IOLMaster IOL Intraocular Lens Power Calculations LASIK Calculation IOL Master Ophthalmology Bag Sulcus IOL Formula Eye Doctor Cataract Surgery Ophthalmologist Eye Surgery Information LASIK PRK RK Biometry Ultrasound Eye Cataract Surgery Eyes

2008-09-13 LASIK IOL Calculations cataract surgeryophthalmology Ophthalmology Clinic ophthalmology is the branch of medicinewhich deals with the diseases and surgery of the visual pathways, including the eye and brain. The word ophthalmologycomes from the Greek roots ophthalmosmeaning eyeand logosmeaning word; ophthalmology literally means The science of eyes. History of ophthalmology History of ophthalmology The establishment of the first dedicated ophthalmic hospital in 1805 - in London, England was a transforming event in modern ophthalmology. Clinical developments at Moorfields and the founding of the Institute of Ophthalmology by Sir Stewart Duke-Elder established the site as the largest eye hospital in the world and a nexus for ophthalmic research. ophthalmologists. Many ophthalmologists also undergo additional specialized training in one of the many subspecialities. Ophthalmology was the first branch of medicine to offer board certification, now a standard practice among all specialties. In the United States, four years of training after medical school are required, with the first year being an internship in surgery, internal medicine, pediatrics, or a general transition year. The scope of a physician's licensure is such that he or she need not be board certified in ophthalmology to practice as an ophthalmologist. The American Academy of ophthalmolog (AAO) promotes the use of the phrase Eye MD to distinguish ophthalmologists from optometrists who hold the degree OD (Doctor of Optometry). (This, however, sometimes leads to confusion among patients, since a few ophthalmologists' primary medical degree is a D.O., or Doctor of osteopathic Medicine, rather than an M.D. In both cases, the same residency and certification requirements must be fulfilled.) Completing the requirements of continuing medical education is mandatory for continuing licensure and re-certification. Professional bodies like AAO, ASCRS organise conferences and help members through CME programs to maintain certification, in addition to congress advocacy and peer support. In India, after completing MBBS degree, post-graduation in ophthalmology is required. The degrees are Doctor of Medicine (MD), Master of Surgery (MS), Diploma in Ophthalmic Medicine and Surgery (DOMS) or Diplomate of National Board (DNB). The concurrent training and work experience is in the form of a Junior Residency at a Medical College, Eye Hospital or Institution under the supervision of experienced faculty. Further work experience in form of fellowship, registrar or senior resident refines the skills of these eye surgeons. All India Ophthalmological Society (AIOS) and various state level Ophthalmological Societies (like DOS) hold regular conferences and actively promote continuing medical education. In Canada, an ophthalmology residency after medical school. A minimum of 5 years after the MD. degree although subspecialty training is undertaken by about 30% of fellows (FRCSC). There are about 30 vacancies per year for ophthalmology training in all of Canada. Formal specialty training programs in veterinaryophthalmology ophthalmology includes sub-specialities which deal either with certain diseases or diseases of certain parts of the eye. Some of them are: Along with Helmholtz and Donders, one of the 'founding fathers' of ophthalmology as a specialty. A brilliant clinician and charismatic teacher who had an international influence on the development of ophthalmology. A pioneer in mapping visual field defects and diagnosis and treatment of glaucoma. Introduced a cataract extraction technique that remained the standard for over 100 years, and many other important surgical techniques such as iridectomy. Rationalised the use of many ophthalmically important drugs, including mydriatics miotics. The founder of the one of the earliest ophthalmic societies (German Ophthalmological Society, 1857) and one of the earliest ophthalmic journals (Graefe's Archives of ophthalmology). The most important ophthalmologist of the 19th century. known as the optical constantsof the eye. His measurements are still used today. great German polymath, invented the ophthalmoscope (1851) and published important work on physiological optics, including colour vision (1850s). (New Zealand/Australia) pioneered programs in Nepal, Eritrea, and Vietnam, and among Australian aborigines, including the establishment of cheap laboratory production of intraocular lenses in Nepal and Eritrea. (United States) developed the cryo-probe used in introduced and Kelman holds the world record for the highest number of cataract operations by an individual doctor. published influential textbooks on eye disease, an ophthalmologist. (Ukraine) (1875-1956) His contributions to the medical world include the tube flap grafting method, corneal transplantation and preservation of grafts from cadaver eyes He foundedOdessa, one of the leading eye care institutes in the world. father of pediatric ophthalmology a leader of American ophthalmology, made many contributions in understanding and treatment of ocular genetics, retinal diseases, and ocular trauma. experimented with chickens trying to transplant cornia. Ophthalmology Various eye surgery procedures American Academy of ophthalmolog American Society of Cataract Refractive Surgery European Society of Cataract Refractive Surgery Royal College of Ophthalmologists American Board of Eye Surgeons American Board of ophthalmolog An On-Line ophthalmology Journal Club (via JournalReview.org) Indian Journal of ophthalmolog All India Ophthalmological Society Delhi Ophthalmological Society The David G. Cogan Ophthalmic Pathology Collection Royal College of Surgeons in Edinburgh

Warren Hill, M.D.
Eye Surgeon Information
Intraocular Lens Power Calculations Main Page

IOL power calculations have certainly come a long way. As recently as 1977, the state of the art calculation to achieve emmetropia with a posterior chamber IOL, was simply adding +19.0 D to the pre-cataractous refraction.

Around 1990, with the formulas available at that time, being within ±1.00 D of the target refraction was considered a high standard.

Today, by paying careful attention to detail, it is possible to be within ±0.50 D in 95 percent of surgeries, or better.

East Valley Ophthalmology specializes in ocular biometry and intraocular lens power calculations, in normal and highly unusual clinical settings.

The following list covers some of the latest developments in those areas:

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A-Scan Biometry using Ultrasound , an important and sometimes challenging preoperative measurement, can be carried out in several ways. In this section, we will compare the advantages of the immersion technique over applanation, and how to improve accuracy.

If your A-scan machine allows for changes in the ultrasound velocity, there are several ways to increase the accuracy of axial length measurements. Follow this link for advanced A-Scan Biometry Techniques to axial length measurements.

Optical coherence Biometry using the Carl Zeiss Meditec IOL Master is a state of the art technique for measuring axial length. By partial coherence interferometry, the IOL Master achieves a level of accuracy and reproducibility never before seen. This has its own section on our site.

What if the posterior capsule is broken? Follow this link for a chart that compares the differences between Capsular Bag and Ciliary Sulcus IOL powers over a standard intraocular lens power range. When the mathematics is done correctly, it yields some surprising answers.

Intraocular lens power calculations for Corneal Transplantation , cataract removal and intraocular lens implantation, as a combined procedure, often result in unpredictable refractive outcomes if all three procedures are carried out during the same operative session. Follow this link for some suggestions as to how to obtain highly accurate post-operative results.

Pseudophakic Correction Factors : When performing A-scan biometry on a pseudophakic eye at a velocity of 1,532 m/sec, add the corresponding correction factor to the axial length displayed to get a close approximation of the true axial length.

Determining the Effective Lens Position (previously referred to as the anterior chamber depth) for each IOL and each surgeon is an effective way to reduce the prediction error to a minimum. The actual postoperative position of the intraocular lens implant can be calculated and used to "personalize" this parameter for your IOL calculation program.

The Haigis Formula : Rather than simply move a fixed formula-specific IOL power prediction curve up (more IOL power recommended) or down (less IOL power recommended), the Haigis formula instead uses three constants.

Prior Keratorefractive Surgery will make direct measurements for corneal power problematic. Learn how to to estimate the true corneal power following RK, PRK, and LASIK.

Tracking outcomes is an essential part of any cataract surgery practice. We have a recommendation for a state of the art software program that will do IOL calculations and Outcomes Database management.

When properly indicated, primary Polypseudophakia makes it possible to implant total IOL powers beyond +40.0 D.

Determining the correct axial length for Pseudophakia presents special challenges. Having the ultrasound machine set to "pseudophakic mode" is not necessarily the best idea, due to the widely different ultrasound velocities of silicone, acrylic, and PMMA.

For eyes with existing intraocular lenses, or aphakic eyes, it is a simple matter to calculate the optical power that must be added to, or subtracted from, using the Refractive Vergence Formula , which is axial length independent.

Silicone Oil is sometimes temporarily placed in the vitreous cavity for recurrent retinal detachments in eyes with proliferative vitreoretinopathy, proliferative diabetic retinopathy, cytomegalovirus retinitis, giant retinal tears, and following perforating injuries. Axial length measurements by ultrasound of an eye in which the vitreous cavity has been filled with silicone oil is an exercise with many potential pitfalls, especially if the silicone oil has become emulsified.

Sometimes the center of the macula is not the most posterior structure in axial myopia with a Staphyloma . Using B-scan ultrasonography, combined with a simultaneous vector A-scan, it is possible to measure the axial length to the center of the macula.

Something not look right? When should you have someone check on your findings? Follow this link for a listing of helpful axial length and keratometry Validation Guidelines .

Not sure about Which IOL Formula to use? If you have not done so already, now is the time to incorporate one of the newer theoretic formulas.

Here are some interesting and useful Links that are updated on a regular basis.

Like to know more about these topics? Follow this link to References for much of the material presented above.

Just about everything on this web site is the result of information and suggestions from others. Many deserve our Special Thanks for graciously offering their guidance.

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