Optimising biometry for best outcomes in cataract surgery

Abstract

Biometry has become one of the most important steps in modern cataract surgery and, according to the Royal College of Ophthalmologists Cataract Surgery Guidelines, what matters most is achieving excellent results. This paper is aimed at the NHS cataract surgeon and intends to be a critical review of the recent literature on biometry for cataract surgery, summarising the evidence for current best practice standards and available practical strategies for improving outcomes for patients. With modern optical biometry for the majority of patients, informed formula choice and intraocular lens (IOL) constant optimisation outcomes of more than 90% within ± 1 D and more than 60% within ± 0.5 D of target are achievable. There are a number of strategies available to surgeons wishing to exceed these outcomes, the most promising of which are the use of strict-tolerance IOLs and second eye prediction refinement.

Epiretinal membrane surgery: an analysis of 2‐step sequential‐ or combined phacovitrectomy surgery on refraction and macular anatomy in a prospective trial

“…The ARE was within AE0.25, AE0.50 and AE1.00 D in 32%, 55% and 83% of the cases in this study after 12 months. In comparison, in cataract surgery, the ARE is within AE0.25,AE0.50 and AE1.00 D in 19%, 55-71% and 85-96%(Eleftheriadis 2003; Gale et al 2009;Aristodemou et al 2011;Sheard 2014). The RE outcomes of combined surgery and cataract surgery in vitrectomized eyes are thus comparable to cataract surgery alone, and the vitreoretinal procedure seems not to have an influence on the refractive outcome in the long term (12 months).…”

Epiretinal membrane surgery: an analysis of sequential or combined surgery on refraction, macular anatomy and corneal endothelium

“…; Aristodemou et al. 2011; Sheard ). The RE outcomes of combined surgery and cataract surgery in vitrectomized eyes are thus comparable to cataract surgery alone, and the vitreoretinal procedure seems not to have an influence on the refractive outcome in the long term (12 months).…”

Comparison of Hill‐radial basis function, Barrett Universal and current third generation formulas for the calculation of intraocular lens power during cataract surgery

“…found that 80% of cases in a large database could achieve refraction within ±0.5 D of target albeit this cohort consisted of highly experienced surgeons only and excluded comorbidity factors . Considering the combination of modern optical biometry, informed formula choice and IOL constant optimization, Sheard more recently proposed that surgeons should be able to achieve 60% and 90% within ±0.5 and ±1.0 D, respectively …”