Preoperative measurements for cataract surgery: a comparison of ultrasound and optical biometric devices

To evaluate differences in preoperative measurements and refractive outcomes between ultrasound and optical biometry when using the Barrett Universal II intraocular lens (IOL) power formula.

In this consecutive case series, cataract extraction and IOL implantation cases from two surgical centers in Toronto, Canada, were recruited between January 2015 and July 2017. Differences between ultrasound (applanation or immersion A-scan) and optical biometry (IOLMaster 500) were compared for axial length (AL), anterior chamber depth and refractive outcomes. The primary outcome was the percentage of cases in each cohort within ± 0.50D of refractive error.

In total, 527 cataract cases underwent IOLMaster testing. Of these, 329 eyes (62.4%) were also measured by applanation A-scan, and the other 198 eyes (37.6%) received immersion A-scan testing. Applanation ultrasound led to 5.8%, 16.0% and 46.4% of eyes within ± 0.25D, ± 0.50D and ± 1.00D of refractive error, respectively, whereas the IOLMaster 500 led to 48.5%, 77.1% and 94.9%, respectively (n = 293, ± 0.50D: p < 0.001). Immersion ultrasound led to 31.2%, 57.6% and 91.2% of eyes within ± 0.25D, ± 0.50D and ± 1.00D of refractive error, respectively, whereas the IOLMaster 500 led to 42.4%, 72.0% and 92.0%, respectively (n = 125, ± 0.50D: p = 0.001). Applanation (n = 329, A-scan AL: 23.64 ± 1.67 mm, IOLMaster AL: 24.20 ± 1.70 mm, p < 0.001) and immersion ultrasound (n = 198, A-scan AL: 25.01 ± 2.06 mm, IOLMaster AL: 25.08 ± 2.13 mm, p = 0.002) yielded significantly lower AL values compared to optical biometry measurements.

Optical biometry yielded a significantly larger percentage of cases within ± 0.50D of refractive error compared to ultrasound biometry when using the Barrett Universal II IOL power formula.