Intraocular Lens (IOL) power calculation is a crucial step in cataract surgery and certain refractive surgeries like phakic IOL implantation. The goal is to determine the appropriate power of the IOL to be implanted into the eye, ensuring that the patient achieves their desired postoperative visual outcome. Several formulas and methods are available for IOL power calculation, and the choice of formula depends on various factors, including the patient's eye measurements and the surgeon's preference. Here, we describe the basic principles and some commonly used formulas.
Ocular Biometry:
Ocular biometry is the process of measuring various dimensions of the eye, primarily the axial length, corneal power, and anterior chamber depth. These measurements are essential for accurate IOL power calculation and achieving the desired post-surgical refractive outcome. Here are the key components of ocular biometry:
Axial Length: This measurement determines the overall length of the eye, from the cornea's front surface to the retina's back surface. Axial length is a critical factor in IOL power calculation because it helps determine the eye's focusing power.
Corneal Power: The cornea is the transparent front surface of the eye, and its curvature affects the eye's refractive power. Corneal power is typically measured using techniques like keratometry or corneal topography. It helps account for the eye's astigmatism and assists in selecting the appropriate IOL.
some basic notions on how they are measured is explored here.
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
Intraocular Lens (IOL) power calculation is a crucial step in cataract surgery and certain refractive surgeries like phakic IOL implantation. The goal is to determine the appropriate power of the IOL to be implanted into the eye, ensuring that the patient achieves their desired postoperative visual outcome. Several formulas and methods are available for IOL power calculation, and the choice of formula depends on various factors, including the patient's eye measurements and the surgeon's preference. Here, we describe the basic principles and some commonly used formulas.
Ocular Biometry:
Ocular biometry is the process of measuring various dimensions of the eye, primarily the axial length, corneal power, and anterior chamber depth. These measurements are essential for accurate IOL power calculation and achieving the desired post-surgical refractive outcome. Here are the key components of ocular biometry:
Axial Length: This measurement determines the overall length of the eye, from the cornea's front surface to the retina's back surface. Axial length is a critical factor in IOL power calculation because it helps determine the eye's focusing power.
Corneal Power: The cornea is the transparent front surface of the eye, and its curvature affects the eye's refractive power. Corneal power is typically measured using techniques like keratometry or corneal topography. It helps account for the eye's astigmatism and assists in selecting the appropriate IOL.
some basic notions on how they are measured is explored here.
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
Biometry is the method of measuring various dimensions of the eye, its components and their inter-relationship. Using these data to calculate the idol intraocular lens power. In 1949, 29th November, Harold Ridley implanted the first IOL but his patient had a refractive surprise of -20 D spherical equivalents.
So, It was long way to travel to refined the out comes. Classic keratometry is based on anterior corneal surface measurements.
Whereas this directly measure the anterior and posterior corneal surface to obtain Total keratometry(TK).
Telecentric keratometry of the anterior corneal surface + swept source OCT of the posterior corneal surface= TOTAL KERATOMETRY.
TK measurements are compatible with existing IOL constants plus two exclusive formulas: barrett true K with TK for post LVC eyes and Barrett TK toric.
introduction into Biometry and it's formulas.pptxQusaiAbusleem1
Biometry is the practice of applying mathematics to biology .
With regard to ophthalmology , there are several biometric systems used for making precise measurements of ocular structures : ultrasound (A- and B-scan , pachymeter) , low coherence interferometry (OCT) , laser interferometry (IOL Master , Lenstar)
These systems are used in measurement of axial length ,keratometry , pachymetry , and retinal thickness , among other things .
The term biometry , as it relates to ophthalmology , typically refers to preoperative measurements made for IOL calculations.
Biometry explanation and the used formulas.pptxQusaiAbusleem1
Biometry is the practice of applying mathematics to biology .
With regard to ophthalmology , there are several biometric systems used for making precise measurements of ocular structures : ultrasound (A- and B-scan , pachymeter) , low coherence interferometry (OCT) , laser interferometry (IOL Master , Lenstar)
These systems are used in measurement of axial length ,keratometry , pachymetry , and retinal thickness , among other things .
The term biometry , as it relates to ophthalmology , typically refers to preoperative measurements made for IOL calculations.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Biometry is the method of measuring various dimensions of the eye, its components and their inter-relationship. Using these data to calculate the idol intraocular lens power. In 1949, 29th November, Harold Ridley implanted the first IOL but his patient had a refractive surprise of -20 D spherical equivalents.
So, It was long way to travel to refined the out comes. Classic keratometry is based on anterior corneal surface measurements.
Whereas this directly measure the anterior and posterior corneal surface to obtain Total keratometry(TK).
Telecentric keratometry of the anterior corneal surface + swept source OCT of the posterior corneal surface= TOTAL KERATOMETRY.
TK measurements are compatible with existing IOL constants plus two exclusive formulas: barrett true K with TK for post LVC eyes and Barrett TK toric.
introduction into Biometry and it's formulas.pptxQusaiAbusleem1
Biometry is the practice of applying mathematics to biology .
With regard to ophthalmology , there are several biometric systems used for making precise measurements of ocular structures : ultrasound (A- and B-scan , pachymeter) , low coherence interferometry (OCT) , laser interferometry (IOL Master , Lenstar)
These systems are used in measurement of axial length ,keratometry , pachymetry , and retinal thickness , among other things .
The term biometry , as it relates to ophthalmology , typically refers to preoperative measurements made for IOL calculations.
Biometry explanation and the used formulas.pptxQusaiAbusleem1
Biometry is the practice of applying mathematics to biology .
With regard to ophthalmology , there are several biometric systems used for making precise measurements of ocular structures : ultrasound (A- and B-scan , pachymeter) , low coherence interferometry (OCT) , laser interferometry (IOL Master , Lenstar)
These systems are used in measurement of axial length ,keratometry , pachymetry , and retinal thickness , among other things .
The term biometry , as it relates to ophthalmology , typically refers to preoperative measurements made for IOL calculations.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
2. Objectives
A-Scan Principles
Steps in Biometry
Source of Errors
Minimizing Errors-good biometrist
IOL calculation formula
3. Pre Test
The usual frequency of A-scan biometry
probe is;
A. 10Mhz
B. 15Mhz
C. 25Mhz
4. Pre test
2. Which technique of biometry has a
higher tendency of corneal compression
A. Contact Biometry
B. Immersion biometry
C. Optical biometry
5. Pre Test
3. Which of the following information can
not be expected from A-scan biometry
A. lens thickness
B. Axial length.
C. Keratometry
D. AC depth
6. Pre Test
4. The junction between any two ocular
media of different densities and
velocities is called
A. Gate
B. Gain
C. Interface
D. Frequency
7. Pre test
5. How many gates do you expect in a
routine a scan measurement?
A. 1
B. 2
C. 3
D. 4
8. Pre Test
6. Which one of the following
measurement is considered the most
important in Iol power determination?
A. Keratometer
B. AC depth
C. Axial length
D. Lens thickness
9. Pre Test
7. Which one of the following uses optical
interferometry for measuring intraocular
distances?
A. A-scan E. A&B
B, B-scan F. C&D
C. Lenstar
D. IOL master
10. Pre Test
8. Ultrasound travels faster in lens than
in aqueous or vitreous
A. True
B. B. False
11. Pre Test
9. The IOL master is better than U/S for
measuring axial length for eyes with
dense cataract or media opacity
A. True
B. False
12. Pre Test
10. Optical Biometry measures axial
length from apex of the cornea to the
level of
A. Internal limiting membrane
B. Retinal nerve fiber level
C. Photoreceptors
D. Retinal Piegment Epithelium
13. Pre Test
11. Which one of the following is a more
reliable IOL calculation formula ?
A. SRK T
B. Holladay II
C. Haigis
D. Hoffer Q
14. Pre Test
12. The most common error in contact
biometry is
A. Corneal Compression
B. Misallignment
C. Wrong IOL formula
D. Wrong label
15. BIOMETRY
Is a clinical procedure used to
Meassure axial length for IOL
powercalculation
Monitor congenital glaucoma, myopia,
nanophthalmos
Meassure intraocular parameters like:
AC depth
Lens thickness
17. A-Scan Ultrasound
(PRINCIPLES)
A-Scan what does A stand for?
Sound wave-a vibration that propagates
as acoustic waves through Gas, liquid or
solid.
AMPLITUDE
18. A-Scan Ultrasound
(PRINCIPLES)
Sound wave frequency ranges 20-
20,000hz
Ultrasound (in audible sound) >20k hz
A-Scan –Biometry uses ultrasound
(10mhz) to measure distances between
ocular structures using echoes of u/s
20. Pulser and Receiver
Comes in a probe
Piezoelectric
Substance that
Generates US when stimulated by burst of
electricity.
The crystal converts the electric energy to
sound wave and Mechanical vibration from
echoes are converted to electrical energy and
plotted as spikes
22. A-Scan principle
In A-scan biometry, one thin, parallel sound beam is emitted
from the probe tip at its given frequency of approximately 10
MHz, with an echo bouncing back into the probe tip as the sound
beam strikes each interface.
An interface is the junction between any two media of different
densities and velocities, which, in the eye, include the anterior
corneal surface, the aqueous/anterior lens surface, the
posterior lens capsule/anterior vitreous, the posterior
vitreous/retinal surface, and the choroid/anterior scleral
surface.
The echoes received back into the probe from each of these
interfaces are converted by the biometer to spikes arising from
baseline.
26. Gates
Electronic calipers on the
display..Biometers are programmed to
place..check correctness
4 typical gaits..3 sections to be
meassured
A. corneal spike
B. ant lens surface spike
C. Post lens surface spike
D. Retinal surface spike
27. Measurement formula principles
Summation of gates
Cornea to ant lens surface (AC depth)
Velocity through aqueous 1532m/s (D=VxT/2)
Ant lens surface to Post lens surface (lens
thickness)
Velocity 1641m/s
Ant vit surface to ant retinal surface
Velocity 1532m/s
28. Modes
Phakic—3 gates displayed as above select
cataract, dens cataract etc to adjust
velocity)
Phakic average..takes average spped of
1550m/s and 2 gates (cornea/retina) –gross
Aphakic -2 gates (Cornea/Retina) V=1532
Pseudophakic –lens options/ if not consider it
as PMMA
30. Gain
Electrical amplification of signals
(Intensity)
Gain knob
Too high..picks signal fast and increases
amplitude of spikes but results in poor
resolution and poor accuracy
Too low ..difficult to get spikes.
….Measurement
Recommended gain 50-70
31. Source of Errors
A 0.1 mm error in an average length eye will result in
about a 0.25 diopter (D) postoperative refractive
error.
A 0.5 mm will result in approximately 1.25 D and an
error of 1.0 mm will result in approximately 2.50 D
Longer eyes are more forgiving, with a 1.0 mm error in
an eye of 30 mm length result in 1.75 D.
Small eyes are the least forgiving, an error of 1.0 mm
in an eye that is 22.0 mm long will result in a post-
operative error of about 3.75 D.
32. Source of errors
Corneal compression-myopic shift
Check for ac depth
Misallignment (not perpendicular)- The
angle of incidence, which is determined
by the probe orientation to the visual
axis… hyperopic shift
low Ant/post lens surface spikes
Absent scleral spike
38. Source of Errors
The shape and smoothness of each interface also
affects spike quality. Lubrication, osd Rx
Macular pathology could adversely affect spike
quality. A perfect high, steeply rising retinal spike
may be impossible when macular pathology is present
(eg, macular edema, macular degeneration, epiretinal
membranes, posterior staphylomas).
40. Source of errors
Gates position..
Not properly placed (adjust or repeat)
Poor spikes repeat
Dry eye, OSD
Corneal opacity
Squint
AMD
Poor patient and eye position
41. Pseudophakic biometry
To check fellow eye power
Iol exchange
Type of iol pmma/foldable –
Reverberation artifact
42. Reverberation artifact
The longer chain of artifact spikes from
polymethyl methacrylate implants. The
image on the right demonstrates the
shorter chain of artifact in the vitreous
43. Steps in Biometry
Calibrate and clean probe
Patient should be seated looking straight ahead or at
the probe light (if could fix)
Stand at the side of the patient and screen should be
placed where you can easily see it
Apply anesthetic drop
Align the probe to the optical axis and applanate at
the cornea apex
Check variation in ACD, and select one with max value
SD should be less than 0.3mm (ideally 0.06)
44. A Good Biometrist .must be
smarter than the machine!
Must be able to recognize
when readings appear abnormal
standard dimensions of the eye.
The average axial eye length is 23.5 mm, with a range of 22.0-24.5 mm.
A patient can be myopic because of steep corneal curvature rather than long axial
length, and a patient can be hyperopic because of flat corneal curvature rather than
short axial length.
Compare axial length to the precataract refractive error of the patient to ensure that
the readings appear accurate.
The reference range of AL between the right eye and the left eye of the same patient
is within 0.3 mm, unless evidence suggests the contrary (eg, previous scleral buckling,
anisometropia, corneal transplantation, keratoconus, refractive surgery, hypotony).
The average anterior chamber depth is 3.24 mm but varies greatly.
The average lens thickness is 4.63 mm but this also varies, and, with cataractous
changes, the lens will increase in thickness to as much as 7.0 mm in extremely dense
cases.
45. A Good Biometrist
Should realize;
The average keratometry (K) reading is 43.0-44.0 D, with one
eye typically within a diopter of each other.
If one eye is found to differ from the other by more than 1 D,
immediately begin researching the cause and alert the physician.
( refractive surgery, corneal transplantation, an injury with a
resultant corneal scar, or has keratoconus)
If any of the above eye measurements is found to be unusual,
another technician should recheck the measurements and
immediately alert the physician.
46. Reviewing measurements
SD of AL with in 0.06mm delete extremes
Check corneal compression by variation of AC depth
Ant and Post lens spikes should be nearly equal (post
slightly shorter)
Retina spike straight and high
Scleral spike should be seen separately from that of
the retina
Do both eyes and if there is a difference of >0.3mm
in AL… review
47. IOL calculation formula
2 variable formula ( AL and
keratometry)
Using the correct IOL calculation formula is important for good
surgical outcomes.
SRK Formula: P=A-2.5L-0.9K
Current 2-variable formulas that are considered the most
accurate include the Hoffer Q, SRK/T, and Holladay I.
Multivariable formulas have proven to be the most accurate due
to more of the eye anatomy being considered
48. IOL Calculation Formula
The Haigis formula is a 3-variable equation, using not
only axial length and corneal curvature but also the
anterior chamber depth of the eye.
The Holladay II formula is a 7-variable equation
widely thought to be the most accurate formula; it
takes into account axial length, corneal curvature,
horizontal white-to-white, anterior chamber depth,
lens thickness, precataract refractive error, and age
of the patient.
49. IOL Calculation Formula
Predicting lens position is one of the most common
causes of a postoperative surprise; by taking more of
the eye anatomy into account, this can be more
accurately predicted. For average-length eyes with
average Ks, these formulas give almost identical
calculations. [3] However, when the eye is small,
formula selection is more critical. In eyes that are
less than 22 mm in length, the Hoffer Q and the
Holladay II IOL Consultant formulas are the most
accurate. For long eyes, the SRK/T and the Holladay
II IOL Consultant formulas are the most accurate.
51. VELOCITY CONVERSION
Intra op You found that the patient is
aphakic hile iol was calculated with
phakic mode
Velocity (correct)/Velocity (measured) X
Apparent Length = True Length
E.g. 1532/1550 X 24.1 = 23.82 mm = true eye
length.
Intraop you found pt has silicon oil
980/1532 X Apparent Vitreous Length =
True Vitreous Length
52. Optical Biometers
Current method for highly accurate axial length measurements
does not use ultrasound at all, but rather optical coherent light.
In this method, optical coherent light passes through the visual
axis and reflects back from the retinal pigment
epithelium.(internal limiting membrane as with
ultrasound/0.1mm)
However, this method cannot be used in the event of significant
media opacity (eg, dense cataracts or corneal or vitreal opacity)
due to absorption of the light
53. Other Biometers
Optical/Laser (near infra red..partial
coherence laser)
IOL MASTER (Carl Zeiss)
Lens star (Hagstreit)
low coherence interferometry
Alladin (Topcon)