Repeatability and Agreement of Four Biometers for Measuring Various Anterior Segment Parameters.

Purpose: To assess the repeatability and agreement of a new swept source optical coherence tomography (SS-OCT) biometer (IOL Master® 700, Carl Zeiss Meditec), an optical low coherence reflectometer (Lenstar LS 900®, Haag-Streit AG, Koeniz, Switzerland), a dual scheimpflug ray tracing biometer (Galilei G6®, Ziemer, Switzerland) and a partial coherence interferometer, AL scan® (Nidek Co. Ltd., Japan) to measure the keratometry (K), astigmatism (AST), axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW) in cataractous eyes in a Cross-sectional study. Methods: 50 eyes of 50 consecutive patients scheduled for cataract surgery were included. Three consecutive scans were performed using the 4 biometers by a single operator. Within-subject standard deviation (Sw), test-retest repeatability and coefficient of variation for assessing repeatability were assessed. Bland-Altman plots for the agreement between the mean measurements of each machine were examined. Results: The mean age of patients was 60.2 ± 10.6 years. Dropouts for AL measurement were significantly higher in AL scan® and Galilei G6® compared to IOL Master® 700. There was good agreement between IOL Master® 700 and Lenstar LS 900® for AL and keratometry (P < 0.5). High variability was seen between the 4 machines for AST and WTW. Conclusion: The new SS-OCT biometer showed valid measurements, good repeatability and good agreement with the optical low coherence reflectometry biometer. The new long range SS-OCT biometer was better than the other three devices in acquiring AL measurements in denser cataracts due to better penetration.

Current review and a simplified “five‑point management algorithm” for keratoconus.

Keratoconus is a slowly progressive, noninflammatory ectatic corneal disease characterized by changes in corneal collagen structure and organization. Though the etiology remains unknown, novel techniques are continuously emerging for the diagnosis and management of the disease. Demographical parameters are known to affect the rate of progression of the disease. Common methods of vision correction for keratoconus range from spectacles and rigid gas‑permeable contact lenses to other specialized lenses such as piggyback, Rose‑K or Boston scleral lenses. Corneal collagen cross‑linking is effective in stabilizing the progression of the disease. Intra‑corneal ring segments can improve vision by flattening the cornea in patients with mild to moderate keratoconus. Topography‑guided custom ablation treatment betters the quality of vision by correcting the refractive error and improving the contact lens fit. In advanced keratoconus with corneal scarring, lamellar or full thickness penetrating keratoplasty will be the treatment of choice. With such a wide spectrum of alternatives available, it is necessary to choose the best possible treatment option for each patient. Based on a brief review of the literature and our own studies we have designed a five‑point management algorithm for the treatment of keratoconus.