Professional Documents
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Biometry
Biometry
( Biometry )
1. Keratometry
2. A-Scan Biometry
3. IOL Formula
A-Scan Biometry
1. History Taking
2. Patient Preparation
3. Biometry Technique
Biometry Technique
Contact
- Applanation Method
- Hand-Held Method
Immersion
Values are 0.14 to 0.36 mm
longer with immersion technique
than with contact method
Potential Sources of Error
with Contact Method
1.Corneal Compression
2. Fluid Excess
3. Misalignment of Sound Beam
4. Inappropriate Eye type
Error caused by
1 mm Corneal Compression
1. Measurement Mode
2. Gates
3. Gain
4. Eye Type
Measurement Mode
Automatic
Semiautomatic
Manual
Gates
1. Phakic
2. Aphakic
3. Pseudophakic
Use of average sound velocity ,although
sufficient in normal phakic eye , may
result in slight error when the lens is
inordinately thin or thick or when the
eye is very short or very long .
The use of individual sound velocity
may provide more consistent and
accurate AL reading .
Aphakia & Pseudophakia
Low Vision
Nystagmus
Blepharospasm
Strabismus
2. Posterior Staphyloma
Immersion technique
is preferable .
4. Macular Lesions
RD
Edema
DMS
Tumor
The presence of an elevated macular
lesion may prevent the display of a
distinct retinal spike and often causes
a shortened AL measurement .
5. Vitreous Lesions
Asteroid Hyalosis
Vitreous Hemorrhage
Gas Bubble
6. Dense Cataract
Axial Length
ACD
Corneal Power
IOL Power Calculation
Hoffer-Q , SRK/T ,Holladay 1, Haigis
Keratometry
If there has been prior keratorefractive surgery. In this case the corneal
power will need to be estimated by either the historical, or the contact
lens method.
The average corneal power difference between the two eyes is greater
than 1.00 diopter.
The patient cannot fixate, as seen with a mature cataract, or macular hole.
A second person should re-measure both eyes if: The axial length is less
than 22.00 mm, or greater than 25.00 mm in either eye.
The axial length is greater than 26.0 mm, and there is a poor retinal spike,
or wide variability in the readings.
There is a difference in axial length between the two eyes of greater than
0.33 mm that cannot be correlated with the patient's oldest refraction.
Axial length measurements do not correlate with the patient's refractive error.
In general, myopes should have eyes longer than 24.0 mm and hyperopes
should have eyes shorter than 24.0 mm. Exceptions to this rule involve steep,
or flat corneas. Be sure to use the oldest refractive data.
There is a difference in IOL power of greater than 1.00 diopter between the
two eyes.
If the patient has had prior keratorefractive surgery and the calculated IOL
power for standard phacoemulsification is less than +20.0 D or greater than
+23.0 D.
Formula
for
IOL Power Calculation
IOL Power Formula
Theoretical
Regression
Refractive
Theoretical Formulas
P = A – 2.5L – 0.9K
A1 = A + 3 AL < 20mm
A1 = A + 2 AL 20-21
A1 = A + 1 AL 21-22
A1 = A AL 22-24.5
A1 = A – 0.5 AL >24.5
SRK/T
1st Generation
Fyodorov , Colenbrander ,Hoffer , SRK I
2nd Generation
Binkhorst , SRK II
3rd Generation
Holladay 1 , Hoffer-Q , SRK/T
4th Generation
Holladay 2 , Haigis
There are currently three IOL constants in use: The
SRK/T formula uses an "A-constant."
AL 22-24.5 mm (72%)
SRK II , Hoffer-Q ,Holladay 1
AL 24.5-26 mm (15%)
Holladay 1 , Hoffer-Q
AL > 26 mm ( 15%)
SRK/T
Axial Length in mm Haigis Hoffer Q Holladay 1 Holladay 2 SRK/T
unoptimized
28.00 to 30.00 0.25 - 0.50 D 0.25 - 0.50 D 0.25 D 0.25 D 0.25 - 0.50 D
Minus power IOLs 0.51 - 1.0 D 0.51 - 1.0 D 0.25 - 0.50 D 0.25 D 0.25 - 0.50 D
Haigis formula
may be appropriate for all
ranges of axial lengths