BIOMETRY
MODERATOR-DR SUBRAMANYA K
PRESENTOR-DR LIKITHA N
BIOMETRY
• Biometry is a method of applying mathematics in biology
CONTACT
ULTRASOUND
IMMERSION
TYPES OF BIOMETRY
PCI
OPTICAL
IOL MASTER 500
OLCR
LENSTAR 900
SS-OCT
IOL MASTER 700
ULTRASOUND BIOMETRY PRINCIPLE
• A piezoelectric crystal embedded in the probe oscillates to generate a
high frequqncy sound wave penetrating the eye
• The probe captures the sound waves refelected by the ocular tissues
to calculate the eyes axial length from the sound velocity and time
needed to capture the returned sound waves
• This gives a one dimensional amplitude representation of echoes
along the path
• A scan machines have a frequency of 10MHz
• Accuracy of +0.1mm
MEDIUM VELOCITY
CORNEA 1641
AQUEOUS/VITREOUS 1532
CRYSTALLINE LENS 1641
SOLID TISSUE 1550
IOL IMPLANTS
SILICONE OIL 980-1040
IMPLANT COMPOSITION SOUND VELOCITY CORRECTION FACTOR(MM)
PMMA 2720 +0.4
SILICONE 980 -0.8
1040 -0.6
ACRYLIC 1900 +0.3
MODES
• PHAKIC
• PSEUDOPHAKIC
• APHAKIC
SILICONE OIL
• CHECK TYPE OF OIL
• 5000cs-1040m/s
• 1000cs-980m/s
Ideal A scan
Ideal a scan
• 5 high amplitude spikes
• Steeply rising retinal spike
• Good resolution of separate retinal and scleral spike
• Parameters measured
• AL
• ACD
• Lens thickness
Gain settings
• Density of cataract determines the need to change the gain setting
due to absorption of sound
• The denser cataract , higher the necessary of gain
GAIN
• Density of the cataract determines the need to change the gain
setting due to absorption of sound
• The denser cataract ,the higher the necessary gain
• Patients who are aphakic ,require less gain to prevent merging of
retinal and scleral spikes
When gain is too high ,the retina and sclera appear The examiner should reduce gain until retinal
as the thickened spike with wide,flattened peak and scleral surfaces are seen as separate spikes
• When the sound beam incidence is parallel and coaxial to the visual
axis ,most returning echoes are received back into the probe tip to be
interpreted on the display as high amplitude spikes
• When the sound beam incidence is oblique to the visual axis ,most
returning echoes is refelected away from the probe tip ,with only
portion received by the probe .as a result spikes will be compromised
• When the macular surface is smooth,more
of the echoes are received back into the
probe to be displayed as high amplitude
echoes
• If macular surface is convex (macular
edema and ped) some echoes are
reflected away from the tip
• If the macular surface is irregular
(cnvm,erm)reflection of echoes away from
the probe tip will occur
Patient position
• Sitting/lying down
• In case of lying dowm position
• Head flat
• Iris plane parallel to the floor
• Probe perpendicular to iris plane
Fixation
• Overhead fixation target
• Patients head
• Fixation light of A scan probe
Corneal compression is demonstrated in the A-scan on the right. Note the more shallow anterior
chamber depth of 2.63 mm as compared to the scan of the same eye on the left, with an anterior
chamber depth of 3.20 mm, indicating 0.57 mm of corneal compression. Note also that the total eye
length is shortened from 24.60 mm in the scan on the left to 24.18 mm in the scan on the right. This
error would result in an unwanted postoperative refractive error of about -1.25 D
MISALINGNMENT ERROR
• A SCAN shows a contact a scan with sloping retinal spike
• A scan shows immersion a scan with steps in the initial retinal spike
• Misalignment demonstrated by decreased amplitude of posterior lens
spike . When either of the lens spike is too short ,the sound beam is
aligned at an angle through the lens rather than its center, and thus is
not aligned along the visual axis
Reverberation artifacts in vitreous cavity resulting
from intraocular lens
• PMMA • ACRYLIC
Misalingment along the optic nerve
missing scleral spike
Axial length in silicone oil filled eye
• Average axial length is 23.5mm
• Range 22.0-24.5mm
• Longer eyes are more forgiving
• 1mm error in 30mm length causes post op refractive error by 1.75D
• Small eyes least forgiving
• Error of 1mm in 20mm post op refractive error of 3.75 D
• DIFFERENCE BETWEEN AL between two eyes should be NO greater than
0.3mm
Immersion A scan
• Probe doesn’t touch cornea –thereby removing indentation error
• PROCEDURE
• Supine
• Topical anaesthetic
• Scleral shell-Hansen /prager
• Saline
• Probe is immersed
• Probe 5-10mm away from cornea
• Fixate with other eye
• Align probe with optical axis
• Note echo spikes
Ideal immersion scan
• The probe and cornea are separate spikes because they are not in
contact with each other, and the corneal spike demonstrate 2 peaks,
representing epithelium and endothelium
• When these peaks are not equally high ,the sound beam is not
directed through the corneal vertex and therefore is not aligned along
the visual axis
Gain must be redued enough to appreciate and resolve these 2 peaks
Ideal immersion scan
Limitations
• Time consuming
• Messy
• Supine position
• Cleaning of probe and shell- soaked in alcohol /hydrogen peroxide
Pearls for accuracy in US A scan
• Callibarate the instrument
• Immersion or contact method with patient in supine
• Iris should be prallel to the floor
• Probe should be perpendicular to iris plane
• Patient fixation is important
• Hold the probe by wire while doing the contact
• Check waveforms of all the scans
• Check ACD to avaoid inadvertent corneal compression
• Do not average the readings
• Take the readings byb choosing best waveforms
Drawbacks
• Measures anatomical axial length .might not coincide with optical
axail length
Keratometry
• Measurement of curvature of anterior surface of cornea across a fixed
chord length usually 2-3mm which lies within the optical spherical
zone
• 1D error in keratometry can give rise to 0.9 D error in IOL power
prediction
Types
OPTICAL BIOMETRY
OPTICAL LOW
PARTIAL COHERENCE COHERENCE SWEPT SOURCE OCT
INTERFEROMETRY REFLECTOMETRY
IOL MASTER 500 LENSTAR 900 IOL MASTER 700
AL SCAN(NIDEK) ALADDIN ARGOS
PENTACAM OA2000
AXL(OCULUS)
Factors affecting ELP
RULE OF THUMB FOR SULCUS
PLACEMENT OF IOL
• More than 28.5D- decrease by 1.5D
• 17-28.0D – decrease by 1.0 D
• 9- 17 D – decrease by 0.5 D
• LESS than 9 D- NO Change
Biometry in aphakic eye
• Required for secondary IOL implantation
• In an aphakic eye sound travels at a speed of 1532m/s
• The 2 lens spikes are absent, these may be replaced by anterior
vitreous face and posterior lens capsule
• Immersion technique is choice for aphakic eye
Biometry in pseudophakic eyes
• Required in patients requiring an iol exchange
• Such eyes have extremely high spike from iol followed by artificial
chain of echoes
• In such eye sound of speed depends in the sound of transmission
characterstics and the center thickness of iol in particular eye
Short axial length
AL <22 mm
NO
ACD MEASURED HOFFER Q
AL>20mm NO KANE FORMULA,EVO
2.0>HAIGIS>HOLLADAY>HOFFE
RQ
CONVENTIONAL
FORMULAE –
Long axial length
Barrette UII
AL<30mm
Long eyes Haigis/SRKT
AL>26mm
Haigis with
AL>30mm optimized
constant
Haigis
/holladay
1WKM
Haigis
Conversion factor
Emmetrophization after birth
• Axial length triphasic growth from birth to adulthood increasing from
mean value of 16.8mm to 23.6mm
• The maximun growth ocuurs in the first 2 years following which the
rate decreases to about 0.4 mm/year till 5-6 years of age
• It then increases by about 1mm until childhood
• Keratometry values decrease from about 51.2d at birth to 43.5D in
adulthood, with maximum change seen in the first 6 months of life
• The mean crystalline lens power decreases from 34.4 D at birth to
18.8D IN adulthood ,with major reduction occurring in the first year
of life
Rule of 7
• Upto age of 7
• Target refraction = 7- age in years
Thank you
