Posters

UniversIOL in 2020: towards perfection in simultaneous spherical and toric intraocular power calculation in cataract surgery

Poster Details

First Author: S.Sayegh USA

Co Author(s):                     

Abstract Details

Purpose:

To contribute significant foundational and implementation-oriented tools to the still vexing situation of accurate IOL power computation.  Additional tools are introduced to UniversIOL, a calculator with a universal IOL database, a universal computational core and a universally accessible interface.  These new tools address the goals of improving refractive results in simultaneous sphere/toric computation, providing a menu of computational choices, targeting exactly zero astigmatism (or a specified astigmatic target) and built-in learning algorithms to improve outcomes of the individual surgeon.

Setting:

Research Center and private clinics and surgical theaters.  200 active accounts for UniversIOL with diverse surgeons (geographically, surgical platforms, choice of IOLs, etc…)    Initial and follow up measurements and refractions at clinics with a variety of devices performing keratometry, axial length measurements, etc...as matched to the mode of IOL calculation.

Methods:

Core structure of UniversIOL was preserved with a universal database of IOLs (up-to-date A constants or corresponding constants for various formulas), simultaneous (instead of the common sequential) optimization of sphere and toric calculation, manufacturer-independent ranking of best IOLs based on chosen target , and inclusion of a hybrid mode improving single formula refractive results as well as a “formula-spread” index correlating with probability of reaching the target. 2020 additions included  (most recent) Wang Koch correction for long eyes Haigis formulas post LASIK Targeting exactly zero as well as exact non zero predetermined astigmatic Self learning for refractive results improvement

Results:

Updated UniversIOL computational environment allowed continued improvement of surgical results.    With the use of the hybrid approach results trended towards 90-95% within the [-0.5D, +0.5D] interval despite the diversity of surgical environments, with optical measurements favoring the slightly better results but with careful and repeated measurements and adjustments of the constants nearly compensating for the "ultrasound deficit." An exact algorithm for choosing the ideal degree of overcorrection with toric IOLs (instead of always undercorrecting or "splitting the difference" as per present toric calculators) resulted in 90-95 % within 0.5 D of zero (or target) astigmatism.

Conclusions:

UniversIOL 2020 release has built on a very strong theoretical and surgical results analysis traditions with new tools that both improve on the accuracy of refractive prediction and expand the modes and choices available to the surgeon.  These allow for the performance of accurate calculations in a user-friendly and safe environment with built-in ability for further improvement of refractive results. It is a step in the right direction away from the common paradigm of sequential sphere-then-toric IOL calculation and contributes a full integration of the computational environment as well as true universality of the surgical approach.

Financial Disclosure:

None