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Moderator
Stephen D. Klyce, PhD
Panelists
Jonathan C. Lake, MD, PhD; Maria S. Romero, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Claudia E Perez-Straziota, MD
Co-Authors
Molly Snider (MD), Bianca Susanna (MD), James Randleman (MD), Bassel Hammoud (MD, MS)
Purpose
To identify any features on preoperative Scheimpflug imaging that predispose patients to presbyopia-correcting intraocular lens intolerance.
Methods
Retrospective review of all patients who had a presbyopia-correcting IOL (PC-IOL) implant at the time of cataract surgery who had preoperative Scheimpflug imaging obtained with the Pentacam HR device. Patients with PC-IOL intolerance were compared to those with successful outcomes. Variables analyzed included multiple keratometry metrics, Total corneal power distribution, thinnest pachymetry, asymmetry indices, Q value, Corneal RMS values, and individual Zernike values.
Results
TBD
Conclusion
TBD
Presenting Author
Sarhej S Nava, MD
Co-Authors
Jaime Macias (MD)
Purpose
To determine the accuracy of swept source OCT biometry with the Barrett Universal II formula for intraocular lens power calculation in short and long axial length eyes undergoing toric IOL implantation aligned with a digital surgical planning system
Methods
A prospective observational study was conducted at a single center including eyes with short (<22.5 mm) and long (>24.5 mm) axial lengths undergoing cataract surgery. Preoperative measurements were obtained with swept source OCT biometry, and intraocular lens power was calculated using the Barrett Universal II formula. Toric IOLs were implanted and their alignment was guided with a digital surgical planning system. Postoperative refractive outcomes and visual acuity were assessed 4-6 weeks after surgery. The primary endpoint was mean absolute prediction error; secondary endpoints included the proportion of eyes within ±0.25D, ±0.50D, ±0.75D, and ±1.00D of predicted refraction
Results
The study included 145 eyes (66 short, 79 long). In short eyes, mean axial length was 22.11 ± 0.30 mm and MAE was ?0.01 ± 0.56 D; in long eyes, mean axial length was 25.87 ± 1.59 mm and MAE was 0.03 ± 0.85 D (p = 0.73). The proportion of eyes within ±0.50 D was 73% in short eyes and 59% in long eyes. All implanted intraocular lenses were toric, and higher prediction errors were observed in eyes with high toricity (T8-T9), likely related to residual astigmatism or IOL rotation. Uncorrected and corrected distance visual acuities were comparable between groups, with most eyes achieving 20/40 or better
Conclusion
Swept source OCT biometry with the Barrett Universal II formula showed good accuracy in IOL power calculation for short and long eyes. Outcomes were favorable, but the mean absolute prediction error was higher in long eyes, with greater variability in high toricity (T8-T9)
Presenting Author
Olga Reitblat, MD, MHA
Co-Authors
Eli Neimark (MD), Irit Bahar (MD, MHA), Lior Kramarski (MD)
Purpose
To characterize the clinical cases in which measured posterior corneal astigmatism alters the choice of a toric IOL power compared to calculations using predicted posterior corneal astigmatism, and to provide recommendations on when direct posterior corneal measurement offers additional value in toric IOL calculation within the clinical practice.
Methods
A mathematical model of 8640 theoretical eyes was created with fixed biometric parameters, varying only in anterior corneal astigmatism (0.5-5.0 D in 0.5 D steps), posterior corneal astigmatism (0-1.0 D in 0.2 D steps), and 15° axis intervals for both. Toric IOL power was calculated using the Barrett and EVO calculators, with both predicted and measured posterior astigmatism, targeting emmetropia. A comprehensive analysis was performed to identify the combinations of anterior and posterior astigmatism power and axis in which the use of posterior measurement changed the toric IOL recommendation compared to predicted values.
Results
TBD
Conclusion
TBD
Presenting Author
Grzegorz Labuz, PhD, BEng
Co-Authors
Gerd Auffarth (MD, PhD), Fatima Cuellar (MSc)
Purpose
To assess the visual performance of RayOne EMV and Acunex Quantum enhanced monofocal intraocular lenses under mini-monovision using the SimVis Gekko IOL simulator and to test their ability to improve binocular intermediate vision while maintaining good distance vision.
Methods
Six healthy volunteers underwent simulations with the SimVis Gekko. Ocular dominance was determined using the hole-in-the-card test. Mini-monovision was induced by applying -0.5 D and -1.0 D of myopia to the non-dominant eye. Monocular and binocular defocus curves were measured from +0.5 D to -2.5 D in 0.5 D increments under photopic conditions. Visual acuity was assessed using standard logMAR charts at 4 meters.
Results
Both IOLs provided excellent distance visual acuity under emmetropic conditions. The Acunex Quantum IOL performed slightly better at intermediate distances. With -0.5 D of monovision, visual acuity remained ?0.2 logMAR up to -1.75 D. When -1.0 D was induced, the useful visual range extended to -2.25 D, with binocular acuity at far distances. Both lenses benefited from mini-monovision without significantly compromising visual quality.
Conclusion
Simulated mini-monovision with enhanced monofocal IOLs effectively expands the functional range of vision. A -1.0 D offset in the non-dominant eye can provide good visual quality at all distances, improving spectacle independence in pseudophakic patients, with a small but noticeable difference between the dominant and non-dominant eyes.
Presenting Author
Aaron Ng, FRCOphth
Co-Authors
Tun Kuan Yeo (FRCOphth)
Purpose
To report the performance of intraocular lens (IOL) power formulae in a population of eyes with evenly distributed IOL powers so that the performance of extreme IOL powers are taken into account.
Methods
Retrospective review of 390 eyes of 390 patients after uncomplicated cataract surgery and implanted with the Tecnis one-piece intraocular lens (ZCB00). 10 eyes of each IOL power from +8.0D to +27.0D were included. Pre-operative biometric data and post operative manifest refraction from at least one-month post-surgery was obtained. Formulae assessed were Barrett Universal II (BUII), EVO2.0 (EVO), Haigis, Hill RBF 3.0, Hoffer Q, Hoffer QST, Holladay I, PEARL-DGS and SRK/T. Constants were optimized to obtain a mean error of 0. The Eytemis tool was used to assess for trueness, precision and accuracy. Outcomes were assessed with regards to axial length, average keratometry and IOL power.
Results
For threshold of absolute SEQ-PE within 0.5D, the best performing formulae were EVO(Tecnis)(85.6%), EVO (85.4%) and Hill-RBF 3.0(84.9%). For precision (Precision of SEQ-PE), the best performing formulae (trimmed mean) were EVO(Tecnis)(0.240), BUII (0.245) and EVO(0.248). For accuracy (absolute SEQ-PE), the best performing formulae were EVO(Tecnis)(0.240), BUII(0.245) and EVO(0.248). For precision and accuracy, no statistically significant differences were noted between the formulae. At higher IOL powers Cooke K6 and PEARL-DGS had hyperopic tendencies, while BUII and EVO had myopic tendencies. EVO(Tecnis) did not share the same myopic tendency as EVO.
Conclusion
Across a dataset of Tecnis IOLs with a range of equally weighted IOL powers, EVO(Tecnis), BUII and EVO had the best precision and accuracy. Tecnis specific adjustments improved the EVO formula. For precision and accuracy, no statistically significant differences were noted between the formulae.
Presenting Author
Janusz Skrzypecki, MD, PhD
Co-Authors
Li Wang (MD, PhD), Douglas Koch (MD)
Purpose
This study compares the predictive accuracy of four toric IOL formulas (Barrett, EVO, Hoffer QST, Kane) integrated in the ESCRS calculator. Barrett and EVO were tested with measured (Barrett M and EVO M) and predicted (Barrett P and EVO P) posterior corneal curvature, using a large dataset of monofocal IOLs.
Methods
We analyzed 6753 eyes implanted with monofocal IOLs. Preoperative biometry, including posterior corneal curvature, was obtained using the IOLMaster 700. Predicted residual astigmatism was calculated via the proprietary websites of the four toric formulas integrated into the ESCRS IOL Power Calculator. Primary endpoints were the proportions of eyes with vector magnitude prediction errors ?0.50 D and the mean vector magnitude error. Vector analysis and double-angle plots were used to further assess error distribution and direction.
Results
Kane demonstrated the lowest mean vector magnitude prediction error (0.537), significantly lower than EVO P (0.561), EVO M (0.57), Barrett M (0.579), Barrett P (0.583), and Hoffer QST (0.622) (all p<0.001). This result was consistent in WTR, ATR, and oblique subgroups. Kane also achieved the highest proportion of eyes with prediction error ?0.50 D (p<0.001). For all formulas, bivariate means and medians were significantly different from zero. The Kane formula showed the lowest total (x,y) variances, significantly lower than all other formulas (p<0.001).
Conclusion
The Kane formula showed statistically superior predictive accuracy with the lowest errors and variances and the highest proportion of eyes within 0.50 D. However, differences between formulas were small, and their clinical relevance for toric IOL outcomes remains uncertain.
Presenting Author
Hun Lee, MD, PhD
Co-Authors
Nahyun Park (MD), Yeaeun Lee (MD), Jeewon Han (None), Kyu Sang Eah (MD), Hoseok Chung (MD), Jae Yong Kim (MD, PhD), Alison Hong (MD), David Cooke (MD), Chung Min Lee (MD)
Purpose
To compare the accuracy of modern intraocular lens (IOL) power calculation formulas from the ESCRS IOL calculator and IOLMaster 700 (Carl Zeiss Meditec AG) in short eyes (?22.5 mm) and long eyes (?25.5 mm), and to investigate the correlation between absolute prediction errors and preoperative biometric parameters.
Methods
This retrospective case-series study included 159 eyes from 113 patients who underwent cataract surgery with implantation of a single IOL model (TECNIS Eyhance, ICB00). Seven formulas from the ESCRS calculator—Barrett Universal II (BUII), Cooke K6, EVO 2.0, Hill-RBF 3.0, Hoffer QST, Kane, and PEARL-DGS—and four formulas from the IOLMaster 700—BUII, Haigis, Holladay 2, and SRK/T—were analyzed in short and long eyes. Median absolute error (MedAE), root mean square absolute error (RMSAE), percentage of eyes with prediction errors within ±0.50 D, and biometric thresholds identified by CART analysis were examined in relation to refractive prediction accuracy.
Results
In short eyes, significant differences were observed among formulas for both MedAE (P=0.008) and RMSAE (P<0.001). K6 had the lowest MedAE(0.28D) and RMSAE(0.431D). Holladay 2 showed the highest MedAE(0.51D) and RMSAE(0.661D). K6 achieved the highest percentage of eyes within ±0.50D(82.2%). Holladay 2 had the lowest(47.9%). In long eyes, no differences were found in MedAE, RMSAE, or ±0.50D intervals. CART analysis identified specific biometric thresholds associated with a higher incidence of AE?0.50D. In short eyes, shallower ACD and longer AL were linked to higher error rates. In long eyes, flatter MeanK, longer AL, thicker LT, and greater lens tilt were associated with reduced accuracy.
Conclusion
In short eyes, K6 demonstrated superior performance, while Holladay 2 showed less favorable results. In long eyes, no differences in accuracy were observed among the formulas. Specific biometric thresholds affected prediction accuracy across axial lengths.
Presenting Author
prof Deen D. Verma, MD
Purpose
To evaluate whether a planned +0.50 D overcorrection in IOL power improves refractive outcomes and increases the rate of post operative emmetropia in patients with intumescent mature cataract
Methods
In this prospective observational study, 50 patients with intumescent mature cataract underwent axial length evaluation using Immersion A-scan ultrasound biometry and keratometry using IOL Master 700. Both SRK-T and Holladay formulas were used and the higher reading of IOL power was regarded as final. To compensate for expected overestimation of axial length due to reduced ultrasound velocity, a strategy of +0.50 D adjustment in IOL power was employed. Clear corneal Temporal Phacoemulsification under Topical anesthesia with in-the-bag IOL implantation was performed by the same surgeon. Post operative refractive status was determined by subjective refraction accepted by patients on POD 5.
Results
The mean preoperative axial length was 23.61 ± 1.06 mm and the mean adjusted IOL power was 21.24 ± 2.18 D. Following cataract surgery, 86.96% of eyes achieved emmetropia, 8.69% showed myopia, while 4.34% were found hypermetropic. The mean postoperative error was –0.75 ± 0.35 D in patients with residual myopia, and +0.38 ± 0.18 D in patients with post operative hypermetropia.
Conclusion
In patients with intumescent mature cataract, accounting for the altered speed of ultrasound during axial length measurement by slightly overcorrecting IOL power can significantly improve refractive outcomes, with 87% emmetropia rate and minimal residual refractive error.
Presenting Author
Danmin Cao, PhD, MD
Purpose
To evaluate the differences and agreement in total corneal curvature parameters measured by IOLMaster 700, CASIA2, and Pentacam between post-myopic excimer laser cataract patients and surgery-naïve controls
Methods
This retrospective cross-sectional study included cataract patients with prior myopic excimer laser surgery and surgery-naïve controls. Three devices were used to measure simulated keratometry (SimK), total keratometry (TK), posterior keratometry (PK), and astigmatism parameters (J0/J45). Friedman test, intraclass correlation coefficient (ICC), and Bland-Altman plots were applied to analyze measurement differences and agreement.
Results
This study included 64 post-excimer cataract patients and 100 naïve controls. In post-excimer group, SimKm, PKm, TKm by 3 devices differed significantly (P<0.05). Like controls, post-excimer group had good SimKm/TKm agreement (ICC=0.964/0.905) but poor PKm agreement (ICC=0.449). Bland-Altman plots showed reduced SimKm/TKm agreement in post-excimer group vs controls, with widened 95% LoA (more error). For corneal astigmatism, post-excimer group had significant PK-J0, PK-J45, TK-J45 differences across 3 instruments (P<0.05).
Conclusion
Measurements of SimKm and TKm in post-excimer eyes demonstrated reduced interdevice agreement compared to refractive-surgery-naïve controls, with significant differences observed in both corneal curvature and astigmatism parameters. Consequently, keratometry values from these three devices are not interchangeable for clinical applications.
Presenting Author
Madelyn Gregston, BSc
Co-Authors
Karanpreet Multani (MD), Jascha Wendelstein (MD), Kamran Riaz (MD)
Purpose
To characterize global practice patterns in intraocular lens (IOL) power calculation, including formula preferences, diagnostic inputs, and tools that guide surgeons' choices in routine and complex eyes.
Methods
A 29-item online survey was distributed internationally to practicing cataract surgeons (Oct 2023-Oct 2024). Items covered included demographics, biometry devices, preoperative imaging (corneal topography/tomography, macular OCT), incorporating posterior corneal power, IOL formula preferences, approaches to short/long axial length and post-myopic laser vision (M-LVC) correction eyes, intraoperative aberrometry (IOA), utilization of the ESCRS formula repository, and adoption of planning software. Analyses used available-case denominators with exploratory subgroup comparisons by gender, geographic region, practice setting, fellowship training, and years in practice.
Results
A total of 230 ophthalmologists responded globally. The most used biometers were IOLMaster 700 (53.0%), Lenstar (39.6%), and IOLMaster 500 (37.4%). In routine eyes, multivariable formulas were prioritized, with Barrett Universal II ranked as first preference by 72.9% of respondents. In long and short axial eyes, multivariable formulas were preferred (73.9%, p<0.001; 68.6%, p<0.001). After M-LVC, 93.8% used online post-refractive calculators and 32.1% routinely used intraoperative aberrometry. ESCRS repository was used by 60.4% and 23.4% reported using planning software. Early-career surgeons favored multivariable/online tools while later-career surgeons favored third-generation formulas.
Conclusion
Globally, cataract surgery planning is heterogeneous, influenced by access to technology, workflow, training era, and formula choices. Mapping these selections highlights opportunities to understand international practice, target education, and refine guidance for complex eyes to support consistent, outcome-focused care.
Presenting Author
Nitin Rangu, BA
Co-Authors
Karanpreet Multani (MD), Neal Rangu (MD), Kamran Riaz (MD), Amanda Pan (BA)
Purpose
To compare the utility of K and TK values in extreme K eyes by testing four third-generation and six multivariable IOL power calculation formulas.
Methods
"Flat" and "Steep" K values were defined as ?42D and ?48D. Eyes with extreme K undergoing phacoemulsification with non-toric monofocal IOLs and postoperative CDVA ?20/30 were included. Exclusion criteria were prior refractive surgery, corneal ectasia, scarring, trauma, CME, or poor follow-up. SS-OCT biometry (IOLMaster 700) captured K and TK, which were substituted into four third-generation formulas (Holladay 1, Hoffer Q, SRK/T, Haigis) and six multivariable formulas (Barrett Universal II, Cooke K6, EVO 2.0, Kane, Hill RBF 3.0, PEARL-DGS) to calculate refractive prediction errors. MAE and RMSE assessed outcomes.
Results
Results for the present study are still being analyzed. Full comparative performance of K vs TK among formulas and by flat/steep strata reporting MAE//RMSE using heteroscedastic testing for testing statistical significance will be presented.
Conclusion
This study will define whether TK confers a clinically meaningful advantage over conventional K in extreme corneas and if specific formula(s) improve accuracy with K or TK values.
Presenting Author
Haley K Jackson, BSc
Co-Authors
Karanpreet Multani (MD), Kamran Riaz (MD)
Purpose
To evaluate the tear film stabilization interventions on biometry measurement consistency in patients undergoing cataract surgery.
Methods
This prospective, randomized, single-site study will enroll cataract surgery patients randomized to: (1) no intervention, (2) artificial tears, (3) perfluorohexyloctane drops, or (4) 5-minute eyelid closure. Power analysis indicated 59 patients per group were required; therefore, we aim to recruit ?70 per group (total ?280). Each patient will undergo two baseline scans with both the IOLMaster and Lenstar, followed by the assigned intervention and a 5-minute wait, then repeat scans. Outcomes include variability of keratometry, axial length, and anterior chamber depth, plus subjective tear film grading via mire pattern and dot clarity.
Results
To date, 28 eyes have been randomized to control (n=7), artificial tears (n=6), Meibo (n=11), or 5-minute eyelid closure (n=4). Axial length, anterior chamber depth, and lens thickness variability did not differ across arms on the IOLMaster or Lenstar (all p>0.20). Keratometry repeatability showed small, device-dependent changes; on the IOLMaster, artificial tears modestly reduced mean K variability, with a difference in K2 SD (p≈0.03). No consistent changes were seen on the Lenstar. Surface quality metrics changed modestly, with IOLMaster mire quality improving by a median of ~0.5 units after tear-film stabilization compared with minimal change in controls (p>0.20). Ongoing data collection.
Conclusion
Small, device-specific changes in keratometry repeatability were noted, most prominently with artificial tears on the IOLMaster. Surface quality metrics improved modestly. Continued enrollment will further define the magnitude and consistency of these effects.
