Precision of the Nidek Tonoref II autokeratometer: how many repeated measurements are required?

PURPOSE: To determine the minimal number of repeated measurements required for precise Nidek Tonoref II autokeratometry. METHODS: This prospective, non-intervention study was performed at the Department of Ophthalmology, Randers, Denmark. We used the Nidek Tonoref II autokeratometer to perform 10 successive measurements on 100 right eyes of cooperative individuals. Each keratometry was converted to the spherical equivalent power (SE), while the net astigmatism was converted to polar values along zero (KP(0)) and 45 degrees (KP(45)). All units were in dioptres (D). The precision was calculated as the mean absolute difference between paired measurements, using one or the average of two, three, four or five autokeratometries. Statistical assessment was performed with Dunn's test for repeated measurements with a Bonferroni correction. RESULTS: The precision of SE, KP(0) and KP(45) increased statistically significantly from one to three measurements, with no significant improvement for autokeratometries based on four or five measurements. There was no significant precision difference between one and two measurements. CONCLUSION: A single keratometry is inadequate, but the vector average of three measurements is sufficient for precise autokeratometry with the Tonoref II device. The consistent use of three keratometries with this device may increase the precision of spherical and toric IOL calculation.

Analysis of Intrasession Repeatability of Ocular Aberrometric Measurements and Validation of Keratometry Provided by a New Integrated System in Mild to Moderate Keratoconus.

PURPOSE: To evaluate the intrasession repeatability and validity of corneal curvature measurements provided by a new multifunctional device and to assess the intrasession repeatability of its ocular aberrometric measures. METHODS: This prospective study comprises 37 mild to moderate keratoconus eyes of 37 patients. In all cases, 3 repeated measures of corneal topography and ocular aberrometry were performed with the iDesign 2 system (iD2; Johnson & Johnson Vision Care Inc, Jacksonville, FL) and one keratometric measurement was performed with the intraocular lens-(IOL) Master 500 (Carl Zeiss Meditec Inc, Dublin, CA) and Sirius (CSO) (SIR) systems. RESULTS: The within-subject SD (Sw) was <0.50 D for all iD2 keratometric measurements, with intraclass correlation coefficient (ICC) >0.980. Sw and ICC for the keratometric axis were 2.60 degrees and 0.992, respectively. Concerning aberrations, all Sw values for high-order Zernike terms were ≤0.11 µm (ICC > 0.900), and all Sw values for refraction data were <0.75 D (ICC > 0.95), except for J45. No statistically significant differences were found between the devices in any keratometric parameter evaluated (P ≥ 0.222), but the limits of agreement between the devices were clinically relevant. The magnitude of K readings and astigmatism correlated significantly with the difference in these parameters between iD2 and SIR (0.432 ≤ r ≤ 0.489, P ≤ 0.041). CONCLUSIONS: The iD2 system provides consistent measures of keratometry and ocular aberrometry in eyes with mild to moderate keratoconus. Keratometric data obtained with this system in these eyes cannot be considered as interchangeable with data provided by intraocular lens-Master 500 and SIR.

Validation of refraction and anterior segment parameters by a new multi-diagnostic platform (VX120) / Validación de los parámetros de refracción y segmento anterior mediante una nueva plataforma multi-diagnóstica (VX120)

Background: The VX120 (Visionix Luneau, France) is a novel multi-diagnostic platform that combines Hartmann-Shack based autorefraction, Placido-disk based corneal-topography and anterior segment measurements made with a stationary-Scheimpflug camera. We investigate the agreement between different parameters measured by the VX120 with accepted or gold-standard techniques to test if they are interchangeable, as well as to evaluate the repeatability and reproducibility. Methods: The right-eyes of healthy subjects were included in the study. Autorefraction of the X120 was compared to subjective refraction. Agreement of anterior segment parameters was compared to the Sirius (CSO, Italy) including autokeratometry, central corneal thickness (CCT), iridiocorneal angle (IA). Inter and intra-test repeatability of the above parameters was assessed. Results were analyzed using Bland and Altman analyses. Results: A total of 164 eyes were evaluated. The mean difference between VX120 autorefraction and subjective refraction for sphere, spherical equivalent (SE), and cylinder was 0.01 ± 0.43 D, 0.14 ± 0.47 D, and -0.26 ± 0.30 D, respectively and high correlation was found to all parameter (r > 0.75) except for J45 (r = 0.61). The mean difference between VX120 and the Sirius system for CCT, IA, and keratometry (k1 and k2) was -3.51 ± 8.64 μm, 7.6 ± 4.2°, 0.003 ± 0.06 mm and 0.004 ± 0.04 mm, respectively and high correlation was found to all parameter (r > 0.97) except for IA (r = 0.67). Intrasession repeatability of VX120 refraction, CCT, IA and keratometry yielded low within-subject standard deviations. Inter-session repeatability showed no statistically significant difference for most of the parameters measured. Conclusions: The VX120 provides consistent refraction and most anterior segment measurements in normal healthy eyes, with high levels of intra and inter-session repeatability

Antecedentes: VX120 (Visionix Luneau, Francia) es una plataforma multi-diagnóstico novedosa que combina la auto-refracción basada en Hartmann-Shack, la topografía corneal mediante discos de Plácido, y las mediciones del segmento anterior realizadas mediante cámara de Scheimpflug. Analizamos la concordancia entre los diferentes parámetros medidos por VX120 con las técnicas aceptadas o de referencia, para probar si eran intercambiables, y evaluamos la repetibilidad y reproducibilidad. Métodos: Se incluyeron en el estudio los ojos derechos de sujetos sanos. Se comparó la auto-refracción de VX120 con la refracción subjetiva. La concordancia de los parámetros del segmento anterior se comparó con la del sistema Sirius (CSO, Italia), incluyendo autoqueratometría, espesor corneal central (ECC) y ángulo iridiocorneal (AI). Se valoró la repetibilidad inter e intra-prueba de los parámetros anteriores. Los resultados se analizaron mediante el método de Bland-Altman. Resultados: Se evaluó un total de 164 ojos. La diferencia media entre la auto-refracción de VX120 y la refracción subjetiva para esfera, equivalente esférico (EE), y cilindro fue de 0,01 ± 0,43 D, 0,14± 0,47 D y -0,26 ± 0,3 D, respectivamente, encontrándose una elevada correlación entre todos los parámetros (r > 0,75) excepto para J45 (r = 0,61). La diferencia media entre VX120 y el sistema Sirius para ECC, AI, y queratometría (k1 y k2) fue de -3,51 ± 8,64 μm, 7,6 ± 4,2°, 0,003 ± 0,06 mm y 0,004 ± 0,04 mm, respectivamente, encontrándose una elevada correlación entre todos los parámetros (r > 0,97) excepto para AI (r = 0,67). La repetibilidad intra-sesión de la refracción VX120, ECC, AI y queratometría reflejó desviaciones estándar bajas entre sujetos. La repetibilidad inter-sesión no reflejó una diferencia significativa para la mayoría de los parámetros medidos. Conclusiones: VX120 aporta medidas consistentes de refracción y de la mayoría de las mediciones del segmento anterior en ojos sanos normales, con elevados niveles de repetibilidad intra e inter-sesión

Validation of refraction and anterior segment parameters by a new multi-diagnostic platform (VX120).

BACKGROUND: The VX120 (Visionix Luneau, France) is a novel multi-diagnostic platform that combines Hartmann-Shack based autorefraction, Placido-disk based corneal-topography and anterior segment measurements made with a stationary-Scheimpflug camera. We investigate the agreement between different parameters measured by the VX120 with accepted or gold-standard techniques to test if they are interchangeable, as well as to evaluate the repeatability and reproducibility. METHODS: The right-eyes of healthy subjects were included in the study. Autorefraction of the VX120 was compared to subjective refraction. Agreement of anterior segment parameters was compared to the Sirius (CSO, Italy) including autokeratometry, central corneal thickness (CCT), iridiocorneal angle (IA). Inter and intra-test repeatability of the above parameters was assessed. Results were analyzed using Bland and Altman analyses. RESULTS: A total of 164 eyes were evaluated. The mean difference between VX120 autorefraction and subjective refraction for sphere, spherical equivalent (SE), and cylinder was 0.01±0.43D, 0.14±0.47D, and -0.26±0.30D, respectively and high correlation was found to all parameter (r>0.75) except for J45 (r=0.61). The mean difference between VX120 and the Sirius system for CCT, IA, and keratometry (k1 and k2) was -3.51±8.64µm, 7.6±4.2°, 0.003±0.06mm and 0.004±0.04mm, respectively and high correlation was found to all parameter (r>0.97) except for IA (r=0.67). Intrasession repeatability of VX120 refraction, CCT, IA and keratometry yielded low within-subject standard deviations. Inter-session repeatability showed no statistically significant difference for most of the parameters measured. CONCLUSIONS: The VX120 provides consistent refraction and most anterior segment measurements in normal healthy eyes, with high levels of intra and inter-session repeatability.

Evaluation of the Robustness of Current Quantitative Criteria for Keratoconus Progression and Corneal Cross-linking.

PURPOSE: To evaluate the robustness of numerical indications of corneal cross-linking by evaluating the inter-session reliability of recently used parameters of progression in keratoconus. METHODS: In this observational study, 100 eyes of 100 patients with keratoconus underwent analysis with the Sirius Scheimpflug Topography System (CSO, Firenze, Italy) by a single user. Two sessions (three scans per session) were performed 2 to 4 weeks apart. Cases having poor quality scans, recent visual deterioration, and ocular surgery were excluded. The corneal variables measured were thinnest point and apex characteristics (pachymetry, polar coordinates), volume, central simulated keratometry (flat, steep, average, astigmatism), central corneal thickness, maximum elevation (anterior, posterior), symmetry indices (front, back), and Baiocchi-Calossi-Versaci index. Intra-session (first session, all three measurements) and inter-session (one measurement from each session, selected randomly) statistics were computed. RESULTS: There were no significant differences in the six measurements for all variables (P > .05, analysis of variance). The intra-session and inter-session intraclass correlations were high (0.937 to 0.997) and within-subject standard deviations (Sw) were satisfactory (< 5 µm for thickness, < 0.50 diopters [D] for curvature, and < 0.11 mm, < 5° for polar coordinates). Inter-session repeatability (2.77 × Sw) was found to be satisfactory when compared to previously used central keratometric (> 1.00 D increase) or pachymetric (> 2%/> 5% decrease) guidelines to define progression. Apex power repeatability (1.24 D) was found to be poorer than previously used recommendations (1.00 D change). CONCLUSIONS: The criteria used to define keratoconus progression were satisfactory when compared to inter-session reliability of corneal parameters. Because higher variability was noted at apex, its curvature repeatability cut-off may be raised to 1.25 D for identifying progressive keratoconus. [J Refract Surg. 2016;32(7):465-472.].

Principles of operation, accuracy and precision of an Eye Surface Profiler.

PURPOSE: To introduce a newly developed instrument for measuring the topography of the anterior eye, provide principles of its operation and to assess its accuracy and precision. METHODS: The Eye Surface Profiler is a new technology based on Fourier transform profilometry for measuring the anterior eye surface encompassing the corneo-scleral area. Details of technical principles of operation are provided for the particular case of sequential double fringe projection. Technical limits of accuracy have been assessed for several key parameters such as the carrier frequency, image quantisation level, sensor size, carrier frequency inaccuracy, and level and type of noise. Further, results from both artificial test surfaces as well as real eyes are used to assess precision and accuracy of the device (here benchmarked against one of popular Placido disk videokeratoscopes). RESULTS: Technically, the Eye Surface Profiler accuracy can reach levels below 1 µm for a range of considered key parameters. For the unit tested and using calibrated artificial surfaces, the accuracy of measurement (in terms of RMS error) was below 10 µm for a central measurement area of 8 mm diameter and below 40 µm for an extended measurement area of 16 mm. In some cases, the error reached levels of up to 200 µm at the very periphery of the measured surface (up to 20 mm). The SimK estimates of the test surfaces from the Eye Surface Profiler were in close agreement with those from a Placido disk videokeratoscope with differences no greater than ±0.1 D. For real eyes, the benchmarked accuracy was within ±0.5D for both the spherical and cylindrical SimK components. CONCLUSIONS: The Eye Surface Profiler can successfully measure the topography of the entire anterior eye including the cornea, limbus and sclera. It has a great potential to become an optometry clinical tool that could substitute the currently used videokeratoscopes and provide a high quality corneo-scleral topography.

OPD-Scan III: a repeatability and inter-device agreement study of a multifunctional device in emmetropia, ametropia, and keratoconus.

The purpose of this study was to test the measurements of a multifunctional device, the NIDEK OPD-Scan III in terms of repeatability and agreement with retinoscopy and Pentacam in cases with emmetropia, ametropia, and KCN (grade 1-3). We enrolled 170 eyes (40 in each group of emmetropia and ametropia, and 90 in the 3 KCN subgroups). Acquisitions were done twice by a single technician to check the intra class correlation, repeatability index, and precision. To assess agreement, we compared OPD-Scan III with retinoscopy and Pentacam results by two blinded technicians. All device functions had acceptable precision in groups with emmetropia, ametropia, and KCN1, except spherical error in ammetropics (0.97 D). In KCN2, repeatability was acceptable with the refractive function, topography, and ocular aberrations but was more than 1.0 D for corneal aberrations. In KCN3, repeatability was low for the refractive function and corneal spherical aberration. Refractive data were not convertible to those obtained by retinoscopy in any group. OPD-Scan III keratometry data were interchangeable with Pentacam counterparts in emmetropes, ammetropes, and KCN1. In KCN2, the OPD-Scan III-Pentacam agreement for Kmax was 0.71 D, and there was 1.25 D difference in Kmin. No OPD-Scan III-Pentacam agreement was observed in KCN3. OPD- Scan III is a multifunctional device with acceptable repeatability in emmetropic, ammetropic, and KCN cases. Its measurements of corneal curvature and ocular aberrations are better than other functions. In cases with high degrees of refractive error and corneal irregularities, device repeatability and agreement with Pentacam is decreased.

Keratoconus: The ABCD Grading System.

PURPOSE: To propose a new keratoconus classification/staging system that utilises current tomographic data and better reflects the anatomical and functional changes seen in keratoconus. METHOD: A previously published normative database was reanalysed to generate both anterior and posterior average radii of curvature (ARC and PRC) taken from a 3.0 mm optical zone centred on the thinnest point of the cornea. Mean and standard deviations were recorded and anterior data were compared to the existing Amsler-Krumeich (AK) Classification. ARC, PRC, thinnest pachymetry and distance visual acuity were then used to construct a keratoconus classification. RESULTS: 672 eyes of 336 patients were analysed. Anterior and posterior values were 7.65 ± 0.236 mm and 6.26 ± 0.214 mm, respectively, and thinnest pachymetry values were 534.2 ± 30.36 µm. The ARC values were 2.63, 5.47 and 6.44 standard deviations from the mean values of stages 1-3 in the AK classification, respectively. PRC staging uses the same standard deviation gates. The pachymetric values differed by 4.42 and 7.72 standard deviations for stages 2 and 3, respectively. CONCLUSION: A new keratoconus staging incorporates anterior and posterior curvature, thinnest pachymetric values, and distance visual acuity and consists of stages 0-4 (5 stages). The proposed system closely matches the existing AK classification stages 1-4 on anterior curvature. As it incorporates posterior curvature and thickness measurements based on the thinnest point, rather than apical measurements, the new staging system better reflects the anatomical changes seen in keratoconus.

A novel Hartman Shack-based topography system: repeatability and agreement for corneal power with Scheimpflug+Placido topographer and rotating prism auto-keratorefractor.

The purpose of this study is to analyze the repeatability and agreement of corneal power using a new Hartman type topographer in comparison to Scheimpflug+Placido and autorefractor devices. In this cross sectional, observational study performed at the cornea services of a specialty hospital, 100 normal eyes (100 consecutive candidates) without any previous ocular surgery or morbidity except refractive error were evaluated. All candidates underwent three measurements each on a Full gradient, Hartman type topographer (FG) (iDesign, AMO), Scheimpflug+Placido topographer (SP) (Sirius, CSO) and rotating prism auto-keratorefractor (AR) (KR1, Nidek). The parameters assessed were flat keratometry (K1), steep keratometry (K2), steep axis (K2 axis), mean K, J 0 and J 45. Intra-device repeatability and inter-device agreement were evaluated. On repeatability analysis, the intra-device means were not significantly different (ANOVA, p > 0.05). Intraclass correlations (ICC) were >0.98 except for J 0 and J 45. In terms of intra-measurement standard deviation (Sw), the SP and FG groups fared better than AR group (p < 0.001, ANOVA). On Sw versus Average plots, no significantly predictive fit was seen (p > 0.05, R (2) < 0.1 for all the values). On inter-device agreement analysis, there was no difference in means (ANOVA, p > 0.05). ICC ranged from 0.92 to 0.99 (p < 0.001). Regression fits on Bland-Altman plots suggested no clinically significant effect of average values over difference in means. The repeatability of Hartman type topographer in normal eyes is comparable to SP combination device and better than AR. The agreement between the three devices is good. However, we recommend against interchanging these devices between follow-ups or pooling their data.

Repeatability of placido-based corneal topography in keratoconus.

PURPOSE: To determine and compare the repeatability of a Placido-based corneal topography (Oculus Keratograph) in a sample of healthy and keratoconus eyes. METHODS: The corneal topography, determined using the Oculus Keratograph, of 25 healthy and 25 keratoconus eyes was assessed three consecutive times. A single randomized eye was included per patient. Coefficient of variation (CV) of the eccentricity, corneal diameter, index of surface variance, index of vertical asymmetry, keratoconus index (KI), smallest sagittal curvature radius (Rmin), aberration coefficient, and maximum corneal power and minimum corneal power (diopters) in the 3.0-mm zone in addition to the maximum corneal power point (MCPP) (diopters) were calculated and compared between healthy and keratoconus eyes. RESULTS: Healthy eyes showed lower topographic values (p < 0.05) than keratoconus eyes, except with regard to the Rmin value. Corneal diameter (p = 0.45) was similar in both groups. All variables showed good CVs in healthy and keratoconus eyes (maximum corneal power [0.21 and 0.47%, respectively], minimum corneal power [0.19 and 0.36%], MCPP [0.22 and 0.77%], corneal diameter [0.27 and 0.33%], index of surface variance [4.82 and 3.10%], index of vertical asymmetry [7.05 and 3.80%], KI [0.29 and 0.72%], Rmin [0.53 and 0.78%], and aberration coefficient [0 and 4.00%]) except for the eccentricity CV (5.79 and 14.53%, respectively). Statistically significant differences (p < 0.05) between healthy and keratoconus groups were found for all variables, except with respect to the MCPP, eccentricity, corneal diameter, KI, and Rmin (p > 0.07). CONCLUSIONS: The Oculus Keratograph provides repeatable measurements of corneal topography in healthy and keratoconus eyes. These results could improve the topographical diagnosis of keratoconus, thus aiding in patient management.

Comparison of three-dimensional optical coherence tomography and combining a rotating Scheimpflug camera with a Placido topography system for forme fruste keratoconus diagnosis.

OBJECTIVE: To evaluate the ability of parameters measured by three-dimensional (3D) corneal and anterior segment optical coherence tomography (CAS-OCT) and a rotating Scheimpflug camera combined with a Placido topography system (Scheimpflug camera with topography) to discriminate between normal eyes and forme fruste keratoconus. METHODS: Forty-eight eyes of 48 patients with keratoconus, 25 eyes of 25 patients with forme fruste keratoconus and 128 eyes of 128 normal subjects were evaluated. Anterior and posterior keratometric parameters (steep K, flat K, average K), elevation, topographic parameters, regular and irregular astigmatism (spherical, asymmetry, regular and higher-order astigmatism) and five pachymetric parameters (minimum, minimum-median, inferior-superior, inferotemporal-superonasal, vertical thinnest location of the cornea) were measured using 3D CAS-OCT and a Scheimpflug camera with topography. The area under the receiver operating curve (AUROC) was calculated to assess the discrimination ability. Compatibility and repeatability of both devices were evaluated. RESULTS: Posterior surface elevation showed higher AUROC values in discrimination analysis of forme fruste keratoconus using both devices. Both instruments showed significant linear correlations (p<0.05, Pearson's correlation coefficient) and good repeatability (ICCs: 0.885-0.999) for normal and forme fruste keratoconus. CONCLUSIONS: Posterior elevation was the best discrimination parameter for forme fruste keratoconus. Both instruments presented good correlation and repeatability for this condition.

Predictive value of corneal topography for ClearKone hybrid contact lenses.

PURPOSE: The purpose of this study was to evaluate the predictive value of corneal topography data for fitting ClearKone hybrid contact lenses on eyes with corneal ectasia. METHODS: Ophthalmic records from eyes with established corneal ectasia that had been successfully fitted with SynergEyes ClearKone lenses (n = 73) were retrospectively reviewed. Correlations between corneal parameters (simulated steep and flat keratometry values, average corneal sagittal height, inferior-superior index for keratoconus, corneal eccentricity, cone displacement, and cone diameter) and ClearKone lens parameters (vault and skirt curvature) were analyzed. RESULTS: Two topographical correlates to ClearKone lens parameters were identified. Mean weighted corneal sagittal height at a 7.4-mm chord was strongly predictive of the optimal ClearKone lens vault; a linear relationship was observed between these parameters (R = 0.96). More significant vertical decentration of the corneal apex was found to be associated with the need for a steeper lens skirt curvature (p < 0.05). CONCLUSIONS: This study demonstrates that baseline corneal topography-derived data are valuable for predicting lens parameters for an optimally fit SynergEyes ClearKone hybrid contact lens.

One-step transepithelial topography-guided ablation in the treatment of myopic astigmatism.

PURPOSE: To evaluate one-step topography-guided transepithelial ablation in the treatment of low to moderate myopic astigmatism using a 1KHz excimer laser. METHODS: Retrospective study of 117 consecutive eyes available for evaluation 12 months after surgery. Pre- and post-operative visual and refractive data as well as post-operative pain and haze were analyzed. A novel technique integrating custom refractive- and epithelial- ablation in a single uninterrupted procedure was used. RESULTS: The mean pre-operative spherical equivalent (SE) and the mean cylinder were: -3.22 diopters (D) ±1.54 (SD) (range -0.63 to -7.25 D) and -0.77 D ±0.65 (range 0 to -4.50 D), respectively. At 12 months after surgery: no eyes lost ≥2 lines of corrected distant visual acuity (CDVA). Safety and efficacy indexes were 1.27 and 1.09, respectively. Uncorrected distant visual acuity (UDVA) was ≥20/20 in 96.6% of the eyes. Manifest refraction spherical equivalent was within ±0.5 D of the desired refraction in 93.2% of the eyes. Average root mean square (RMS) wavefront error measured at central 6 mm, increased from 0.38 pre-operatively to 0.47 µm post-operatively. Refractive stability was achieved and sustained 1 month after surgery. No visually significant haze was registered during the observation period. Post-operative pain was reported in 4.5% of patients. CONCLUSIONS: One-step transepithelial topography-guided treatment for low to moderate myopia and astigmatism performed with a 1 KHz laser, provided safe, effective, predictable and stable results with low pain and no visually significant haze.

Factors affecting corneoscleral topography.

PURPOSE: To evaluate factors affecting corneoscleral profile (CSP) using anterior segment optical coherence tomography (AS-OCT) in combination with conventional videokeratoscopy. METHODS: OCT DATA WERE COLLECTED FROM 204 SUBJECTS OF MEAN AGE 34.9 YEARS (SD: ±15.2 years, range 18-65) using the Zeiss Visante AS-OCT and Medmont M300 corneal topographer. Measurements of corneal diameter (CD), corneal sagittal height (CS), iris diameter (ID), corneoscleral junction angle (CSJ), and scleral radius (SR) were extracted from multiple OCT images. Horizontal visible iris diameter (HVID) and vertical palpebral aperture (PA) were measured using a slit lamp graticule. Subject body height was also measured. Associations were then sought between CSP variables and age, height, ethnicity, sex, and refractive error. RESULTS: Significant correlations were found between age and ocular topography variables of HVID, PA, CSJ, SR, and ID (P < 0.0001), while height correlated with HVID, CD, and ID, and power vector terms with vertical plane keratometry, CD, and CS. Significant differences were noted between ethnicities with respect to CD (P = 0.0046), horizontal and vertical CS (P = 0.0068 and P = 0.0095), and horizontal ID (P = 0.0010). The same variables, with the exception of vertical CS, also varied with sex; horizontal CD (P = 0.0018), horizontal CS (P = 0.0018), and ID (P = 0.0012). Age accounted for the greatest variance in topography variables (36%). CONCLUSIONS: Age is the main factor influencing CSP; this should be taken into consideration in contact lens design, IOL selection, and in the optimization of surgical procedures. Ocular topography also varied with height, sex, ethnicity, and refractive error.

Distribution of radii of curvature of anterior and posterior best fit sphere in a normal population: the Tehran Eye Study.

PURPOSE: To determine the distribution and determinants of the radii of curvature of the anterior and posterior best fit spheres (ABFS and PBFS) of the cornea in a sample from the general normal population of Tehran. METHODS: A stratified random cluster sampling was used to select samples from the first 4 districts of Tehran proportionate to the population of each stratum. We examined the distribution of the ABFS and PBFS, as measured with the Orbscan II in different groups of age, sex, and refractive error, and determined their relationship with other variables by using both univariate and multiple regression analyses. Valid data was collected from 800 eyes, and analyses were done with data from 399 right eyes only. RESULTS: Mean ABFS and PBFS in the studied sample were 43.31±1.79D and 52.67±3.04D, respectively. ABFS increased with age while PBFS showed no significant association; both showed significant inter-sex differences. In the multiple linear regression model, both ABFS and PBFS significantly correlated directly with age and average keratometry, and inversely with corneal diameter; PBFS correlated directly with anterior chamber depth as well. Mean PBFS/ABFS ratio was 1.22±0.05 which significantly decreased with age and was significantly higher in females. CONCLUSION: Knowledge of normal ranges of ABFS and PBFS and their determinants, including age, mean keratometry, and corneal diameter, as well as the choice of measurement device, is necessary for comparing information from different populations and interpreting results.

Anterior segment characteristics of keratoconus eyes in a sample of Asian population.

PURPOSE: To assess changes in anterior segment parameters of keratoconus eyes at different stages of the disease in a sample of the Asian population. METHODS: Files of 32 patients (48 eyes) diagnosed as clinical keratoconus were assessed and the following parameters noted: central corneal thickness (CCT), thinnest corneal thickness (TCT), location of thinnest pachymetry, anterior chamber depth (ACD) at the centre from posterior corneal surface, ACD at 1, 2 and 3mm inferior-paracentral, ACD at thinnest pachymetry, anterior chamber volume (ACV) and anterior chamber angle (ACA). For analysis, keratoconus eyes were classified into 3 subgroups according to mean keratometry readings (mild: K≤47.0D, moderate: 47.0

A comprehensive assessment of the precision and agreement of anterior corneal power measurements obtained using 8 different devices.

PURPOSE: To comprehensively assess the precision and agreement of anterior corneal power measurements using 8 different devices. METHODS: Thirty-five eyes from 35 healthy subjects were included in the prospective study. In the first session, a single examiner performed on each subject randomly measurements with the RC-5000 (Tomey Corp., Japan), KR-8000 (Topcon, Japan), IOLMaster (Carl Zeiss Meditec, Germany), E300 (Medmont International, Australia), Allegro Topolyzer (Wavelight AG, Germany), Vista (EyeSys, TX), Pentacam (Oculus, Germany) and Sirius (CSO, Italy). Measurements were repeated in the second session (1 to 2 weeks later). Repeatability and reproducibility of corneal power measurements were assessed based on the intrasession and intersession within-subject standard deviation (Sw), repeatability (2.77Sw), coefficient of variation (COV), and intraclass correlation coefficient (ICC). Agreement was evaluated by 95% limits of agreement (LoA). RESULTS: All devices demonstrated high repeatability and reproducibility of the keratometric values (2.77Sw<0.36D, COV<0.3%, ICC>0.98). Repeated-measures analysis of variance with Bonferroni post test showed statistically significant differences (P<0.01) among mean keratometric values of most instruments; the largest differences were observed between the EyeSys Vista and Medmont E300. Good agreement (i.e., 95%LoA within ± 0.5D) was found between most instruments for flat, steep and mean keratometry, except for EyeSys and Medmont. Repeatability and reproducibility of vectors J(0) and J(45) was good, as the ICCs were higher than 0.9, except J(45) of Medmont and Pentacam. For the 95% LoAs of J(0) and J(45), they were all ≤ ± 0.31 among any two paired devices. CONCLUSIONS: The 8 devices showed excellent repeatability and reproducibility. The results obtained using the RC-5000, KR-8000, IOLMaster, Allegro Topolyzer, Pentacam and Sirius were comparable, suggesting that they could be used interchangeably in most clinical settings. Caution is warranted with the measurements of the EyeSys Vista and Medmont E300, which should not be used interchangeably with other devices due to lower agreement. TRIAL REGISTRATION: ClinicalTrials.gov NCT01587287.

Future directions in non-invasive measurements of tear film surface kinetics.

PURPOSE: To review the methods for dynamic, non-invasive, and objective assessment of tear film surface quality and to outline their current state-of-the-art and their future potential. METHODS: Among the methods available, high-speed videokeratoscopy, lateral shearing interferometry, and dynamic wavefront sensing are being considered. RESULTS: The principles of operations, their advantages and disadvantages, and limitations of each method are being outlined. The possible future directions of each method are also discussed. CONCLUSIONS: To gain a better understanding of tear film, its structure and function, it is essential to combine macroimaging technologies with those focusing on tear film microstructure. In this way, one can envisage a clinical device that could help, in future, early diagnosis of dry eye syndrome and development of better materials for contact lenses and eye lubricants.

Accuracy and repeatability of a new tono-pachymeter for measuring central corneal thickness.

OBJECTIVES: The recently developed noncontact tonopachymeter Tonopachy NT-530 P provides intraocular pressure values corrected for central corneal thickness (CCT). The purpose of this study was to assess the accuracy and repeatability of its CCT measurements. METHODS: The CCT measurements were obtained in 64 right eyes of 64 young healthy subjects using the Orbscan corneal topography system followed by the Tonopachy and then by ultrasound pachymetry (UP). Another sample of 31 subjects was used to test the repeatability of the tonopachy measurements in 2 separate sessions 1 week apart. To compare the tonometers and determine intersession repeatability for the tonopachymeter, differences in the readings provided by pairs of the instruments or obtained in the two sessions were plotted against mean differences. The hypothesis of zero bias was examined by a paired t-test. The coefficient of repeatability was calculated as the 95% limits of agreement (LoAs) of differences between the 2 sessions. RESULTS: Measurements made using the three instruments were significantly correlated (P<0.001). Mean CCTs (±SD) measured using the Tonopachy, Orbscan (acoustic factor set at 0.92) and ultrasound pachymeter were 530.42 ± 34.96, 526.73 ± 39.53, and 550.69 ± 37.26 µm, respectively. The differences between modalities (±95% LoAs) were -3.68 ± 24.36 for Orbscan versus Tonopachy, 20.66 ± 14.69 for UP versus Tonopachy, and 23.95 ± 24.21 for UP versus Orbscan. The coefficient of repeatability for the tonopachymeter was ±15.11 µm. CONCLUSIONS: The Tonopachy offers similar CCT measurements to those provided by conventional pachymeters with good repeatability.

Precision analysis of posterior corneal topography measured by Visante Omni: repeatability, reproducibility, and agreement with Orbscan II.

PURPOSE: To evaluate the repeatability and reproducibility of posterior corneal curvature and posterior corneal elevation best-fit sphere (BFS) obtained with the Visante Omni (Carl Zeiss Meditec) and to compare the results with the Orbscan II (Bausch & Lomb). METHODS: Thirty eyes from 30 healthy volunteers were included in this study. All patients were examined 5 times with the Visante Omni and Orbscan II by 2 independent operators. The posterior corneal curvature (3- and 6-mm zone) and posterior corneal elevation BFS (5- and 8-mm zone) were generated for each system. Intraoperator repeatability and interoperator reproducibility and agreement between the systems were evaluated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS: The repeatability of posterior corneal curvature and posterior corneal elevation BFS measured by the Visante Omni was high for all analysis zones (ICC, 0.99 to 1.00). The reproducibility also showed similar results (ICC, 0.99 to 1.00). Agreement between the Visante Omni and Orbscan II was high for posterior corneal curvature (ICC, 0.94 to 0.97) and posterior corneal elevation BFS (ICC, 0.96 to 0.98) with 95% limits of agreement at -0.26 to 0.22 diopters for posterior corneal curvature and 0.11 to 0.69 mm for posterior corneal elevation BFS. CONCLUSIONS: The Visante Omni provides good repeatability and reproducibility of posterior corneal topography. Overall agreement with the Orbscan II system was high.