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    Increasing IOL power prediction accuracy

    Multicenter trial finds meaningful benefit for using intraoperative aberrometry

    Salt Lake City—Intraoperative aberrometry with a microscope-mounted proprietary device (ORA with VerifEye, Alcon Laboratories) significantly improves refractive outcomes after cataract surgery, according to results of a multicenter trial. 

    Speaking on behalf of his co-investigators, Robert J. Cionni, MD, medical director, The Eye Institute of Utah, Salt Lake City, reported on the study that included 162 eyes. Refractive outcome was evaluated at 21 to 35 days after implantation of a monofocal, presbyopia-correcting or toric IOL. Some patients also received astigmatic correction with manual or femtosecond laser-created incisions.

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    In all patients, IOL power was calculated preoperatively using newer generation, optimized formulas, but final power selection was guided by intraoperative aberrometry. Mean absolute value of the prediction error (MAVPE) and median absolute error (MAE) were calculated for the implanted IOL and presuming use of an IOL chosen based on the preoperative power calculation.

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    The results showed that MAVPE was significantly lower using intraoperative aberrometry to guide IOL power selection compared with preoperative power prediction (0.29 ± 0.26 D versus 0.35 ± 0.37 D; p = 0.04). MAE and MAE range using intraoperative aberrometry were also lower than with the preoperatively calculated IOL power (0.22 versus 0.27 D and 0.01-1.47 D versus 0.00-3.17 D).

    In addition, the distribution of eyes with an absolute error within 0.50 D of target was significantly higher using intraoperative aberrometry to guide IOL power selection compared with use of the preoperative power calculation (85% versus 76%; p = 0.025).

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    “Our goal as surgeons is to get the refractive outcome right the first time in order to avoid an unhappy patient who needs an enhancement,” Dr. Cionni said. “Preoperative calculations for IOL power selection are good, but in my mind, not good enough to meet the higher expectations of today’s patient population.”

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