IOLMaster version 5'4 and Premium IOL Surgery

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IOLMaster (version 5.4) and Premium IOL Surgery

• Jack A. Singer, MD
• Randolph, VT USA

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IOLMaster version 5.4

• Digital-signal processing
• Statistical noise detected filtered
• Composite axial length
• Measurement possible through dense cataracts with
  low S/N
• Real-time axial length analysis
• Focus indicator for K
• Focus indicator for ACD

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Real-time axial length analysis

• Measuring error
• Performing additional measurements
• Uncertain value
• Perform additional measurements
• Look carefully for multiple peaks
• Value with good SNR
• Evaluate quality of signal
• Avoid double peaks from RPE/ILM
• Validation criteria met

RED
YELLOW
GREEN
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Real-time axial length analysis

• Sources of low SNR
• Dense media opacity
• Restless patient
• Inadequate alignment
• Retina pathology

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Real-time axial length analysis

• Inadequate AL measurements

dip
ramp
flat
noise
movement
waves
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IOLMaster version 5.4 Auto K

• Very fast acquisition
• Focus indicator
• 3 sets of consecutive Ks captured
• Pauses when or

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IOLMaster version 5.4 Auto K

• Measures at 2.5mm diameter
• most manual keratometers measure at 3mm or more
• 30 data points per measurement
• 6 spots (measured 5 times each)

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IOLMaster version 5.4 ACD Adjustment Aid
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IOLMaster version 5.4 video
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(No Transcript)
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Haigis Formula

• 3-variable formula
• Optimization
• Surgeon specific
• IOL geometry specific

d the effective lens position d a0 (a1
ACD) (a2 AL)
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Haigis Formula

• Optimized for crystalens Five-0
• IOLMaster axial length
• IOLMaster K's
• 198 eyes
• AL 19.93 to 22.01, n 68
• AL 22.02 to 25.99, n 119
• AL 26.00 to 28.10, n 11

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Haigis Formula

• Optimized for crystalens Five-0
• mean postop sph -0.49
• mean postop cyl 0.28
• R squared 0.571
• a0 -0.825 (a0 is negative)
• a1 0.004
• a2 0.249
• SRK/T A-constant 119.17

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Crystalens Refractive Targetcrystalens Five-O

• Accommodative blended vision
• plano to -0.25 in dominant eye
• -0.50 to -0.75 in non-dominant eye
• Skew towards myopia in myopes
• Skew towards plano in low hyperopes

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Crystalens Refractive TargetCrystalens HD

• Accommodative blended vision not needed!
• Plano to 0.25 in dominant eye
• Plano to -0.25 in non-dominant eye

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Capsulotomy gt optic hinges
AT50SE AT52SE (crystalens Five-O) HD500 HD520
(Crystalens HD)
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Crystalens Five-O
8 days
4 weeks
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• Surgivision IOL Registry
• An online outcomes database
• Singer Eye Center Outcomes

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(Surgivision Datalink online outcomes database)
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Refractive Stability
100 Eyes (sorted by change in SE)
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Distance
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Intermediate
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Near
J1
J1
J2
J3
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
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Haigis-L Formula

• Power calculation after myopic LASIK/PRK/LASEK
• Power calculation after hyperopic LASIK/PRK/LASEK
• Uses same IOLMaster AL Ks
• High rate of predictability

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Haigis-L Formula
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Dense Cataract case 1
1st SNR2.3
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Dense Cataract case 1
2nd SNR2.9
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Dense Cataract case 1
3rd SNR2.6
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Dense Cataract case 1
4th SNR4.7
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Dense Cataract case 1
Composite SNR106.1
Composite
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Dense Cataract case 2
1st SNR1.7
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Dense Cataract case 2
2nd SNR1.9
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Dense Cataract case 2
Composite SNR11.5
Composite
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Dense Cataracts case 3
OS SNR 1.6-2.5
OD Needed A-scan
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Dense Cataracts case 3
SNR 1.6-2.5
Composite SNR11.5
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IOLMaster version 5.4

• Digital-signal processing
• Composite axial length
• Measurement possible through dense cataracts with
  low S/N
• Real-time axial length analysis
• Auto K fast and accurate
• ACD Adjustment Aid
• Haigis
• Haigis-L (post myopic hyperopic)

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crystalens Premium IOL Surgery

• Requires precise biometry
• Requires precise IOL power calcs
• IOLMaster version 5.4 is key
• Enhanced outcome predictability
• Avg Desired SE -0.20
• Avg Achieved SE -0.36 (StDev 0.42)
• Reduced enhancement rate
• My enhancement rate lt3
• Happier patients

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Thank you for your attention
Singer Eye Center Randolph, Vermont,
USA www.SingerEye.com