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Agreement of ocular biometry and evaluation of IOL calculation using a parameter‑hybrid strategy: a comparison of
Weiwen Lin1, Siping Wu1, Yingyan Chen1
1Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China.
Purpose:
This study aimed to explore the agreement of biometric measurements and evaluate a parameter-hybrid strategy for intraocular lens (IOL) power calculations among CASIA2, IOL Master 700, and OA2000 in cataract patients.
Methods:
Preoperative measurements were obtained from all three devices. Parameters included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometry (Km, Kf, Ks), white-to-white distance (WTW), and corneal cylinder (CYL). Since the CASIA2 does not provide AL measurement, a hybrid calculation strategy was designed. IOL power was calculated using the Barrett Universal II formula in four configurations: (1) IOLMaster 700 (standalone), (2) OA2000 (standalone), (3) CASIA2-derived anterior segment parameters + IOL Master 700 AL, and (4) CASIA2-derived anterior segment parameters + OA2000 AL. Refractive prediction accuracy was evaluated at one month postoperatively. Statistical analyses included repeated-measures ANOVA, the Friedman test, intraclass correlation coefficient (ICC), and Bland-Altman plots.
Results:
The three SS-OCT devices showed excellent agreement for most parameters. However, clinically significant differences were observed in corneal curvature (Km, Kf, Ks) measurements among devices. The calculated IOL power providing emmetropia showed a statistically significant result. The standard strategy using IOL Master 700 parameters yielded the highest prediction precision (lowest mean absolute error) and the highest percentage of eyes within ± 0.50 D of the target refraction. Both hybrid strategies resulted in a systematic hyperopia bias, higher prediction errors, and a reduced proportion of eyes within ± 0.50 D. All strategies maintained safety, with over 91% of eyes within ± 1.00 D.
Conclusions:
The hybrid strategy introduces a hyperopia bias and reduces refractive prediction accuracy. Using a single, consistent device for preoperative measurements is recommended for routine cataract surgery. The hybrid approach may serve only as a contingency in complex cases.
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