Eyeworld

EW RESIDENTS 108 October 2018 EyeWorld journal club by Asadolah Movahedan, MD, Stefanie Sherman, MD, Nandita Anand, MD, Megan Silas, MD, Blake Williams, MD, Christos Theophanous, MD, Ema Avdagic, MD, Andrea Blitzer, MD, Lincoln Shaw, MD, and Peter Veldman, MD landmark first step in determining the utility of this new technology in today's ever-changing ophthalmo- logic surgery toolkit. Nevertheless, the results of such a large study should be interpreted with caution, and the applicability of this study to routine practice should be vetted. The authors indi- cate that there is a mean absolute prediction error (MAPE) difference of 0.06 D between IA and stan- dard aberrometry (p<0.001). While statistically significant, the clinical significance of such a small differ- ence may be minimal. Additionally, by reporting superior performance of IA in terms of MAPE, the study fails to mention the final refractive outcome or other clinically relevant endpoints, such as visual acuity and spectacle independence. Of note, the authors do not describe the timing of the measurement of postoperative refractions, which has been shown to alter refractive outcome. 2 The authors also cite the statistical significance of a "greater broad adaptation of this technology into routine cataract surgery is not yet well studied. 1 The article by Cionni et al. is a retrospective analysis of intraop- erative aberrometry calculations performed by the Optiwave Refrac- tive Analysis (ORA) system (Alcon, Fort Worth, Texas) and standard IOL biometry in more than 30,000 eyes undergoing phacoemulsification. The purpose of the study is to com- pare the absolute prediction error of IA in IOL power calculation to conventional preoperative biometry. The authors conclude that calcula- tions using IA outperform calcula- tions from preoperative biometry in this cohort. The study is designed to reflect a general population, with the cohort including patients with a wide range of axial lengths, various types of intraocular lens implants, and dif- ferent surgeons. With a sample size of 32,189 eyes, the study is highly powered to detect subtle differenc- es among subgroups. It serves as a A s technology has ad- vanced, the goal of cata- ract surgery has evolved from restoration of vision to visual enhancement. Many patients expect spectacle inde- pendence after cataract surgery, and it has become increasingly import- ant to have reliable and predictable postoperative refractive outcomes. Despite prior advancements, min- imizing prediction error remains a major concern. Current preoperative biometric devices with the latest generation theoretical formulas are popular among surgeons around the world, and their accuracy has been compared in different clinical set- tings in numerous studies. Intraop- erative aberrometry (IA) is a relative- ly new surgical planning modality that measures aphakic refraction at the time of cataract surgery, promis- ing a more accurate IOL power cal- culation. Prior studies on the use of IA have demonstrated advantages in IOL selection in certain circumstanc- es; however, the applicability and Review of "A large retrospective database of intraoperative aberrometry with Peter Veldman, MD, residency program director, Department of Ophthalmology and Visual Science, University of Chicago Many have debated whether the refractive outcomes justify the additional cost and time of conducting intraoperative aber- rometry. I asked the University of Chicago residents to review this study that appears in the October issue of JCRS. —David F. Chang, MD, EyeWorld journal club editor University of Chicago residents, from left: Megan Silas, MD, Lincoln Shaw, MD, Asadolah Movahedan, MD, Stefanie Sherman, MD, Blake Williams, MD, Ema Avdagic, MD, Andrea Blitzer, MD, Nandita Anand, MD; not pictured: Christos Theophanous, MD

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