Cataract surgery is the most performed surgery in ophthalmology and remains as the ultimate refractive surgery.It offers an opportunity to improve a patient’s visual acuity and target a degree of spectacle independen...Cataract surgery is the most performed surgery in ophthalmology and remains as the ultimate refractive surgery.It offers an opportunity to improve a patient’s visual acuity and target a degree of spectacle independence.The process of intraocular lens(IOL)calculations serves as a crucial element in achieving successful post-operative refractive outcomes.A modern-day surgeon has access to several IOL formulas to pick the most appropriate lens to achieve a desired target refraction.These formulas,however,have both advantages and limitations and therefore reach within 0.50 diopters of the target refraction only 70-80%of the time.There is a lack of a single,ideal formula that can simplify complexities of this process and achieve higher degrees of accuracy.The development of the IOL Ladas‘super formula’may provide a simplistic,accurate,and ever-evolving solution to improving outcomes.展开更多
Purpose To evaluate the refractive prediction error of common intraocular lens(IOL)power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques.Methods This is a prospe...Purpose To evaluate the refractive prediction error of common intraocular lens(IOL)power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques.Methods This is a prospective,randomized,longitudinal,single-site,single-surgeon study.Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively.Refraction was measured using the best-corrected visual acuity at 4 m(EDTRS chart).Lens decentration,tilt and effective lens position(ELP)were assessed using an anterior segment optical coherence tomography(AS-OCT).The prediction error(PE)and the absolute error(AE)were evaluated for the SRK/T,Hollayday1 and Hoffer Q formula.Subsequently,correlations between the PE and axial length,keratometry,white to white and ELP were assessed.Results In total,53 eyes of 53 patients were included in the study.Twenty-four eyes of 24 patients were in the Yamane group(YG)and 29 eyes of 29 patients were in the Carlevale group(CG).In the YG,the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE(0.02±0.56 D,and 0.13±0.64 D,respectively)while in the SRK/T formula the PE was slightly myopic(−0.16±0.56 D).In the CG,SRK/T and Holladay 1 formulae led to a myopic PE(−0.1±0.80 D and−0.04±0.74 D,respectively),Hoffer Q to a hyperopic PE(0.04±0.75 D).There was no difference between the PE of the same formulae across both groups(P>0.05).In both groups the AE differed significantly from zero in each evaluated formula.The AE error was within±0.50 D in 45%–71%and was within±1.00 D in 72%–92%of eyes depending on the formula and surgical method used.No significant differences were found between formulae within and across groups(P>0.05).Intraocular lens tilt was lower in the CG(6.45±2.03°)compared to the YG(7.67±3.70°)(P<0.001).Lens decentration was higher in the YG(0.57±0.37 mm)than in the CG(0.38±0.21 mm),though the difference was not statistically significant(P=0.9996).Conclusions Refractive predictability was similar in both groups.IOL tilt was better in the CG,however this did not influence the refractive predictability.Though not significant,Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae.However,significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs.展开更多
Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane librar...Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and WangKoch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.展开更多
Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane librar...Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and Wang,Koch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.展开更多
Background:The accuracy of using total keratometry(TK)value in recent IOL power calculation formulas in highly myopic eyes remained unknown.Methods:Highly myopic patients who underwent uneventful cataract surgery were...Background:The accuracy of using total keratometry(TK)value in recent IOL power calculation formulas in highly myopic eyes remained unknown.Methods:Highly myopic patients who underwent uneventful cataract surgery were prospectively enrolled in this prospective comparative study.At one month postoperatively,standard deviation(SD)of the prediction errors(PEs),mean and median absolute error(MedAE)of 103 highly myopic eyes were back-calculated and compared among ten formulas,including XGboost,RBF 3.0,Kane,Barrett Universal II,Emmetropia Verifying Optical 2.0,Cooke K6,Haigis,SRK/T,and Wang-Koch modifications of Haigis and SRK/T formulas,using either TK or standard keratometry(K)value.Results:In highly myopic eyes,despite good agreement between TK and K(P>0.05),larger differences between the two were associated with smaller central corneal thickness(P<0.05).As to the refractive errors,TK method showed no differences compared to K method.The XGBoost,RBF 3.0 and Kane ranked top three when considering SDs of PEs.Using TK value,the XGboost calculator was comparable with the RBF 3.0 formula(P>0.05),which both presented smaller MedAEs than others(all P<0.05).As for the percentage of eyes within±0.50 D or±0.75 D of PE,the XGBoost TK showed comparable percentages with the RBF 3.0 TK formula(74.76%vs.66.99%,or 90.29%vs.87.38%,P>0.05),and statistically larger percentages than the other eight formulas(P<0.05).Conclusions:Highly myopic eyes with thinner corneas tend to have larger differences between TK and K.The XGboost enhancement calculator and RBF 3.0 formula using TK showed the most promising outcomes in highly myopic eyes.展开更多
Purpose:This prospective cohort study aimed to assess the influence of tear film stability on corneal refractive power measurement and surgical planning in cataract patients.Methods:Participants were divided into tear...Purpose:This prospective cohort study aimed to assess the influence of tear film stability on corneal refractive power measurement and surgical planning in cataract patients.Methods:Participants were divided into tear film instability(tear film stability level 2)and control(level 0–1)groups based on Keratograph 5M results.Using IOL Master 700,two consecutive measurements were obtained with a 10-min interval.Parameters including standard keratometry(Kf,Ks and K),keratometric corneal astigmatism(KCA),total keratometry(TKf,TKs and TK)and total corneal astigmatism(TCA)were recorded.IOL power was calculated using SRK-T,SRK-T TK,Haigis,Haigis TK,Barrett Universal II,and Barrett Universal II TK formulas.Results:The results showed significantly higher differences between two measurements in Kf,K,KCA,TKf,TK,and TCA,as well as the vector variability of corneal astigmatism in the tear film instability group(all P<0.05).Of all formulas,only the SRK-T formula displayed significantly higher variability in IOL power calculations in the tear film instability group compared to the control group(P<0.05).Conclusions:This study highlights that tear film instability can lead to deviations in corneal refractive power and astigmatism measurements,contributing to increased prediction errors in IOL power calculation,particularly with the SRK-T formula.展开更多
The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular deg...The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of prematurity.Cataract management is another feld that can beneft from greater AI application.Cataract is the leading cause of reversible visual impairment with a rising global clinical burden.Improved diagnosis,monitoring,and surgical management are necessary to address this challenge.In addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 pandemic.AI on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical barriers.First,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs.This utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts appropriately.Second,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional formulas.Third,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical procedures.Fourth,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser capsulotomy.These advances in AI could transform cataract management and enable delivery of efcient ophthalmic services.The key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of end-users.展开更多
文摘Cataract surgery is the most performed surgery in ophthalmology and remains as the ultimate refractive surgery.It offers an opportunity to improve a patient’s visual acuity and target a degree of spectacle independence.The process of intraocular lens(IOL)calculations serves as a crucial element in achieving successful post-operative refractive outcomes.A modern-day surgeon has access to several IOL formulas to pick the most appropriate lens to achieve a desired target refraction.These formulas,however,have both advantages and limitations and therefore reach within 0.50 diopters of the target refraction only 70-80%of the time.There is a lack of a single,ideal formula that can simplify complexities of this process and achieve higher degrees of accuracy.The development of the IOL Ladas‘super formula’may provide a simplistic,accurate,and ever-evolving solution to improving outcomes.
文摘Purpose To evaluate the refractive prediction error of common intraocular lens(IOL)power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques.Methods This is a prospective,randomized,longitudinal,single-site,single-surgeon study.Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively.Refraction was measured using the best-corrected visual acuity at 4 m(EDTRS chart).Lens decentration,tilt and effective lens position(ELP)were assessed using an anterior segment optical coherence tomography(AS-OCT).The prediction error(PE)and the absolute error(AE)were evaluated for the SRK/T,Hollayday1 and Hoffer Q formula.Subsequently,correlations between the PE and axial length,keratometry,white to white and ELP were assessed.Results In total,53 eyes of 53 patients were included in the study.Twenty-four eyes of 24 patients were in the Yamane group(YG)and 29 eyes of 29 patients were in the Carlevale group(CG).In the YG,the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE(0.02±0.56 D,and 0.13±0.64 D,respectively)while in the SRK/T formula the PE was slightly myopic(−0.16±0.56 D).In the CG,SRK/T and Holladay 1 formulae led to a myopic PE(−0.1±0.80 D and−0.04±0.74 D,respectively),Hoffer Q to a hyperopic PE(0.04±0.75 D).There was no difference between the PE of the same formulae across both groups(P>0.05).In both groups the AE differed significantly from zero in each evaluated formula.The AE error was within±0.50 D in 45%–71%and was within±1.00 D in 72%–92%of eyes depending on the formula and surgical method used.No significant differences were found between formulae within and across groups(P>0.05).Intraocular lens tilt was lower in the CG(6.45±2.03°)compared to the YG(7.67±3.70°)(P<0.001).Lens decentration was higher in the YG(0.57±0.37 mm)than in the CG(0.38±0.21 mm),though the difference was not statistically significant(P=0.9996).Conclusions Refractive predictability was similar in both groups.IOL tilt was better in the CG,however this did not influence the refractive predictability.Though not significant,Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae.However,significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs.
基金This study was supported by the Technology Foundation of Tianjin Municipal Health Bureau of China(grant no.2014KY37 to Jun Li)the Natural Science Foundation of the Tianjin Science and Technology Committee of China(grant no.18JCZDJC36400 to Li Nan).
文摘Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and WangKoch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.
基金supported by the Technology Foun dation of Tianjin Municipal Health Bureau of China(Grant No.2014KY37)the Natural Science Foundation of the Tianjin Science and Technology Committee of China(Grant No.18JCZDJC36400).
文摘Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and Wang,Koch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.
基金supported by research grants from the National Natural Science Foundation of China(Grant Nos.82122017,81870642,81970780 and 81670835)Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission(Grant Nos.19441900700 and 21S31904900)+1 种基金Clinical Research Plan of Shanghai Shenkang Hospital Development Center(Grant Nos.SHDC2020CR4078 and SHDC12019X08)the Fudan University“Outstanding 2025”Program.
文摘Background:The accuracy of using total keratometry(TK)value in recent IOL power calculation formulas in highly myopic eyes remained unknown.Methods:Highly myopic patients who underwent uneventful cataract surgery were prospectively enrolled in this prospective comparative study.At one month postoperatively,standard deviation(SD)of the prediction errors(PEs),mean and median absolute error(MedAE)of 103 highly myopic eyes were back-calculated and compared among ten formulas,including XGboost,RBF 3.0,Kane,Barrett Universal II,Emmetropia Verifying Optical 2.0,Cooke K6,Haigis,SRK/T,and Wang-Koch modifications of Haigis and SRK/T formulas,using either TK or standard keratometry(K)value.Results:In highly myopic eyes,despite good agreement between TK and K(P>0.05),larger differences between the two were associated with smaller central corneal thickness(P<0.05).As to the refractive errors,TK method showed no differences compared to K method.The XGBoost,RBF 3.0 and Kane ranked top three when considering SDs of PEs.Using TK value,the XGboost calculator was comparable with the RBF 3.0 formula(P>0.05),which both presented smaller MedAEs than others(all P<0.05).As for the percentage of eyes within±0.50 D or±0.75 D of PE,the XGBoost TK showed comparable percentages with the RBF 3.0 TK formula(74.76%vs.66.99%,or 90.29%vs.87.38%,P>0.05),and statistically larger percentages than the other eight formulas(P<0.05).Conclusions:Highly myopic eyes with thinner corneas tend to have larger differences between TK and K.The XGboost enhancement calculator and RBF 3.0 formula using TK showed the most promising outcomes in highly myopic eyes.
基金supported by the 2022 Science and Technology Project of Tianjin Binhai New Area Health Commission(2022BWKQ008)Tianjin Medical University"Clinical Talent Training 123 Climbing Plan"and Tianjin Medical University Eye Hospital High-level Innovative Talent Programmer(YDYYRCXM-E2023-05).
文摘Purpose:This prospective cohort study aimed to assess the influence of tear film stability on corneal refractive power measurement and surgical planning in cataract patients.Methods:Participants were divided into tear film instability(tear film stability level 2)and control(level 0–1)groups based on Keratograph 5M results.Using IOL Master 700,two consecutive measurements were obtained with a 10-min interval.Parameters including standard keratometry(Kf,Ks and K),keratometric corneal astigmatism(KCA),total keratometry(TKf,TKs and TK)and total corneal astigmatism(TCA)were recorded.IOL power was calculated using SRK-T,SRK-T TK,Haigis,Haigis TK,Barrett Universal II,and Barrett Universal II TK formulas.Results:The results showed significantly higher differences between two measurements in Kf,K,KCA,TKf,TK,and TCA,as well as the vector variability of corneal astigmatism in the tear film instability group(all P<0.05).Of all formulas,only the SRK-T formula displayed significantly higher variability in IOL power calculations in the tear film instability group compared to the control group(P<0.05).Conclusions:This study highlights that tear film instability can lead to deviations in corneal refractive power and astigmatism measurements,contributing to increased prediction errors in IOL power calculation,particularly with the SRK-T formula.
文摘The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of medicine.In ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of prematurity.Cataract management is another feld that can beneft from greater AI application.Cataract is the leading cause of reversible visual impairment with a rising global clinical burden.Improved diagnosis,monitoring,and surgical management are necessary to address this challenge.In addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 pandemic.AI on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical barriers.First,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs.This utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts appropriately.Second,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional formulas.Third,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical procedures.Fourth,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser capsulotomy.These advances in AI could transform cataract management and enable delivery of efcient ophthalmic services.The key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of end-users.
