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Sardari S, Khabazkhoob M, Jafarzadehpur E, Fotouhi A. The Repeatability of Axial Length Measurements Using a Scheimpflug-based System. JOVR [Internet]. 2023Nov.30 [cited 2024May14];18(4):396–404. Available from: https://knepublishing.com/index.php/JOVR/article/view/14551
https://doi.org/10.18502/jovr.v18i4.14551
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authors
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Sara Sardari
Sara Sardari
Research and Technology Deputy, Tehran University of Medical Sciences, Tehran, Iran
-
Mehdi Khabazkhoob
Mehdi Khabazkhoob
Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ebrahim Jafarzadehpur
Ebrahim Jafarzadehpur
Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Akbar Fotouhi
Akbar Fotouhi
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Published Date
- Nov 30, 2023
The Repeatability of Axial Length Measurements Using a Scheimpflug-based System
Abstract
Purpose: To assess the repeatability of Pentacam AXL as a Scheimpflug-based system or measuring axial length according to the age, sex, lens type, axial length value, and type of cataract.
Methods: The present study was conducted using multistage cluster sampling in Tehran, Iran. Ocular biometry was performed, using the Pentacam AXL, by an experienced optometrist on all the participants. The axial length (AL) measurements were taken thrice, with a gap of 10 minutes. To evaluate the repeatability, the intraclass correlation coefficient (ICC) and the repeatability coefficient (RC) were calculated. To determine the significant difference in the repeatability index among study variables, the tolerance index (TI) was calculated.
Results: In this report, 897 eyes of 677 individuals aged between 20 and 91 years (mean ± SD: 64.90 ± 13.62 years) were reported. The ICC of the axial length measurements was 0.981 for all cases. Based on the within-subject standard deviation, the RC was 0.401. The ICC was 0.976 and 0.985 in men and women, respectively. The TI showed better RC of measurements among females. The ICC decreased from 0.999 in participants under 40 years to 0.973 in individuals over 60 years of age. The TI showed a decrease in RC with advancing age. The RC was worse in eyes with nuclear cataracts; the RC was also worse in the first quartile of the signal-to-noise ratio (SNR) compared to the other SNR quartiles.
Conclusion: The Scheimpflug-based system Pentacam AXL had high repeatability in measuring axial length. Some variables such as male gender, older age, and nuclear cataract were associated with reduced repeatability of the measurements. A higher SNR was associated with better repeatability of the axial length measurements.
Keywords:
Axial Length, Signal-To-Noise Ratio, Repeatability, Scheimpflug Imaging, Imaging; Partial Coherence Interferometry
References
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2. Shammas HJ, Ortiz S, Shammas MC, Kim SH, Chong C. Biometry measurements using a new large-coherencelength swept-source optical coherence tomographer. J Cataract Refract Surg 2016;42:50–61.
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4. Santodomingo-Rubido J, Mallen EA, Gilmartin B, Wolffsohn JS. A new non-contact optical device for ocular biometry. Br J Ophthalmol 2002;86:458–462.
5. Lee BW, Galor A, Feuer WJ, Pouyeh B, Pelletier JS, Vaddavalli PK, et al. Agreement between Pentacam and IOL master in patients undergoing toric IOL implantation. J Refract Surg 2013;29:114–120.
6. Zhao J, Chen Z, Zhou Z, Ding L, Zhou X. Evaluation of the repeatability of the Lenstar and comparison with two other non-contact biometric devices in myopes. Clin Exp Optom 2013;96:92–99.
7. Rozema JJ, Wouters K, Mathysen DG, Tassignon MJ. Overview of the repeatability, reproducibility, and agreement of the biometry values provided by various ophthalmic devices. Am J Ophthalmol 2014;158:1111–1120 e1111.
8. Fernandez-Vigo JI, Fernandez-Vigo JA, Macarro-Merino A, Fernandez-Perez C, Martinez-de-la-Casa JM, Garcia- Feijoo J. Determinants of anterior chamber depth in a large Caucasian population and agreement between intraocular lens Master and Pentacam measurements of this variable. Acta Ophthalmol 2016;94:e150–e155.
9. Shajari M, Lehmann UC, Kohnen T. Comparison of corneal diameter and anterior chamber depth measurements using 4 different devices. Cornea 2016;35:838–842.
10. Shajari M, Cremonese C, Petermann K, Singh P, Muller M, Kohnen T. Comparison of axial length, corneal curvature, and anterior chamber depth measurements of 2 recently introduced devices to a known biometer. Am J Ophthalmol 2017;178:58–64.
11. Pinero DP, Soto-Negro R, Ruiz-Fortes P, Perez-Cambrodi RJ, Fukumitsu H. Analysis of intrasession repeatability of ocular aberrometric measurements and validation of keratometry provided by a new integrated system in mild to moderate Keratoconus. Cornea 2019;38:1097–1104.
12. Molina-Martin A, Pinero DP, Caballero MT, de Fez D, Camps VJ. Comparative analysis of anterior corneal curvature and astigmatism measurements obtained with three different devices. Clin Exp Optom 2020;103:618–624.
13. Song JS, Yoon DY, Hyon JY, Jeon HS. Comparison of ocular biometry and refractive outcomes using IOL Master 500, IOL Master 700, and Lenstar LS900. Korean J Ophthalmol 2020;34:126–132.
14. Olsen T. Calculation of intraocular lens power: A review. Acta Ophthalmol Scand 2007;85:472–485.
15. Norrby S. Sources of error in intraocular lens power calculation. J Cataract Refract Surg 2008;34:368–376.
16. Ruiz-Mesa R, Abengozar-Vela A, Ruiz-Santos M. Comparison of a new Scheimpflug imaging combinedwith partial coherence interferometry biometer and a low-coherence reflectometry biometer. J Cataract Refract Surg 2017;43:1406–1412.
17. Pereira JMM, Neves A, Alfaiate P, Santos M, Aragao H, Sousa JC. Lenstar(R) LS 900 vs Pentacam(R)-AXL: Comparative study of ocular biometric measurements and intraocular lens power calculation. Eur J Ophthalmol 2018;28:645–651.
18. Muzyka-Wozniak M, Oleszko A. Comparison of anterior segment parameters and axial length measurements performed on a Scheimpflug device with biometry function and a reference optical biometer. Int Ophthalmol 2019;39:1115–1122.
19. Haddad JS, Barnwell E, Rocha KM, Ambrosio R, Jr., Waring Iv GO. Comparison of biometry measurements using standard partial coherence interferometry versus new Scheimpflug tomography with integrated axial length capability. Clin Ophthalmol 2020;14:353–358.
20. Henriquez MA, Zuniga R, Camino M, Camargo J, Ruiz-Montenegro K, Izquierdo L, Jr. Effectiveness and agreement of 3 optical biometers in measuring axial length in the eyes of patients with mature cataracts. J Cataract Refract Surg 2020;46:1222–1228.
21. Bae GH, Kim JR, Kim CH, Lim DH, Chung ES, Chung TY. Corneal topographic and tomographic analysis of fellow eyes in unilateral keratoconus patients using Pentacam. Am J Ophthalmol 2014;157:103–109 e101.
22. Loffler F, Bohm M, Herzog M, Petermann K, Kohnen T. Tomographic analysis of anterior and posterior and total corneal refractive power changes after femtosecond laserassisted keratotomy. Am J Ophthalmol 2017;180:102–109.
23. Kataria P, Padmanabhan P, Gopalakrishnan A, Padmanaban V, Mahadik S, Ambrosio R, Jr. Accuracy of Scheimpflug-derived corneal biomechanical and tomographic indices for detecting subclinical and mild keratectasia in a South Asian population. J Cataract Refract Surg 2019;45:328–336.
24. Xia T, Martinez CE, Tsai LM. Update on intraocular lens formulas and calculations. Asia Pac J Ophthalmol (Phila) 2020;9:186–193.
25. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: Theory and application. Am J Med 2006;119:166 e167–116.
26. Ghosh A, Collins MJ, Read SA, Davis BA. Axial length changes with shifts of gaze direction in myopes and emmetropes. Invest Ophthalmol Vis Sci 2012;53:6465– 6471.
27. Hall AB, Thompson JR, Deane JS, Rosenthal AR. LOCS III versus the Oxford Clinical Cataract Classification and Grading System for the assessment of nuclear, cortical and posterior subcapsular cataract. Ophthalmic Epidemiol 1997;4:179–194.
28. Chirapapaisan C, Srivannaboon S, Chonpimai P. Efficacy of swept-source optical coherence tomography in axial length measurement for advanced cataract patients. Optom Vis Sci 2020;97:186–191.
29. Ryu SJ, Kim DR, Song IS, Shin YU, Seong M, Cho H, et al. The influence of low signal-to-noise ratio of axial length measurement on prediction of target refraction, achieved using IOLMaster. PLoS One 2019;14:e0217584.
30. Bland JM, Altman DG. Measurement error. BMJ 1996;313:744.
31. Bergin C, Guber I, Hashemi K, Majo F. Tolerance and relative utility: Two proposed indices for comparing change in clinical measurement noise between different populations (repeatability) or measurement methods (agreement). Invest Ophthalmol Vis Sci 2015;56:5543– 5547.
32. Schroder S, Langenbucher A, Schrecker J. Comparison of corneal elevation and pachymetry measurements made by two state of the art corneal tomographers with different measurement principles. PLoS One 2019;14:e0223770.
33. Srivannaboon S, Chirapapaisan C, Chonpimai P, Loket S. Clinical comparison of a new swept-source optical coherence tomography-based optical biometer and a time-domain optical coherence tomography-based optical biometer. J Cataract Refract Surg 2015;41:2224–2232.
34. Sikorski BL, Suchon P. OCT Biometry (B-OCT): A new method for measuring ocular axial dimensions. J Ophthalmol 2019;2019:9192456.
35. Chan TCY, Wan KH, Tang FY, Wang YM, Yu M, Cheung C. Repeatability and agreement of a swept-source optical coherence tomography-based biometer IOLMaster 700 versus a Scheimpflug imaging-based biometer AL-Scan in cataract patients. Eye Contact Lens 2020;46:35–45.
36. Chia TMT, Nguyen MT, Jung HC. Comparison of optical biometry versus ultrasound biometry in cases with borderline signal-to-noise ratio. Clin Ophthalmol 2018;12:1757–1762.
2. Shammas HJ, Ortiz S, Shammas MC, Kim SH, Chong C. Biometry measurements using a new large-coherencelength swept-source optical coherence tomographer. J Cataract Refract Surg 2016;42:50–61.
3. Sel S, Stange J, Kaiser D, Kiraly L. Repeatability and agreement of Scheimpflug-based and swept-source optical biometry measurements. Cont Lens Anterior Eye 2017;40:318–322.
4. Santodomingo-Rubido J, Mallen EA, Gilmartin B, Wolffsohn JS. A new non-contact optical device for ocular biometry. Br J Ophthalmol 2002;86:458–462.
5. Lee BW, Galor A, Feuer WJ, Pouyeh B, Pelletier JS, Vaddavalli PK, et al. Agreement between Pentacam and IOL master in patients undergoing toric IOL implantation. J Refract Surg 2013;29:114–120.
6. Zhao J, Chen Z, Zhou Z, Ding L, Zhou X. Evaluation of the repeatability of the Lenstar and comparison with two other non-contact biometric devices in myopes. Clin Exp Optom 2013;96:92–99.
7. Rozema JJ, Wouters K, Mathysen DG, Tassignon MJ. Overview of the repeatability, reproducibility, and agreement of the biometry values provided by various ophthalmic devices. Am J Ophthalmol 2014;158:1111–1120 e1111.
8. Fernandez-Vigo JI, Fernandez-Vigo JA, Macarro-Merino A, Fernandez-Perez C, Martinez-de-la-Casa JM, Garcia- Feijoo J. Determinants of anterior chamber depth in a large Caucasian population and agreement between intraocular lens Master and Pentacam measurements of this variable. Acta Ophthalmol 2016;94:e150–e155.
9. Shajari M, Lehmann UC, Kohnen T. Comparison of corneal diameter and anterior chamber depth measurements using 4 different devices. Cornea 2016;35:838–842.
10. Shajari M, Cremonese C, Petermann K, Singh P, Muller M, Kohnen T. Comparison of axial length, corneal curvature, and anterior chamber depth measurements of 2 recently introduced devices to a known biometer. Am J Ophthalmol 2017;178:58–64.
11. Pinero DP, Soto-Negro R, Ruiz-Fortes P, Perez-Cambrodi RJ, Fukumitsu H. Analysis of intrasession repeatability of ocular aberrometric measurements and validation of keratometry provided by a new integrated system in mild to moderate Keratoconus. Cornea 2019;38:1097–1104.
12. Molina-Martin A, Pinero DP, Caballero MT, de Fez D, Camps VJ. Comparative analysis of anterior corneal curvature and astigmatism measurements obtained with three different devices. Clin Exp Optom 2020;103:618–624.
13. Song JS, Yoon DY, Hyon JY, Jeon HS. Comparison of ocular biometry and refractive outcomes using IOL Master 500, IOL Master 700, and Lenstar LS900. Korean J Ophthalmol 2020;34:126–132.
14. Olsen T. Calculation of intraocular lens power: A review. Acta Ophthalmol Scand 2007;85:472–485.
15. Norrby S. Sources of error in intraocular lens power calculation. J Cataract Refract Surg 2008;34:368–376.
16. Ruiz-Mesa R, Abengozar-Vela A, Ruiz-Santos M. Comparison of a new Scheimpflug imaging combinedwith partial coherence interferometry biometer and a low-coherence reflectometry biometer. J Cataract Refract Surg 2017;43:1406–1412.
17. Pereira JMM, Neves A, Alfaiate P, Santos M, Aragao H, Sousa JC. Lenstar(R) LS 900 vs Pentacam(R)-AXL: Comparative study of ocular biometric measurements and intraocular lens power calculation. Eur J Ophthalmol 2018;28:645–651.
18. Muzyka-Wozniak M, Oleszko A. Comparison of anterior segment parameters and axial length measurements performed on a Scheimpflug device with biometry function and a reference optical biometer. Int Ophthalmol 2019;39:1115–1122.
19. Haddad JS, Barnwell E, Rocha KM, Ambrosio R, Jr., Waring Iv GO. Comparison of biometry measurements using standard partial coherence interferometry versus new Scheimpflug tomography with integrated axial length capability. Clin Ophthalmol 2020;14:353–358.
20. Henriquez MA, Zuniga R, Camino M, Camargo J, Ruiz-Montenegro K, Izquierdo L, Jr. Effectiveness and agreement of 3 optical biometers in measuring axial length in the eyes of patients with mature cataracts. J Cataract Refract Surg 2020;46:1222–1228.
21. Bae GH, Kim JR, Kim CH, Lim DH, Chung ES, Chung TY. Corneal topographic and tomographic analysis of fellow eyes in unilateral keratoconus patients using Pentacam. Am J Ophthalmol 2014;157:103–109 e101.
22. Loffler F, Bohm M, Herzog M, Petermann K, Kohnen T. Tomographic analysis of anterior and posterior and total corneal refractive power changes after femtosecond laserassisted keratotomy. Am J Ophthalmol 2017;180:102–109.
23. Kataria P, Padmanabhan P, Gopalakrishnan A, Padmanaban V, Mahadik S, Ambrosio R, Jr. Accuracy of Scheimpflug-derived corneal biomechanical and tomographic indices for detecting subclinical and mild keratectasia in a South Asian population. J Cataract Refract Surg 2019;45:328–336.
24. Xia T, Martinez CE, Tsai LM. Update on intraocular lens formulas and calculations. Asia Pac J Ophthalmol (Phila) 2020;9:186–193.
25. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: Theory and application. Am J Med 2006;119:166 e167–116.
26. Ghosh A, Collins MJ, Read SA, Davis BA. Axial length changes with shifts of gaze direction in myopes and emmetropes. Invest Ophthalmol Vis Sci 2012;53:6465– 6471.
27. Hall AB, Thompson JR, Deane JS, Rosenthal AR. LOCS III versus the Oxford Clinical Cataract Classification and Grading System for the assessment of nuclear, cortical and posterior subcapsular cataract. Ophthalmic Epidemiol 1997;4:179–194.
28. Chirapapaisan C, Srivannaboon S, Chonpimai P. Efficacy of swept-source optical coherence tomography in axial length measurement for advanced cataract patients. Optom Vis Sci 2020;97:186–191.
29. Ryu SJ, Kim DR, Song IS, Shin YU, Seong M, Cho H, et al. The influence of low signal-to-noise ratio of axial length measurement on prediction of target refraction, achieved using IOLMaster. PLoS One 2019;14:e0217584.
30. Bland JM, Altman DG. Measurement error. BMJ 1996;313:744.
31. Bergin C, Guber I, Hashemi K, Majo F. Tolerance and relative utility: Two proposed indices for comparing change in clinical measurement noise between different populations (repeatability) or measurement methods (agreement). Invest Ophthalmol Vis Sci 2015;56:5543– 5547.
32. Schroder S, Langenbucher A, Schrecker J. Comparison of corneal elevation and pachymetry measurements made by two state of the art corneal tomographers with different measurement principles. PLoS One 2019;14:e0223770.
33. Srivannaboon S, Chirapapaisan C, Chonpimai P, Loket S. Clinical comparison of a new swept-source optical coherence tomography-based optical biometer and a time-domain optical coherence tomography-based optical biometer. J Cataract Refract Surg 2015;41:2224–2232.
34. Sikorski BL, Suchon P. OCT Biometry (B-OCT): A new method for measuring ocular axial dimensions. J Ophthalmol 2019;2019:9192456.
35. Chan TCY, Wan KH, Tang FY, Wang YM, Yu M, Cheung C. Repeatability and agreement of a swept-source optical coherence tomography-based biometer IOLMaster 700 versus a Scheimpflug imaging-based biometer AL-Scan in cataract patients. Eye Contact Lens 2020;46:35–45.
36. Chia TMT, Nguyen MT, Jung HC. Comparison of optical biometry versus ultrasound biometry in cases with borderline signal-to-noise ratio. Clin Ophthalmol 2018;12:1757–1762.