BIOMETRY
ANISA +
AMANDA
B IO M E T RY
Introduction
Principles and Parameters
Corneal power
TABLE OF Axial Length
Techniques
CONTENT Optical Challenges
Immersion
Contact
Challenges
B-scan
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BIOMETRY
Biometry is the application of
INTRO-DUCTION mathematics to biology. In the
context of ophthalmology, it plays
O R I G I N A L LY U S E D B Y ‘ W H E W E L L ’ I N T H E
1 8 0 0 S F O R C A L C U L A T I N G L I F E E X P E C T A N C Y. a crucial role in determining the
THE REFRACTIVE POWER OF THE EYE
DEPENDS ON: appropriate power of intraocular
* CORNEA lenses (IOLs) for cataract surgery.
* LENS
* OCULAR MEDIA
* AXIAL LENGTH OF THE EYE.
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PRINCIPLES AND PARAMETERS
Parameters in Biometry:
[Link] Length (AL): Measurement from the cornea to the retina
[Link] Power (K): Refractive power of the cornea.
3. A-constant: A factor used in IOL power calculations.
4. Eff ective Lens Position (ELP): Position of the IOL within the eye.
[Link] Length Measurement (AL): A-scan biometry primarily focuses on determining
the axial length of the eye. This measurement is crucial for intraocular lens (IOL) power
calculation during cataract surgery. Accurate AL measurement ensures optimal visual
outcomes for patients.
[Link] Power (Keratometry): Along with AL, precise corneal power calculation is
essential. The curvature of the cornea affects the overall refractive power of the
eye. Combining AL and corneal power helps determine the appropriate IOL strength.
[Link] ective Lens Position (ELP): The position of the IOL within the eye (ELP)
significantly impacts visual results. A-scan biometry aids in estimating the ELP, which
guides IOL selection and placement. Eg. Sulcus IOL
[Link] Selection: Various formulas are available for IOL power calculation.
Choosing the most suitable formula based on individual patient characteristics is
BIOMETRY
AXIAL LENGTH
The axial length of the eye refers to the distance between the anterior surface of the
cornea and the pigment epithelium at the fovea.
Normal Axial Length:
1. At Birth 17 mm
2. A typical axial eye length ranges from 23 to 24 millimeters(avg). Males tend to
have eyes about 0.5mm longer than females.
3. Myopia tends to occur when the axial length exceeds 24mm.
4. If the axial length surpasses 26mm, the risk of vision problems in adulthood
signifi cantly increases.
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5. In Hyperopia AL tends to be Less than 24 mm.
BIOMETRY
AXIAL LENGTH
The need for axial length precision is well known
For every 0.33 mm measurement error, there is approximately 1D post
operative error.
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BIOMETRY
Techniques
AXIAL LENGTH
A-Scan Ultrasound (Immersion / Contact ) + Optical Biometry
Principle: A-scan, short for applanation ultrasound, has been used for many
years. It involves using high-frequency sound waves to measure axial length.
Procedure: The A-scan machine sends out 10 MHz soundwaves, which bounce
back from ocular structures. By analyzing these echoes, it provides a picture and
measurements of the eye.
How It Works:
1. The total refractive power of an emmetropic (normal) eye is approximately 60
diopters.
2. The cornea contributes roughly 40 diopters, while the crystalline lens provides 20
diopters.
Instruments used for this test typically require
7 direct contact with the cornea
BIOMETRY
ULTRASOUND METHODS
Techniques
A-Scan Ultrasound – Immersion
Method
STEPS :
Position the patient comfortably
(patient to be placed in a supine
position.)
Apply topical anesthetic to the
cornea.
Placement of scleral shell – pt to
fixate at ceiling, gentle place shell on
the scleral, avoid contact with cornea
Immerse the probe in the coupling
medium (usually saline) – Keep prob
5-10 mm away from the cornea
Align the probe with the optical axis 8
and obtain measurements
BIOMETRY
Techniques
A-Scan Ultrasound – Contact Method
Applanation Technique
STEPS:
Position the patient comfortably in an
upright position.
Apply topical anesthetic to the
cornea.
Ask patient to fixate straight with
non-testing eye
Use a handheld A-scan probe- Clean
prob tip with sterile alcohol swab
before every use
Gently applanate the cornea to
obtain accurate measurements.
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Doesn’t require scleral shell
BIOMETRY
Techniques - Optical
Biometer
Optical biometry is a highly accurate and non-invasive method
used for measuring the anatomical characteristics of the eye.
Optical Biometry:
[Link]-invasive and comfortable for the patient.
[Link] partial coherence interferometry for some
measurements and slit imagery for others.
[Link] AL, corneal curvature, ACD, and white-to-white
diameter.
[Link] ZEISS IOLMaster is a widely used optical biometry
device.
Advantages of Optical Biometry:
1. Highly accurate due to infrared laser light (780 nm)
interference.
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2. No need for corneal contact, reducing variations.
BIOMETRY
Formula - Barrett Universal (BU), SRK/T, Holladay 1,
Hoffer Q, and Haigis Formulas
AL – Average 23-24mm , Myopia- 24-26>
ACD- Anterior chamber depth (ACD): The distance from
the cornea to the iris.
K1 and K2 – Keratometry, measurements of corneal power
SE- Spherical equivalent
Cyl- Cylinder value, measured in diopters, indicates the lens
power needed for astigmatism correction.
Eye Status – Aphakic, Pseudophakic ,Phackic
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“
Optical Biometry
CHALLENGES
”
Can’t be utilized in 100% of patients, so immersion must
still be used when :
• Mature/dense cataracts, strong PSC
• Fixation diffi culties- the machine cant measure to the
fovea
• Nystagmus / tremor
• Signifi cant corneal or vitreal opacity
• RPE defects
• Pigmen epithelial detachment
• Physical disabilities preventing access
“ CHALLENGES
Immersion + Contact Biometry
”
Contact Ascan can cause corneal compression which will lead to
shortening of the true axial length
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