (9 points x 2)
Anterior Chamber Depth Scheimpflug image Slit image Optical Interference Optical Interference
(ACD) Crystalline lens is observable
Central Corneal Thickness Measured by Scheimpflug N/A Optical Interference Optical Interference
(CCT) image
Toric IOL support Anterior ocular image + KM N/A N/A N/A
Multifocal IOL support Pupil diameter Pupil diameter Pupil diameter N/A

Post LASIK support Camellin-Calossi Haigis-L N/A OKULIX (external PC)

Auto Tracking function 3D tracking Manual alignment Manual alignment 3D tracking
A-constant = IOL Master (ULIB) ULIB / Zeiss ULIB / HS (few lenses) A-constant specified by
+ IOL Master the IOL manufacturer

A-constant optimization Yes Yes Yes N/A

function
Other Optical and US Biometry in one
unit. IOL Calculation and A
constant optimization.
Lens thickness data available
from US biometry.
Device itself is expensive.
Ultrasound device is
external and expensive.
Taking measurements is Requires multiple devices
difficult and depends on the for IOL calculations.
user.
Optical lens thickness
measurement

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Product Comparison –implemented Formulas

NIDEK Zeiss Haag Tomey

AL-Scan IOLMaster 500 LS900 OA-1000 Advance
IOL calculation SRK
Formula SRK II SRK II SRK II
for normal eye SRK/T SRK/T SRK/T SRK/T
Binkhorst
Holladay 1 Holladay 1 Holladay 1 Holladay 1
Holladay 2
Hoffer Q Hoffer Q Hoffer Q Hoffer Q
Haigis Haigis Haigis
Haigis optimized
IOL calculation Refractive History Meth.
Formula Contact Lens Method
for post LASIK eye No History Camellin-Calos.
History Camellin-Calossi
Haigis-L (No-History)
Shammas-PL
Oculix (external PC)

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 Part 3

IOL CALCULATION

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 Key Points for IOL Power Calc.

•Accurate Measured Data

-Axial Length / KM / ACD etc…

•Accurate Formula
-Standard formula
-For optical biometry
-For post refractive surgery

•Optimized IOL constants

-IOL constants for optical biometry
-Standard A constant for US measurement

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 Optimal IOL Calculation

• Problem of not knowing the exact IOL position after

implantation. ('effective lens position')
• 'Prediction' of the effective lens position using IOL
specific 'A-constants'
• Correlation of ELP with additional biometric data.
• Optimization of A-constants using regression analysis
of large number post OP data.

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 Entering IOL Constants

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 Optical and Ultrasound Constants

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 IOL Constant

User Group for Laser Interference Biometry

http://www.augenklinik.uni-wuerzburg.de/ulib/index.htm
Organized by Prof. Wolfgang Haigis

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 IOL calculation Formula for Normal eye

IOL calculation Comment / Remarks Input parameters A const.

Formula in ULIB
SRK ・OLD formula Axial Length , Kerato No
value
SRK II ・OLD formula Axial Length , Kerato Yes
value
SRK/T ・Most popular in Japan. Axial Length , Kerato Yes
・Suitable for normal axial length eyes. value

Binkhorst ・OLD formula Axial Length , Kerato No

value
Holladay 1 ・Suitable for normal / long axial length eyes. Axial Length , Kerato Yes
value
Hoffer Q ・Suitable for normal / short axial length eyes. Axial Length , Kerato Yes
value
Camerrin-Calossi ・for normal cataract eye Axial Length , Kerato No
(for Normal eye) value , ACD , Lens
Thickness
Haigis ・Most popular in Germany; Most ULIB data based on IOL Master Axial Length , Kerato Yes
value , ACD

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IOL calculation Formula for post LASIK eyes

IOL calculation Comment / Remarks Input parameters

Formula
Camerrin-Calossi ・Refractive correction type = myopia Axial Length , Kerato
use for 'History' (Incisional surgery, Laser ablation ) value , ACD , Lens
Thickness ,
SIRC
Camerrin-Calossi ・Refractive correction type = myopia Axial Length , Kerato
use for 'Non-History' value , ACD , Lens
Thickness , Corneal
Thickness (9 points)
Haigis -L ・No-History Axial Length , Kerato
・exclusively for IOL-Master. value , ACD
・Refractive correction type = hyperopia, myopia
Refractive history ・
method
Contact lens method ・
Corrected K-Values Using standard IOL Formula in post Lasik Eyes ECCP

39
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 Online Post LASIK IOL Calculation

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 http://iol.ocularmd.com/

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 Part 4

CLINICAL EVALUATION

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 Comparison Study

AL-Scan vs IOL Master 500

Sample number: 371

AL (mm) K_SE (D) ACD (mm)

AL-Scan 23.60 43.66 3.095
IOL Master 500 23.61 43.67 3.053
Mean diff -0.006 -0.012 +0.042

IOL Power 0.015D 0.011D 0.063D

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 Clinical Evaluation

•Result - Measured Data -

-Axial Length, KM, ACD
 All values revealed high correlation.
Axial: -0.005mm  0.01D
KM: -0.018D  0.02D
ACD: +0.021mm  0.03D

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 Clinical trial

Pr Marc LABETOULLE
Dr Godefroy Kaswin
Centre Hospitalier Universitaire BICETRE

Dr CANTAGALLI
Ambulatorio Medico Oculistico AMO

Dr KERMANI
Augenklinik am Neumarkt

Dr Godefroy KASWIN Chicago / ASCRS 2012

 Results Biometric Measurement

Axial Length (AL)

0.30

0.28

0.26

0.24

0.22
R² = 0.9995 n = 324 Eyes
0.20
0.20 0.22 0.24 0.26 0.28 0.30

K 2.4mm ACD
0.05
0.49
0.04
0.47
0.04
0.45
0.43 0.03
0.41
0.03
0.39
0.37
R² = 0.9627 0.02 R² = 0.8407
0.35 0.02
0.35 0.40 0.45 0.50 0.02 0.02 0.03 0.03 0.04 0.04 0.05
 Thank you for your
attention!!!

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 AL-Scan Quiz

• What needs to be measured for all IOL

calculation formulas?
• Why do we need IOL specific constants?
• Why can K-values and ACD be different
between AL-Scan and IOL Master?

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