1647: do you trust intra-op aberrometry?

The idea behind intra-operative aberrometry is great: measure the eye in the aphakic state and then you can determine the ideal IOL power for the cataract surgery. Using an auto-refractor on the aphakic eye can produce some good data, but is that sufficient for IOL power determination via a refractive vergence calculation? If this is accurate then why do we need to also enter the keratometry data, anterior chamber depth, axial length, and your pre-determined IOL calculation? When you step on your bathroom scale to measure your weight, do you first enter your height and waist circumference? For IOL power determination there are other factors involved in determining the effective lens position of the optic and that, of course, changes the post-op refractive results. I need the help of my CataractCoach viewers: Do you trust intra-operative aberrometry so that when it differs from your previously done IOL calculations you switch to what the aberrometer says? This video is from an anonymous surgeon who asks, “What should I do when prior calculations say +20.0 but the aberrometer says +21.0?”

please leave a comment below on CataractCoach.com or on the YouTube video

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  1. I see plenty of patients referred because ORA suggested a different power than the Lenstar/IOL master did and it was wrong. Now they need an IOL exchange. The fact is that I would not measure a patient’s eye with my Lenstar if they’ve had so much as anesthetic drops placed in the eye….much less a tonometry. I also would not give patients a glasses Rx immediately after cataract surgery….or an hour or a day or a week later because we KNOW that the prescription will change. So how is it smart to throw out completely pristine Lenstar data done under ideal conditions with calculations by Barrett/Hill/Kane formulas for an aphakic autorefraction based calculation done DURING surgery after the patient has received X number of drops, perhaps applanation for Femto, has had phaco, a cornea wound /paras placed, has an eye full of viscoelastic, is lying flat on his back with a speculum in his eye, has an unknown IOP and perhaps some cornea edema. Would you finish your surgery….sit the patient up and refract them for glasses and think that this is reliable? Of course not….so why on god’s earth would you give him an IOL based on even less reliable data? For me ORA was always a flawed concept that made no sense. The machines we measure the eye with keep improving and giving us more data and the formulas keep advancing but intraoperative aberrometry will always be limited by the conditions under which it measures. It is inevitable that it will end up in the trash bin of failed experiments in our profession like RK, CK, Holmium sclerostomy, Cypass, etc.

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