Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D....

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Phoebe D. Lenhart, M.D. Phoebe D. Lenhart, M.D. 1 , Amy K. Hutchinson, M.D. , Amy K. Hutchinson, M.D. 1 , Michael J. Lynn, M.S. , Michael J. Lynn, M.S. 2 , , Scott R. Lambert M.D. Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University, Atlanta, Georgia, Department of Ophthalmology, Emory University, Atlanta, Georgia, 2 Rollins Rollins School of Public Health School of Public Health American Society of Cataract and Refractive Surgery Meeting American Society of Cataract and Refractive Surgery Meeting Boston, Massachusetts, April 2010 Boston, Massachusetts, April 2010 Financial interests: None Financial interests: None Supported by National Institutes of Health Grants U10 EY13272 and U10 EY013287 and in Supported by National Institutes of Health Grants U10 EY13272 and U10 EY013287 and in Partial Coherence Interferometry Compared Partial Coherence Interferometry Compared with Immersion Ultrasound with Immersion Ultrasound for Axial Length measurement in children for Axial Length measurement in children

Transcript of Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D....

Page 1: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

Phoebe D. Lenhart, M.D.Phoebe D. Lenhart, M.D.11, Amy K. Hutchinson, M.D., Amy K. Hutchinson, M.D.11, Michael J. Lynn, M.S., Michael J. Lynn, M.S.22, Scott R. , Scott R. Lambert M.D.Lambert M.D.11

  11Department of Ophthalmology, Emory University, Atlanta, Georgia, Department of Ophthalmology, Emory University, Atlanta, Georgia, 22Rollins School of Rollins School of

Public HealthPublic Health    

  

  

  

American Society of Cataract and Refractive Surgery Meeting American Society of Cataract and Refractive Surgery Meeting

Boston, Massachusetts, April 2010Boston, Massachusetts, April 2010

  

  

Financial interests: NoneFinancial interests: None    

  Supported by National Institutes of Health Grants U10 EY13272 and U10 EY013287 and in part by NIH Supported by National Institutes of Health Grants U10 EY13272 and U10 EY013287 and in part by NIH Departmental Core Grant EY06360 and Research to Prevent Blindness, Inc, New York, New YorkDepartmental Core Grant EY06360 and Research to Prevent Blindness, Inc, New York, New York

Partial Coherence Interferometry Compared Partial Coherence Interferometry Compared with Immersion Ultrasound with Immersion Ultrasound

for Axial Length measurement in childrenfor Axial Length measurement in children

Page 2: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

PurposePurpose

To determine whether measurements To determine whether measurements obtained by partial coherence interferometry obtained by partial coherence interferometry (PCI) correlate well with measurements (PCI) correlate well with measurements obtained using immersion ultrasonography obtained using immersion ultrasonography (IUS) in children(IUS) in children

Page 3: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

MethodsMethods

• We reviewed the charts of 18 pediatric patients We reviewed the charts of 18 pediatric patients (ages 4-16 years) who underwent cataract surgery (ages 4-16 years) who underwent cataract surgery on 27 eyes at the Emory Eye Center from August on 27 eyes at the Emory Eye Center from August 2008 to September 20092008 to September 2009

• Axial length measurements of the operative eye Axial length measurements of the operative eye were obtained for 21/27 (78%) of eyes using PCI were obtained for 21/27 (78%) of eyes using PCI during the preoperative clinic visitduring the preoperative clinic visit

• Axial length measurements were then obtained Axial length measurements were then obtained using IUS in the operating room prior to surgeryusing IUS in the operating room prior to surgery

• The data were compared to evaluate the degree of The data were compared to evaluate the degree of agreement agreement Emory University Institutional Review Board approval was obtained and the

study was in compliance with the Health Insurance Portability and Accountability Act.

Page 4: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

DataData

OD=Right eye; OS=Left eye PCI=Partial coherence interferometry; IUS=Immersion Ultrasonography

Page 5: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

ResultsResults

• Axial lengths using PCI were, on average, 0.13 Axial lengths using PCI were, on average, 0.13 mm less than IUS values (95% CI -0.21 to -mm less than IUS values (95% CI -0.21 to -0.06; p-value 0.002). 0.06; p-value 0.002).

• For axial lengths For axial lengths 23.5 mm, all patients had 23.5 mm, all patients had PCI values that were less than the IUS value. PCI values that were less than the IUS value.

• For patients with axial lengths For patients with axial lengths 23.5 mm, 23.5 mm, there was no systematic pattern of one there was no systematic pattern of one measurement being greater or less than the measurement being greater or less than the other.other.

Page 6: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

ResultsResults

Mean axial length PCI: 22.14 Mean axial length IUS: 22.27

Page 7: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

ResultsResults

•Negative mean (-0.13) indicates PCI values were, on average, 0.13 mm less than the IUS values.

•95% confidence interval (-0.21 to -0.06)

•p-value= 0.002

•Points below the line represent patients with PCI < IUS.•For axial lengths ≤ 23.5, all patients had PCI ≤ IUS. •For patients with axial lengths > 23.5, there was no systematic pattern of one measurement being greater or less than the other.

Page 8: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

DiscussionDiscussion

• There is a systematic difference in axial There is a systematic difference in axial length measurement between PCI and IUS length measurement between PCI and IUS with PCI tending to give lower values, with PCI tending to give lower values, particularly for children with axial lengths of particularly for children with axial lengths of 23.5 mm.23.5 mm.

• A 0.13 mm error in axial length A 0.13 mm error in axial length measurement, depending on the length of the measurement, depending on the length of the eye, could result in a 0.33-0.49 D difference in eye, could result in a 0.33-0.49 D difference in IOL calculation that may be clinically IOL calculation that may be clinically significant in some patients.significant in some patients.

Page 9: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

strengthsstrengths

Comparison of PCI to IUS in a pediatric Comparison of PCI to IUS in a pediatric population. population. • In previous studies of adults and children In previous studies of adults and children

comparing PCI to applanation A-scan comparing PCI to applanation A-scan ultrasound, the potential for contact-induced ultrasound, the potential for contact-induced distortion of axial length measurements may distortion of axial length measurements may have limited direct comparison of values have limited direct comparison of values obtained by the two devices. obtained by the two devices.

Page 10: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

limitationslimitations

• Small number of eyes (27)Small number of eyes (27)

• Unable to obtain more than five axial length Unable to obtain more than five axial length measurements for multiple childrenmeasurements for multiple children

• Difference between PCI and IUS detected in Difference between PCI and IUS detected in our study using IUS could have been due to our study using IUS could have been due to suboptimal alignment of scans along suboptimal alignment of scans along anatomic axis of eye or poor gate positioning  anatomic axis of eye or poor gate positioning    

Page 11: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

Future directionsFuture directions

Further studies are needed to determine the Further studies are needed to determine the utility of the IOLMaster in honing utility of the IOLMaster in honing postoperative refractive outcome in children postoperative refractive outcome in children and to evaluate the IOLMaster as a tool for and to evaluate the IOLMaster as a tool for the longitudinal follow-up of axial length the longitudinal follow-up of axial length measurement in children. measurement in children.

Page 12: Phoebe D. Lenhart, M.D. 1, Amy K. Hutchinson, M.D. 1, Michael J. Lynn, M.S. 2, Scott R. Lambert M.D. 1 1 Department of Ophthalmology, Emory University,

referencesreferences

• Carkeet A et al. Repeatability of IOLMaster biometry in children. Optometry and Visual Science Carkeet A et al. Repeatability of IOLMaster biometry in children. Optometry and Visual Science 2004;81:829-834.2004;81:829-834.

• Hussin HM, Spry PGD, Jamid MA, and Gouws P. Reliability and validity of the partial coherence Hussin HM, Spry PGD, Jamid MA, and Gouws P. Reliability and validity of the partial coherence interferometry for measurement of ocular axial length in children. Eye 2006;20:1021-1024.interferometry for measurement of ocular axial length in children. Eye 2006;20:1021-1024.

• Quinn GE et al. Highly precise eye length measurements in children aged 3 through 12 years. Quinn GE et al. Highly precise eye length measurements in children aged 3 through 12 years. Arch Ophthalmol 2003;121:985-990. Arch Ophthalmol 2003;121:985-990.

• Narvaez J et al. Comparing immersion ultrasound with partial coherence interferometry for Narvaez J et al. Comparing immersion ultrasound with partial coherence interferometry for intraocular lens power calculation. Ophthalmic Surg Lasers Imaging 2008;39:30-34.intraocular lens power calculation. Ophthalmic Surg Lasers Imaging 2008;39:30-34.

• Borchert M et al. Testability of the Retinomax autorefractor and IOLMaster in preschool Borchert M et al. Testability of the Retinomax autorefractor and IOLMaster in preschool children: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2008;115:1422-1425.children: the Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2008;115:1422-1425.

• Gordon RA, Donzis PB. Refractive development of the human eye. Arch Ophthalmol Gordon RA, Donzis PB. Refractive development of the human eye. Arch Ophthalmol 1985;103(6):785-9.1985;103(6):785-9.

• Griener ED, Dahan E, Lambert SR. Effect of age at time of cataract surgery on subsequent axial Griener ED, Dahan E, Lambert SR. Effect of age at time of cataract surgery on subsequent axial length growth in infant eyes. J Cataract Refract Surg 1999;25(9):1209-13.length growth in infant eyes. J Cataract Refract Surg 1999;25(9):1209-13.