Posterior Corneal Astigmatism: Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011
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1 : Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011
2 Corneal Imaging What major challenge do we face when imaging the cornea? Measuring the curvature & refractive power of the posterior surface - Especially in IOL calculations following corneal refractive surgery Will posterior surface info improve our results?
3 Corneal Imaging As technology improves, patient expectations increase: Complication- & pain-free surgery Instant visual recovery Excellent uncorrected visual acuity Spectacle independence Management of astigmatism is increasingly important: Presbyopia correcting IOLs (PCRIs) Toric IOLs
4 Traditional measurement of corneal astigmatism: Based on anterior surface Assumes fixed anterior-posterior curvature ratio (adjusted η) Ignores contribution of posterior surface Retrospective study of posterior corneal astigmatism: Galilei DSA measurements *Wang L, et al. ARVO 2011
5 Purpose To determine the effect of posterior corneal astigmatism on overall corneal astigmatism Using a combined Placido-disc & dual-camera Scheimpflug corneal analyzer
6 Methods Consecutive preop visits prior to cataract or refractive surgery: No prior ocular trauma or surgery No corneal or other ocular disease No CL wear w/in 2 weeks of measurement 715 Eyes of 434 patients: Mean age: 55 ± 20 yr (range yr) 280 Patients w/ both eyes included *Wang L, et al. ARVO 2011
7 Methods Corneal astigmatism (CA) measurements w/ Galilei DSA: CASimK: Simulated keratometry over 1-4 mm zone (Axial) CATCP: Total corneal power Combined astigmatism from anterior & posterior corneal surfaces Calculated via ray tracing CAFront: Axial astigmatism of anterior corneal surface Calculated from CASimK by multiplying by 376/337.5 CABack: Axial astigmatism of posterior corneal surface As displayed on the device *Wang L, et al. ARVO 2011
8 Statistical Analyses CAFront vs CABack: Magnitude of astigmatism Location of steep meridian Change with age CASimK estimation error: Compared to CATCP as gold standard Vector difference in astigmatism - CATCP - CASimK % Eyes with difference in - Magnitude of astigmatism ± 0.25 D & ± 0.50 D Location of steep meridian ± 5 & ± 10 *Wang L, et al. ARVO 2011
9 Corneal Magnitude Mean ± SD (D) Range (D) CATCP 1.07 ± to 4.26 CASimK 1.08 ± to 4.40 CAFront 1.20 ± to 4.90 CABack ± to *Wang L, et al. ARVO 2011
10 Corneal Magnitude 0.25D 0.50D 0.75D 1.00D CATCP 7.0% 22% 38% 54% CASimK 5% 22% 37% 54% CAFront 4.3% 18% 32% 47% CABack 43% 91% 99% 100% *Wang L, et al. ARVO 2011
11 Steep Meridian - Ant. vs. Post. Surface (D) Anterior Corneal Surface (D) y = x R 2 = *Wang L, et al. ARVO 2011
12 Steep Meridian - Ant. vs. Post. Posterior Steep Meridian (degrees) % % Anterior Steep Meridian (degrees) *Wang L, et al. ARVO 2011
13 Anterior Corneal Steep Meridian 100 % Eyes Steep Meridian Vertical Steep Meridian Horizontal Age Group (years) *Wang L, et al. ARVO 2011
14 Steep Meridian % Eyes 50 Steep Meridian Vertical Steep Meridian Horizontal Age Group (years) *Wang L, et al. ARVO 2011
15 Astig. Vectors CASimK vs CATCP CASimK CATCP Each Ring = 1 D ± ± 105 Outer Ring = 5 D For TCP measurements, (-) 90 on posterior surface creates less total (+) power vertically ( WTR)
16 Vector Difference CATCP - CASimK Mean vector difference: 0.22 ± ± 0.25 D: 53.0% ± 0.50 D: 95.1% ± 1.00 D: 99.8% Each Ring = 0.50 D Outer Ring = 2.00 D For TCP measurements, (-) 90 on posterior surface creates more net (+) power horizontally (as compared to SimK)
17 CASimK Est. Error CATCP - CASimK Differences in Magnitude: Arithmetic mean ± to 1.22 Absolute mean 0.19 ± to 1.22 ± 0.25D 71.3% ± 0.50D 97.9% Differences in Steep Meridian: Absolute mean 7 ± 11 0 to 89 ± % ± % *Wang L, et al. ARVO 2011
18 CATCP vs CASimK Difference in Magnitude (D) WTR on anterior surface (+) & steep vertically on posterior surface (-) Difference in Steep Meridian (deg) ATR on anterior surface (+) & steep vertically on posterior surface (-) y = x R 2 = *Wang L, et al. ARVO 2011
19 SimK astig: Post. astig: TCP astig: Aspheric IOL implanted Post-op MR: Sph (20/20) Case 1
20 SimK astig: Post. astig: TCP astig: Aspheric IOL implanted Post-op MR: Sph (20/20) Case 2
21 SimK astig: Post. astig: TCP astig: Aspheric IOL implanted Post-op MR: x 5 (20/20) Case 3
22 SimK astig: Post. astig: TCP astig: Case 4
23 Conclusions Posterior corneal astigmatism magnitude tends to increase with increasing anterior corneal astigmatism Anterior corneal steep meridian transitioned from vertical to horizontal w/ increasing age ( WTR to ATR ): Posterior corneal steep meridian remained vertical as age increased Posterior corneal astigmatism tended to partially compensate for anterior corneal astigmatism in approximately 50% of eyes: Primarily in patients up to age 60
24 Conclusions SimK estimation of total corneal astigmatism produces errors Estimation Errors: > 0.50D in 5% of eyes IOL toricity error or astigmatism magnitude estimation error: > 0.50D in 2.1% of eyes Toric IOL alignment error or steep meridian estimation error: > 10 in 17.2% of eyes
25 Conclusions Ignoring the posterior corneal surface may result in the incorrect estimation of total corneal astigmatism in some patients: Especially in elderly patients undergoing cataract surgery Posterior corneal astigmatism may provide another variable to improve the accuracy of IOL calculations
26 Acknowledgements Douglas D. Koch, M.D. Li Wang, M.D./Ph.D. Shazia Ali, B.S.
27 : Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011
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