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Papers in This Session
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Femtosecond Laser Astigmatic Keratotomy Analyzed By Machine Learning
Authors
Gerald P. Clarke, MD
David A. Price
Methods
125 retrospective patient records were analyzed with preoperative topography, FLAK with iris registration and cataract surgery with recording of 2.4 mm incision was performed, and postop topography recorded minimum 6 weeks postop. Results were analyzed using Alpins analysis. SIA was measured, and a new definition of Moment was developed. Moment measures the resultant misalignment of SIA from TIA. SIA magnitude was the first outcome measure, and all variables were entered into a machine learning ensemble. A mixed model was developed to predict SIA magnitude, and second model predicted Moment. A 2 stage genetic algorithm predicts best parameters to predict desired SIA and smallest Moment.
Results
A machine learning ensemble 92% weighted with a linear model, predicted SIA magnitude with Rsquared= 0.89, and the Moment with Rsquared = 0.88; The most important variables are Ks at 3mm, Total Corneal Astigmatism, including posterior astigmatism, and Q shape Factor.
Conclusion
Machine Learning can use all corneal variables to arrive at better predictive models to predict the FLAK SIA magnitude, and the risk of misalignment of the SIA angles.
Gerald P. Clarke, MD
David A. Price
Methods
125 retrospective patient records were analyzed with preoperative topography, FLAK with iris registration and cataract surgery with recording of 2.4 mm incision was performed, and postop topography recorded minimum 6 weeks postop. Results were analyzed using Alpins analysis. SIA was measured, and a new definition of Moment was developed. Moment measures the resultant misalignment of SIA from TIA. SIA magnitude was the first outcome measure, and all variables were entered into a machine learning ensemble. A mixed model was developed to predict SIA magnitude, and second model predicted Moment. A 2 stage genetic algorithm predicts best parameters to predict desired SIA and smallest Moment.
Results
A machine learning ensemble 92% weighted with a linear model, predicted SIA magnitude with Rsquared= 0.89, and the Moment with Rsquared = 0.88; The most important variables are Ks at 3mm, Total Corneal Astigmatism, including posterior astigmatism, and Q shape Factor.
Conclusion
Machine Learning can use all corneal variables to arrive at better predictive models to predict the FLAK SIA magnitude, and the risk of misalignment of the SIA angles.
Correcting Astigmatism in Cataract Surgery with Monofocal Toric Intraocular Lens Designed to be Spherical Aberration Neutral
Authors
Helga F. Pizio, MD, FACS, MD, FACS
George M. Lau, OD
Valeri Kolesnitchenko, MD
Methods
A single-center, single-surgeon, prospective case series involving 117 eyes of 86 patients (31 bilateral) with age-related cataract and clinically significant corneal astigmatism treated with standard cataract extraction and implanted with the MX60T IOL. Early postoperative outcomes were analyzed and compared with preoperative parameters. Clinical outcomes include: keratometry (K), uncorrected distance visual acuity (UCDVA), refractive cylinder (Cyl), manifest spherical equivalent (MRSE), and safety (reposition).
Results
Preoperative delta K, Cyl, and MRSE were 1.6±0.94D, -1.72D±1.0D, and -1.71±3.9D respectively. Average BCDVA without glare was 0.2±0.18 logMAR. At 1-week post-op, both cylinder and MRSE improved (Cyl: -0.34±0.54D and MRSE: plano±0.33D). Average UCDVA was 0.09±0.14 logMAR with 75% of eyes seeing 20/25 or better. One patient required repositioning and improved to 20/20 UCDVA with a 0.25D MRSE.
Conclusion
Patients implanted with aberration-neutral monofocal toric IOL demonstrated excellent uncorrected distance visual acuity and exceptional reduction in refractive cylinder postoperatively.
Helga F. Pizio, MD, FACS, MD, FACS
George M. Lau, OD
Valeri Kolesnitchenko, MD
Methods
A single-center, single-surgeon, prospective case series involving 117 eyes of 86 patients (31 bilateral) with age-related cataract and clinically significant corneal astigmatism treated with standard cataract extraction and implanted with the MX60T IOL. Early postoperative outcomes were analyzed and compared with preoperative parameters. Clinical outcomes include: keratometry (K), uncorrected distance visual acuity (UCDVA), refractive cylinder (Cyl), manifest spherical equivalent (MRSE), and safety (reposition).
Results
Preoperative delta K, Cyl, and MRSE were 1.6±0.94D, -1.72D±1.0D, and -1.71±3.9D respectively. Average BCDVA without glare was 0.2±0.18 logMAR. At 1-week post-op, both cylinder and MRSE improved (Cyl: -0.34±0.54D and MRSE: plano±0.33D). Average UCDVA was 0.09±0.14 logMAR with 75% of eyes seeing 20/25 or better. One patient required repositioning and improved to 20/20 UCDVA with a 0.25D MRSE.
Conclusion
Patients implanted with aberration-neutral monofocal toric IOL demonstrated excellent uncorrected distance visual acuity and exceptional reduction in refractive cylinder postoperatively.
Visual Results and Rotational Stability after Implantation of a Toric Panfocal Intraocular Lens – 3 Months Results
Authors
Thomas Kohnen, MD, PhD
Christoph Lwowski, MD
Raimund Forster, MSc
Eva Hemkeppler, MSc
Kerstin Petermann, MSc
Methods
50 eyes of 25 patients were bilaterally implanted with a toric panfocal IOL (Panoptix, Alcon, USA) during cataract surgery or refractive lens exchange to reach spectacle independence postoperatively. Main outcome measures were uncorrected and best spectacle corrected distant, intermediate, and near visual acuity (UDVA, UIVA, UNVA, CDVA, DCIVA, DCNVA; logMAR), defocus curve, spherical equivalent (MRSE), visual quality, and rotational stability 3 months after surgery.
Results
At 3 months postoperative the patients had a binocular CDVA of -0.07±0.10 logMAR which was significant better than the preoperative CDVA 0.20±0.05logMAR (p<0.001). DCIVA and DCNVA were 0.04±0.13 and 0.07±0.19logMAR 3 months postoperative. The MRSE was -0.16D±0.88. The defocus curve shows excellent far, intermediate and near visual acuity. Mean cylindrical IOL power was -1.5D±0.25. The IOL was stable regarding rotational stability with a mean deviation of intended axis 2.51°±2.30. The amount of visual phenomenons was comparable to the non-toric Panoptix.
Conclusion
The toric panfocal IOL offers excellent vision in all distances without the need of glasses for near, intermediate or distant vision. There was no significant deviation of the IOL axis after 3 months.
Thomas Kohnen, MD, PhD
Christoph Lwowski, MD
Raimund Forster, MSc
Eva Hemkeppler, MSc
Kerstin Petermann, MSc
Methods
50 eyes of 25 patients were bilaterally implanted with a toric panfocal IOL (Panoptix, Alcon, USA) during cataract surgery or refractive lens exchange to reach spectacle independence postoperatively. Main outcome measures were uncorrected and best spectacle corrected distant, intermediate, and near visual acuity (UDVA, UIVA, UNVA, CDVA, DCIVA, DCNVA; logMAR), defocus curve, spherical equivalent (MRSE), visual quality, and rotational stability 3 months after surgery.
Results
At 3 months postoperative the patients had a binocular CDVA of -0.07±0.10 logMAR which was significant better than the preoperative CDVA 0.20±0.05logMAR (p<0.001). DCIVA and DCNVA were 0.04±0.13 and 0.07±0.19logMAR 3 months postoperative. The MRSE was -0.16D±0.88. The defocus curve shows excellent far, intermediate and near visual acuity. Mean cylindrical IOL power was -1.5D±0.25. The IOL was stable regarding rotational stability with a mean deviation of intended axis 2.51°±2.30. The amount of visual phenomenons was comparable to the non-toric Panoptix.
Conclusion
The toric panfocal IOL offers excellent vision in all distances without the need of glasses for near, intermediate or distant vision. There was no significant deviation of the IOL axis after 3 months.
Residual Astigmatism after Toric IOL Placement: An Update in Rotational Trends
Authors
Brent A. Kramer, MD
David R. Hardten, MD
John P. Berdahl, MD
Methods
Retrospective review of entries made to the astigmatismfix.com website will be filtered and analyzed. Rotation/misalignment will be defined as and IOL >5° from the intended axis. The rate of rotation/misalignment will be determined by comparing the amount of entries to their respective rate of background residual astigmatism entries (an ‘internal validation’ method that has been used in previous astigmatismfix studies).
Results
From 9/5/2013 through 12/31/19 there were 28,791 entries to the AstigmatismFix website which were deemed to represent actual patients through a filtering process previously described. The overall rate of rotation was 72.9. There was a statistically significant trend of increasing rotation per year. A subset from 3/2019 through 12/2019 was used to compare rotation rates from three common monofocal toric IOLs. The rates of rotation for AcrySof, TECNIS, and enVista were 73.4%, 83.9%, and 83.0% respectively. The enVista and TECNIS IOLs were found to rotate 1.77x and 1.89x more than the AcrySof IOLs (p <0.001).
Conclusion
The overall increase in toric rotation over the years in the AstigmatismFix database is likely relative and secondary to better pre-operative measurements and calculations. The AcrySof toric IOL remains the most stable toric IOL when compared to the TECNIS toric (ZCTx) and enVista toric (MX60T).
Brent A. Kramer, MD
David R. Hardten, MD
John P. Berdahl, MD
Methods
Retrospective review of entries made to the astigmatismfix.com website will be filtered and analyzed. Rotation/misalignment will be defined as and IOL >5° from the intended axis. The rate of rotation/misalignment will be determined by comparing the amount of entries to their respective rate of background residual astigmatism entries (an ‘internal validation’ method that has been used in previous astigmatismfix studies).
Results
From 9/5/2013 through 12/31/19 there were 28,791 entries to the AstigmatismFix website which were deemed to represent actual patients through a filtering process previously described. The overall rate of rotation was 72.9. There was a statistically significant trend of increasing rotation per year. A subset from 3/2019 through 12/2019 was used to compare rotation rates from three common monofocal toric IOLs. The rates of rotation for AcrySof, TECNIS, and enVista were 73.4%, 83.9%, and 83.0% respectively. The enVista and TECNIS IOLs were found to rotate 1.77x and 1.89x more than the AcrySof IOLs (p <0.001).
Conclusion
The overall increase in toric rotation over the years in the AstigmatismFix database is likely relative and secondary to better pre-operative measurements and calculations. The AcrySof toric IOL remains the most stable toric IOL when compared to the TECNIS toric (ZCTx) and enVista toric (MX60T).
Clinical Outcomes and Patients’ Satisfaction of a New Trifocal Toric Intraocular Lens
Author
P. Dee G. Stephenson, MD, ABO
Methods
Prospective, single-surgeon, consecutive case series in which novel toric IOLs were implanted and intraoperative aberrometry was used to confirm IOL power and axis alignment. All patients were assessed for uncorrected visual acuities (UCVAs) at distance and intermediate and near, MRSE and absolute prediction error (APE) were collected. Surgical technique with new toric IOL will be shared at the conference.
Results
Initial outcomes showed improved surgical efficiency with enhanced toric (MX60ET) IOL. Enhanced time for haptics to engage capsular and quicker toric alignment with intraocular aberrometry. Additional clinical endpoints are currently being collected and will be presented at the conference.
Conclusion
Initial outcomes show improved surgical efficiency with new enhanced toric IOL as compared to the previous non-enhanced version.
P. Dee G. Stephenson, MD, ABO
Methods
Prospective, single-surgeon, consecutive case series in which novel toric IOLs were implanted and intraoperative aberrometry was used to confirm IOL power and axis alignment. All patients were assessed for uncorrected visual acuities (UCVAs) at distance and intermediate and near, MRSE and absolute prediction error (APE) were collected. Surgical technique with new toric IOL will be shared at the conference.
Results
Initial outcomes showed improved surgical efficiency with enhanced toric (MX60ET) IOL. Enhanced time for haptics to engage capsular and quicker toric alignment with intraocular aberrometry. Additional clinical endpoints are currently being collected and will be presented at the conference.
Conclusion
Initial outcomes show improved surgical efficiency with new enhanced toric IOL as compared to the previous non-enhanced version.
Image Quality or Depth of Field or Both? Clinical Outcomes from Spherical Aberration Neutral Monofocal Toric IOL
Author
Alice T. Epitropoulos, MD, FACS, ABO
Methods
Prospective, single-site, single-surgeon, case series on spherical aberration neutral monofocal toric IOL (enVista MX60T, Bausch and Lomb, Inc). A total of 29 eyes (n=25, 4 bilateral) were included in this study. Study parameters included: Pre-op MRSE, pre-op delta K, Post-op visual acuities at distance, intermediate, and near, post-op manifest refraction, BCDVA, refractive prediction error, and absolute IOL rotation at 1 day and 1 month.
Results
Average pre-op MRSE was -0.87D (±3.58) with average cylinder of 1.57D (±0.87D). Post-op at 1M, MRSE improved to -0.41D (±-0.51D) with cylinder of 0.19D (±0.23D). Most eyes (≥91%) achieved MRSE of ±0.50D from predicted and all eyes showed ≤0.75D of refractive cylinder. At 1M, 91% of eyes had 20/25 or better visual acuity at distance and 87% of eyes achieved the same acuity level at intermediate. Average near acuity was J2.5 with 83% of eyes seeing J3 or better. All eyes were rotationally stable with 100% showing ≤5° rotation from surgery to 1 day and 1 month. No complications were observed post-operatively.
Conclusion
In this prospective case series, EnVista Toric IOL was predictable, rotationally stable, and effective in reducing refractive astigmatism. The aberration free optic appeared to improve range of vision while maintaining image quality.
Alice T. Epitropoulos, MD, FACS, ABO
Methods
Prospective, single-site, single-surgeon, case series on spherical aberration neutral monofocal toric IOL (enVista MX60T, Bausch and Lomb, Inc). A total of 29 eyes (n=25, 4 bilateral) were included in this study. Study parameters included: Pre-op MRSE, pre-op delta K, Post-op visual acuities at distance, intermediate, and near, post-op manifest refraction, BCDVA, refractive prediction error, and absolute IOL rotation at 1 day and 1 month.
Results
Average pre-op MRSE was -0.87D (±3.58) with average cylinder of 1.57D (±0.87D). Post-op at 1M, MRSE improved to -0.41D (±-0.51D) with cylinder of 0.19D (±0.23D). Most eyes (≥91%) achieved MRSE of ±0.50D from predicted and all eyes showed ≤0.75D of refractive cylinder. At 1M, 91% of eyes had 20/25 or better visual acuity at distance and 87% of eyes achieved the same acuity level at intermediate. Average near acuity was J2.5 with 83% of eyes seeing J3 or better. All eyes were rotationally stable with 100% showing ≤5° rotation from surgery to 1 day and 1 month. No complications were observed post-operatively.
Conclusion
In this prospective case series, EnVista Toric IOL was predictable, rotationally stable, and effective in reducing refractive astigmatism. The aberration free optic appeared to improve range of vision while maintaining image quality.