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Accuracy of Predicted Refractive Error in Resident-Performed Cataract Surgery Using Partial Coherence Interferometry Nickolas P. Katsoulakis, M.D., Paul.

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Presentation on theme: "Accuracy of Predicted Refractive Error in Resident-Performed Cataract Surgery Using Partial Coherence Interferometry Nickolas P. Katsoulakis, M.D., Paul."— Presentation transcript:

1 Accuracy of Predicted Refractive Error in Resident-Performed Cataract Surgery Using Partial Coherence Interferometry Nickolas P. Katsoulakis, M.D., Paul B. Greenberg, M.D., Dina Gewaily, M.M.S., Theodoros Filippopoulos, M.D., and Sunil K. Rao, M.D. Ophthalmology Section, Department of Veterans Affairs Medical Center, Providence, R.I. Division of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, R.I. ASCRS – 2008 Chicago,Illinois USA

2 Purpose: To determine the accuracy of predicted post-operative refractive error in a cohort of U.S. veterans undergoing resident-performed cataract surgery that had preoperative axial length measurements using partial interferometry (PCI).

3 Methods: Retrospective review of patients who had extracapsular cataract extraction by phacoemulsification with in-the- bag intraocular lens implantation between February 2006 and May 2007 at a Veterans Affairs Medical Center. All cases were performed by resident surgeons with attending supervision with preoperative axial length biometry performed by PCI (Zeiss IOLMaster, Carl Zeiss Meditec AG). Inclusion criteria were patients with (a) recorded pre-operative target and post-operative refractions after at least one month of follow-up and (b) post-operative visual acuities of 20/50 or better.

4 Results: 148 cataract surgeries were performed between February 2006 and May 2007 with preoperative biometry performed using PCI. 64 eyes met inclusion criteria; 41 eyes were excluded due to inability to obtain adequate measurements using PCI.

5 Results: 60 males and 4 females Mean age: 71.8 ± 9.4 years (range: 53-90) Mean pre-operative BCVA: 0.42 Mean post-operative logMAR BCVA: 0.02 Mean absolute deviation from target refractive error: 0.49D (SD=0.40) 87.5% of patients were within 1D of target refraction and 100% were within 2D

6 Eyes within* Eleftheriadis†RoseKissKatsoulakis ± 0.5 D84% (67%)N/A56%60.9% ± 1.0 D96% (90%)85%89%87.5% ± 1.5 D100% (98%)N/A94%98.4% ± 2.0 D(100%)100% MAE‡0.29 (0.49)0.420.480.49 * Percentage of eyes within 0.50 D, 1.00 D, 1.50 D, and 2.00 D of intended refraction. † Values in parentheses are refractive outcomes for patients whose IOL calculations were performed theoretically using the SRK II formula. ‡ Mean absolute error.

7 Conclusions: The accuracy of target refractions in patients undergoing resident-performed cataract surgery at a Veterans Affairs Medical center is comparable to prior studies in which preoperative biometry was performed using PCI. A significant percentage of patients in this cohort were unable to have PCI axial length measurements due primarily to dense lens opacity.

8 References: The Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmology. 2004; 122: 477–485 Rose LT, Moshegov CN. Comparison of the Zeiss IOLMaster and applanation A-scan ultrasound: biometry for intraocular lens calculation. Clin Experiment Ophthalmol. 2003; 31:121-124 Eleftheriadis H. IOLMaster biometry: Refractive results of 100 consecutive cases. Br J Ophthalmol 2003; 87:960–963 Kiss B, Findl O, Menapace R et al. Refractive outcome of cataract surgery using partial coherence interferometry and ultrasound biometry: Clinical feasibility study of a commercial prototype II. J Cataract Refract Surg. 2002; 28:230-234 Randleman JB, Wolfe JD, Woodward M, et al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007;125:1215-1219 Bhagat N, Nissirios N, Potdevin L et al. Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol. 2007; 91:1315-1317 Blomquist PH, Rugwani RM. Visual outcomes after vitreous loss during cataract surgery performed by residents. J Cataract and Refract Surg. 2002; 28:847-852 Corey RP, Olson RJ. Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg. 1998; 24:66-72 Justice AC, Erdos J, Brandt C, et al. The Veterans Affairs Healthcare System: A unique laboratory for observational and interventional research. Med Care 2006; 44:S7-S12 Holladay JT. Visual acuity measurements. J Cataract Refract Surg. 2004; 30:287-290 Freeman G, Pesudovs K. The impact of cataract severity on measurement acquisition on with the IOLMaster. Acta Ophthalmol Scan. 2005: 83: 439-442 Rogers WH, Kazis LE, Miller DR et al. Comparing the health status of VA and non-VA ambulatory patients: The veterans’ health and medical outcomes studies. J Ambul Care Manage. 2004; 27: 249-262

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