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Moderator
Jonathan C. Lake, MD, PhD
Panelists
Mitchell P. Weikert, MD, MS, 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
Brad Hall, PhD
Co-Authors
Kendrick Wang (MD), Morgan Micheletti (MD)
Purpose
To compare the need for manual and confirmatory A-scans between two SS-OCT biometers and assess associated clinic time savings.
Methods
This study is a single-center, prospective, non-interventional, observational study of 70 patients who previously underwent complex cataract surgery for reasons of poor visualization or red reflex and had a preoperative biometry with the IOL Master 700 and Argos. Outcomes measures included the percentage of eyes that were able to acquire axial length measurements, the percentage of eyes that required ultrasound a-scans due to missing axial length, the percentage of eyes that had to use the enhanced retina visualization (ERV) mode, technician time and patient time, and differences between postoperative axial lengths and preoperative axial lengths.
Results
The Argos was able to successfully acquire axial length (AL) in 58/61 eyes (95%) compared to 46/61 eyes (75%) for the IOLMaster 700 (p < 0.001). The mean absolute difference in preoperative AL measurements compared to postoperative AL measurements were 0.15 ± 0.37 mm for Argos and 0.40 ± 1.14 mm for IOL Master 700 (p < 0.001). The mean absolute difference in preoperative AL manual A-scan measurements compared to postoperative AL measurements were 0.42 ± 1.01 mm for Argos and 0.40 ± 1.00 mm for IOL Master 700. In addition, preoperative ERV mode was needed in 17/61 (28%) eyes and manual a-scans we performed in 23/61 (38%) eyes.
Conclusion
The results of this study suggest that SS-OCT biometers improve AL accuracy in dense cataracts. Argos outperformed IOL Master 700, with a smaller pre-to-postoperative AL difference. When Argos acquires a value, confirmatory a-scans may not be necessary, reducing technician workload and improving clinic efficiency without compromising accuracy.
Presenting Author
Carlton Yuen, MD, BSc
Co-Authors
Caitlin Yuen (None), Camerynn Keahi (BA), Brad Hall (PhD), Alana Dunn (None), Corban Yuen (None)
Purpose
To evaluate the effective phaco time (EFT) and endothelial cell loss per phacoemulsification procedure with the Veritas Vision System.
Methods
This was a prospective, single-site, single arm, observational study of EFT and endothelial cell loss per phacoemulsification procedure with the Veritas Vision System. A total of 50 eyes were targeted. Surgical outcome measures included EFT, total case time, total phaco time, and total volume used. One-month postoperative outcomes measures included endothelial cell loss and retinal thickness changes.
Results
To date, 34 eyes have completed the study. Mean effective phaco time was 100.4 ± 67.9 s, mean total case time was 262.5 ± 48.6 s, and mean fluid volume used was 77.8 ± 19 mL. Preoperatively, mean endothelial cell density was 2357.4 ± 356.8 cells/mm� compared to 2390.8 ± 283.9 cells/mm� at 1 month postoperatively. Additionally, preoperative central corneal thickness was 548.8 ± 50.3 µm compared to 540.7 ± 38.7 µm at 1 month postoperatively. Finally, central subfield thickness of the retina was 234.4 ± 52.7 µm preoperatively, compared to 235.6 ± 40.4 µm at 1 month postoperatively.
Conclusion
Interim results suggest low effective phaco time per phacoemulsification procedure, and minimal endothelial cell loss with the Veritas Vision System.
Presenting Author
Francisco Mendes, MD
Co-Authors
Kusona Fortingo (BSc), Xuesen Cheng (MD, PhD), Li Wang (MD, PhD), Allison Chen (MD, MPH), Mitchell Weikert (MD, MS), Douglas Koch (MD)
Purpose
To evaluate the repeatability of biometry values — including anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), axial length (AL), white-to-white (WTW), keratometry (K), and lens tilt and decentration —in phakic eyes using the Eyestar 900 swept-source optical coherence tomography (SS-OCT) biometer (Haag-Streit).
Methods
In phakic eyes scheduled for cataract surgery, 3 consecutive ss-OCT measurements were obtained during a single visit for ACD, CCT, LT, AL, WTW, K, and lens tilt and decentration. Repeatability was analyzed using within-subject standard deviation (Sw), coefficient of variation (CoV), and intraclass correlation coefficient (ICC).
Results
Eleven eyes (11 patients) were studied. For ACD, Sw, CoV and ICC were 0.007 mm, 18.2 %, and 1.000 (95% CI, 0.999-1.000). For CCT, Sw, CoV and ICC were 2.421 µm, 37.4 %, and 0.996 (95% CI, 0.988-0.999). For LT and AL, Sws, CoVs and ICCs were 0.011 and 6 %, 0.003 mm and 1.000 (95% CI, 1.000-1.000) for both. For K1 and K2, Sws, CoVs and ICCs were 0.072 D and 0.079 D; 14.5 % and 15.2 %; and 0.999 (95% CI, 0.998-1.000) for both. For lens tilt (axial angle), Sw, CoV and ICC were 0.072, 178.3 % and 0.992 (95% CI, 0.978-0.998). Sws and ICCs were 0.008 mm and 0.014 mm, 0.991 (95% CI, 0.977-0.997) and 0.948 (95% CI, 0.868-0.984) for lens decentration X and Y.
Conclusion
In this preliminary cohort, swept-source OCT demonstrated excellent repeatability across biometric and crystalline lens parameters in phakic eyes. Enrollment is ongoing to achieve a validated sample size.
Presenting Author
Jaime Zacharias, MD
Co-Authors
Nathia Niklitschek (MD)
Purpose
To compare fluid streaming, cavitation and acoustic patterns in 3D space surrounding phacoemulsification (phaco) tips as well as the thermal profile at the level of the corneal incision of the Hybrid and Balanced tips using the UNITY Vitreoretinal Cataract System (UVCS) with three different ultrasound modes: Volumetric, Torsional and Longitudinal.
Methods
Particle image velocimetry (PIV), was used to evaluate the flow patterns to determine details about fluid streaming and turbulence. High-speed high-definition video recordings with simultaneous video overlay allowed visualization of the change in cavitation bubbles with increasing ultrasound power. A directional hydrophone setup was used to determine ultrasonic acoustic pressure as well as cavitation events at increasing ultrasound power. The thermal profile was recorded to determine the amount of heat generated in the region of a simulated incision-sleeve-tip complex using a forward looking infrared (FLIR) camera. All testing was performed under controlled flow conditions of 30 cc/min.
Results
Particle image velocimetry showed retrograde streaming opposing aspiration with axial, whereas torsional and volumetric modes produced flow aligned with aspiration. The Hybrid tip caused less fluid disturbance than the Balanced tip. Optical cavitation surrounded the probe in axial mode, was mainly lateral in torsional mode, and showed a similar but reduced frontal pattern in volumetric mode. Acoustic cavitation was highest with longitudinal ultrasound, lowest with torsional at low power, and intermediate with volumetric, becoming similar to torsional at higher power. Incision temperature rise was greatest with axial mode and similar between torsional and volumetric modes for both tips.
Conclusion
Volumetric ultrasound demonstrated a fluidic and cavitation profile closer to torsional than axial phaco, with favorable streaming direction, moderated cavitation, and reduced thermal load. These data suggest volumetric phaco may offer improved fluidic efficiency and thermal safety while avoiding unwanted effects seen with longitudinal motion.
Presenting Author
Jaime Zacharias, MD
Purpose
To compare the efficiency of Hybrid and Balanced phaco tips across Volumetric (i.e., UNITY 4D Phaco) and torsional (i.e., Ozil) ultrasound modes, and to test the hypothesis that 4D Phaco motion could reduce emulsification time in dense cataracts with the Hybrid phaco tip.
Methods
Porcine lenses chemically modified to simulate human cataractous tissue were graded and emulsified using 4D Phaco and Ozil ultrasound modes with Hybrid and Balanced tips. For each lens grade, emulsification time at comparable ultrasonic power was recorded. High-speed videography, combined with stroboscopic illumination and UNITY Vitreoretinal Cataract System (UVCS) video overlay, enabled detailed visualization of motion at the tip’s distal end, along the shaft, and at the corneal incision site as well as tip-tissue interactions. All experiments were conducted under standardized flow conditions.
Results
High-speed imaging showed that volumetric ultrasound generated a multidimensional distal tip motion combining axial, lateral, and vertical components, forming a continuously evolving trajectory distinct from a combination of torsional and longitudinal modes. In alternating-mode experiments, lens fragments served as their own control. Fragment displacement and velocity consistently demonstrated higher emulsification efficiency with volumetric phaco than with torsional phaco. In multiple trials, lens fragments advanced into the tip only during volumetric activation, with progression halting during torsional cycles. These findings were consistent for both Hybrid and Balanced phaco tips.
Conclusion
Volumetric phacoemulsification exhibits a spatial motion pattern that translates into superior emulsification efficiency compared with torsional ultrasound. This effect was reproducible across tip designs and was particularly evident in dense lens material, supporting volumetric motion as a distinct and more effective ultrasound modality.
Presenting Author
Jaime Zacharias, MD
Purpose
Innovations in phacoemulsification technology may impact the post-occlusion surge response in eyes with different compliance. This study compares the post-occlusion surge of the UNITY Vitreoretinal Cataract System (UVCS) and CENTURION Active Sentry (CAS) in a refined bicameral mechanical eye model with adjustable eye compliance.
Methods
A bicameral eye model had anterior and posterior chambers separated by an impermeable membrane mimicking the posterior capsule with adjustable compliance to match different human eye response curves: low, medium and high. Sensors were used to detect changes in pressure and surge volume produced by intraocular pressure (IOP) variations as well as during occlusion and post-occlusion break events. Using the same Balanced Tip for both study arms, testing was performed at IOP set points of 30, 40 and 50 mmHg, vacuum limits of 350, 500 and 650 mmHg and flow rate of 30 cc/min. Quantitative and qualitative video footage are collected to fully evaluate the dynamic response of the two systems.
Results
Post-occlusion surge volume and capsule motion increased as eye compliance decreased and vacuum increased across all experimental settings. In the low-compliance model, UVCS demonstrated a ~60–65% reduction in surge compared with CAS, with a concurrent ~10% reduction in capsule motion. In the medium-compliance model, surge reduction with UVCS reached ~70–75%, with capsule motion reduced by ~20%. In the high-compliance model, absolute surge and capsule motion were lower for both systems, with UVCS maintaining ~45–50% lower surge and ~10–12% less capsule displacement. Opening the shunt reduced surge and capsule motion in both systems.
Conclusion
In a bicameral in-vitro eye model, post-occlusion surge and capsule motion depended on eye compliance and shunt state. UVCS reduced surge (≈45–75%) and capsule displacement (≈10–20%) versus CAS, with the largest differences in low- and medium-compliance conditions, underscoring the role of fluidics design in surge control.
Presenting Author
Anahita P. Shroff, MBBS, DNB
Co-Authors
Haripriya Aravind (MD), Rengaraj Venkatesh (MD)
Purpose
To assess whether a virtual reality-based counseling tool improves patient understanding of intraocular lens (IOL) options and supports informed decision-making in cataract surgery.
Methods
A prospective pilot study was conducted at a tertiary eye care hospital. Patients with early or immature cataracts and BCVA ?6/12 in the worse eye were included; exclusions were macular disease and ineligibility for presbyopia-correcting IOLs. Participants underwent VR-based counseling simulating postoperative vision with monofocal, extended depth of focus, and multifocal IOLs. Structured feedback was obtained on accuracy, clarity, and ease of decision-making.
Results
Sixty-seven patients completed the study. VR counseling was rated consistent with traditional counseling by 100% of participants. Improved understanding was reported by 94%, and 66 of 67 found IOL decision-making easier. Final lens choices included 36 extended depth of focus, 27 monofocal, and 4 multifocal. VR counseling significantly increased acceptance of presbyopia-correcting IOLs and boosted confidence in surgical decisions.
Conclusion
Virtual reality counseling enhances patient comprehension and facilitates IOL decision-making in cataract surgery. It shows promise as a valuable adjunct for ophthalmic patient education and shared decision-making.
Presenting Author
Marah Shelbayh, MD
Co-Authors
Gaurav Prakash (MD, FRCS), Vishal Jhanji (MD)
Purpose
To determine observed normative limits of interocular differences in global and zonular biometry using swept-source optical biometry and to compare symmetry between normal and post-LASIK eyes, based on real-life clinically observed dataset.
Methods
This retrospective study included 728 patients (1,456 eyes) who underwent bilateral swept-source optical biometry using the IOLMaster 700 (Carl Zeiss). Interocular absolute differences( |OD-OS|) were calculated for axial length (AL), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), white to white (WTW), and zonular parameters measured at 30° intervals (AL_0-150°, ACD_0-150°, LT_0-150°, CCT_0-150°). Means, standard deviations, and 95% limits were derived. Subgroup comparisons between bilateral normal and bilateral post-LASIK eyes were performed using independent t-tests.
Results
Global AL symmetry was noted at a mean interocular difference of 0.26 mm; limits were ±1 SD = 0.36 mm and ±2 SD = 0.72 mm. Keratometry differences averaged 0.11 D, with ±1 SD = 0.15-0.17 D and ±2 SD = 0.30-0.34 D. CCT differences averaged 0.01 mm (10 µm), with ±1 SD = 20 µm and ±2 SD = 40 µm, while WTW differences averaged 0.14 mm, with ±1 SD = 0.13 mm and ±2 SD = 0.26 mm. Comparable limits were observed across zonular parameters (AL_0-150°, ACD_0-150°, LT_0-150°, CCT_0-150°), indicating stable symmetry across meridians. Subgroup analysis showed axial length remained consistent across groups, while keratometry variability was significantly greater in post-LASIK eyes (p<0.001)
Conclusion
Swept-source optical biometry showed high interocular symmetry across zonular & global parameters. This study formalizes the clinical intuition for repeat biometry, recommending re-measurement if ?AL >0.7mm or ?K >0.3D. These thresholds provide objective, data-driven criteria for outlier detection & quality control in cataract surgery planning
Presenting Author
Amulya G. Punati, MBBS, MS
Co-Authors
Naren Shetty (MS, PhD), Rohitha Nayak (MBBS, DOMS, DNB), Harsha Rao (MD, PhD)
Purpose
To evaluate the effectiveness of preoperative Nd:YAG laser capsulotomy in preventing Argentinian Flag Sign in various types of intumescent mature cataracts, as classified by anterior segment OCT (AS-OCT), and to assess associated changes in anterior segment parameters.
Methods
This prospective observational study included 90 eyes diagnosed with intumescent mature cataracts based on slit-lamp biomicroscopy. AS-OCT was used to classify cataracts into four morphological types. Each eye underwent preoperative biometry using immersion ultrasound, IOLMaster, and Argos. A single Nd:YAG laser shot was applied to the anterior capsule 30 minutes prior to phacoemulsification. CASIA-2 AS-OCT scans were obtained before and after laser application. Parameters analyzed included anterior chamber depth (ACD), angle width, lens biometry, and crystalline lens rise. Intraoperative complications were recorded
Results
Nd:YAG laser was most effective in type II and III intumescent cataracts. Post-laser AS-OCT revealed significant reduction in anterior capsule convexity and lens rise, along with increased ACD and improved angle configuration. No cases of Argentinian Flag Sign, capsulorhexis extension, posterior capsular rupture, or nucleus drop were observed.
Conclusion
Preoperative Nd:YAG laser capsulotomy significantly reduces intraoperative risk in intumescent cataracts by flattening the anterior capsule and deepening the anterior chamber, as demonstrated by AS-OCT analysis. This technique effectively prevents Argentinian Flag Sign and enhances surgical safety.
Presenting Author
Karen E Asfar, MD
Co-Authors
Xuesen Cheng (MD, PhD), Li Wang (MD, PhD), Mitchell Weikert (MD, MS), Douglas Koch (MD), Kusona Fortingo (BSc), Francisco Mendes (MD), Allison Chen (MD, MPH)
Purpose
To evaluate the accuracy of corneal astigmatism measurements in post-refractive eyes (PRK, LASIK, RK) using 5 devices
Methods
Eyes with prior PRK/LASIK/RK undergoing cataract surgery with spherical or toric IOLs will be enrolled. Preop corneal astigmatism will be measured with Anterion, Cassini, Eyestar, Galilei, and IOLMaster 700. Toric alignment will be confirmed at slit lamp 3 weeks postoperatively. Only eyes with CDVA ?20/30 will be analyzed. Back-calculated corneal astigmatism will equal postop manifest refraction at the corneal plane minus effective toric IOL power at the corneal plane. Devices' predictive accuracies will be determined by comparing preop keratometric values with back-calculated corneal astigmatism. Error distribution and agreement across devices will be assessed via vector analysis in R
Results
In the toric IOL group mean vector corneal astigmatism PEs for the Anterion,Cassini,EyeStar,IOLMaster700 were [email protected],[email protected],[email protected],[email protected] in ATR eyes and [email protected],[email protected],[email protected],[email protected] in oblique eyes for anterior keratometry(K),and [email protected],[email protected],[email protected],[email protected] in ATR eyes and [email protected],[email protected],[email protected],[email protected] in oblique eyes for total corneal astigmatism(TCA). In the monofocal IOL group PEs were [email protected],[email protected],[email protected],[email protected] for WTR eyes and [email protected],[email protected],[email protected],[email protected] for oblique eyes for anterior K,and [email protected],[email protected],[email protected],[email protected] for WTR eyes and [email protected],[email protected],[email protected],[email protected] for oblique eyes for TCA
Conclusion
Small number of cases were included in each subgroup. More eyes will be enrolled, and statistical analysis will be performed to compare the PEs among devices
Presenting Author
Hisaharu Suzuki, MD, PhD
Co-Authors
Marcia Ong (MS), Satish Yalamanchili (MBA, MS), Mai Kurose (MS), Sarah Makari (OD), Samantha Do (OD)
Purpose
Previous work evaluated anterior chamber (AC) stability of UNITY VCS (UVCS) and CENTURION ACTIVE SENTRY (CAS) during simulated occlusion break via the slit side view (SSV) slit lamp method. This study aims to quantify AC stability in an operative room (OR) setting using intraoperative OCT (iOCT) and iris movement via surgical microscope.
Methods
12 porcine eyes were tested at intraocular pressure (IOP) 20, 30, 40 mmHg, vacuum limits 550, 600, 650 mmHg, and aspiration rate 40 cc/min. Each eye was pinned on a fixture and a 2.4mm incision was created under a surgical microscope. The phaco handpiece was secured to minimize leakage and movement throughout the procedure. UVCS and CAS were tested in each eye and choice of first machine was alternated. Continuous irrigation was used to stabilize IOP before an occlusion break was simulated by pinching the aspiration line with pliers for 3s then released. The AC depth (ACD) and pupil diameter change ratio using iOCT and the pupil area change ratio using a surgical microscope were recorded.
Results
The percent change in ACD was statistically significantly less with UVCS compared to CAS across all tested settings (p<0.0001). Similarly, pupil area and pupil diameter changes during surge events with UVCS were less across all settings (both p<0.0001). As IOP decreased, there was more AC stability and less iris movement observed with UVCS. There is a statistically significant relationship between iOCT ACD, microscope pupil area, and iOCT pupil diameter change (all p<0.0001). These results follow a similar trend to the previous SSV method, which demonstrate more AC stability with UVCS vs. CAS during occlusion break surge events.
Conclusion
AC stability can be objectively measured in the OR using iOCT. UVCS demonstrated better stability than CAS during simulated occlusion break, especially at lower IOP corroborating prior SSV method findings. Iris movement observed via surgical microscope may be a viable alternative to objectively and quantitatively assess the stability of the AC.
Presenting Author
Mohammad Javad Ghanbarnia, MD
Co-Authors
Jia Yue You (MD, FRCSC), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
To investigate the indications for use and the visual and clinical outcomes of scleral-fixated capsular tension segment (CTS) implantation to stabilize the capsular bag in eyes with subluxated cataract
Methods
In this retrospective, single centre study, patients who underwent cataract surgery with CTS implantation, with or without other capsular support devices, for subluxated cataract were included. The primary outcome was change in best corrected visual acuity (BCVA), measured in LogMAR, from baseline. Indications for CTS use and pertinent preoperative characteristics, intraoperative performance, intraoperative and post-operative complications including the incidence of posterior capsule opacification (PCO) and risk factors for such complications, Intraocular lens (IOL) stability and centration and the need for additional procedures were also investigated.
Results
Ninety-two eyes of 78 patients with mean age of 46±21 years were included. Median follow-up was 26.3 (IQR 3.6-63.4) months. Trauma (32%) and Marfan syndrome (18%) were the most common causes of zonular instability. One CTS was used in 76% and two CTSs in 24% of cases, accompanied by vitrectomy in 27% and glaucoma procedures in 21%. Median BCVA improved significantly from 0.6 (IQR 0.4-1.0) to 0.2 (0.1-0.5) LogMAR (P<0.001) at the last visit. Mean prediction error was 0.4±1.1 D. PCO developed in 34% (n=31), requiring Nd:YAG capsulotomy in 26% (n=24). IOL tilt or decentration occurred in 5 eyes and IOL subluxation in 4 eyes, with 2 requiring additional surgery. No IOL dislocation occurred.
Conclusion
Scleral-fixated CTS for subluxated cataracts significantly improved visual acuity with low rates of clinically significant IOL instability and no dislocations.
Presenting Author
Brett D. Brimhall, MD
Purpose
To evaluate the initial real-world outcomes of a novel vibration-assisted device designed to close primary clear corneal incisions at the time of cataract surgery. Primary objectives are to determine safety and efficacy of the device. A secondary objective is to determine effects of the device on postoperative peri-incisional corneal edema.
Methods
Retrospective real-world data collection was done via records review over a one-month period of consecutive cataract surgeries from a single surgeon. Treatment was performed using a pen-like device that generates rapid, low-amplitude vibrations applied for 8-16 seconds over the incision site. The rate of successful intraoperative closure was calculated. Rates of postoperative day-one corneal edema as observed at the slit lamp were compared between a treatment group (eyes that initially leaked and received treatment with the device) and a control group (eyes that spontaneously sealed without treatment). A paired z-test was used to determine statistical difference between the two groups.
Results
The treatment group consisted of 73 treated eyes and the control group of 36 spontaneously sealed eyes. The treatment group demonstrated successful intraoperative closure in all eyes (73 of 73). Supplemental treatment with stromal hydration or sutures was not required in any case. All treated eyes (73 of 73) demonstrated sealed wounds on the postoperative day-one visit. No complications were observed intraoperatively or postoperatively. On postoperative day-one, 19 of 71 treated eyes (27%) and 17 of 36 control eyes (47%) demonstrated peri-incisional corneal edema. A two-tailed z-test demonstrated that the treatment group had less corneal edema than the control group (p=0.034).
Conclusion
The device appears both safe and effective at closing primary clear corneal incisions during cataract surgery. Treatment also demonstrated improved early post-operative corneal edema from the control baseline. Further studies are warranted, including post-surgical assessment of incision architecture in treated eyes.
