A video technique for phakometry of the human crystalline lens

Accurate measurement of the dioptric power of the human crystalline lens is important in any study of ocular development and refractive error. Previous studies have used comparison ophthalmophakometry, measuring crystalline lens curvature and power from still flash photographs of Purkinje images I, III, and IV. This report presents a video-based technique for in vivo measurement of crystalline lens power suitable for use with children. The repeatability and validity of this video system were evaluated in comparison to a still photograph system through the measurement of anterior and posterior lens curvatures of 40 normal adults. The video system's repeatability (95% limits of agreement) was +/- 0.52 diopters for the anterior lens power, +/- 0.73 D for the posterior lens power, and +/- 0.88 D for the total lens power. The repeatability of the still flash photography system was +/- 0.78 D for the anterior, +/- 1.43 D for the posterior, and +/- 1.84 D for the lens power as a whole. An indirect method of calculating lens power using other ocular component measures gave a repeatability of +/- 1.78 D. The validity of the video system was improved by having the camera and the light source closer to the optic axis of the eye. The bias induced by having a more off-axis configuration (40 degrees separation between camera and light source) was a +0.10 D overestimation of surface power for the anterior and +0.73 D for the posterior lens surface power compared to a more coaxial arrangement (20 degrees between camera and light source). The use of video phakometry improved the repeatability and the validity of lens curvature measures relative to still flash photograph comparison ophthalmophakometry and to an indirect method of calculating lens power. This was achieved through the system's ability to analyze multiple frames, the use of a collimated light source, and the placement of the light source for the Purkinje images closer to the eye's optic axis.