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Sponsored by ZEISS

Increasing Presurgical Precision with the ZEISS IOLMaster 700

Content guidance: William Trattler, MD

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“Modern surgeons are lucky enough to live in an age with advanced biometers that allow surgeons to improve the precision of their presurgical IOL calculations.”

–William Trattler, MD

Let's explore how the ZEISS IOLMaster 700 captures and analyzes a complete set of biometric parameters for the latest IOL power calculations.

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1. Preoperative measurements

Obtain comprehensive and precise biometric, keratometric, and anatomic scans with confidence that fixation was on target.

Why is angle kappa important?

Efficiency and Repeatability

  • With 2,000 scans per second, ZEISS IOLMaster 700 can measure both eyes in less than 45 seconds.2
  • Alignment assistance functions make the results largely independent of the operator.
  • A penetration rate of more than 99% of cataracts to reduce the need for ultrasound.3

Very dense cataract that was measured successfully.
Image courtesy of Prof. M. de La Torre, DLT Ophthalmic Center, Peru.

Keratometry

Directly measure the anterior and posterior corneal surface to obtain a Total Keratometry (TK).

Telecentric keratometry is distance independent, provides accurate corneal readings regardless of pupil size, and penetrates the sclera.

What is the difference between keratometry and Total Keratometry?

  • The same IOL constants can be used for both keratometry and TK.
  • TK measurements are compatible with existing IOL constants and classic IOL calculation formulas, plus two exclusive formulas: Barrett True K with Total Keratometry (TK) and Universal II and Barrett TK Toric

What do the studies show?

Cornea-to-Retina Scan

SWEPT Source Biometry provides a full-length OCT image showing anatomical details on a longitudinal cut through the entire eye.

SCAN CAPABILITIES:

Detect unusual eye geometries such as tilt or decentration of the crystalline lens. Use your mouse to compare typical geometry and suspected lens tilt below:

Image courtesy of Prof. W. Sekundo, Philipps University Hospital Marburg, Germany.

Verify good fixation by visualizing the foveal pit with a 1-mm central retina scan.

Reduce the risk of refractive surprises due to incorrect measurements caused by undetected poor fixation

Reveal abnormalities of the retinal surface and macular pathologies that requires further investigation.

Macular hole: Fixation Check image (middle) combined with ZEISS CIRRUS retina OCT image (via photo editor program). Findings need to be verified and pathologies diagnosed with a dedicated retina OCT. Image courtesy of Prof. W. Sekundo, Philipps University Hospital Marburg, Germany.

Visually verify evaluation by correlating measurement calipers with images of anatomical structures to eliminate complex interpretation of A-scans and reduce potential sources of error.

Direct comparison of Lenstar (Haag-Streit) A-Scan with the ZEISS IOLMaster 700 B-Scan. Case courtesy of Prof. M. Blum, HELIOS Klinikum Erfurt, Germany.

Central Topography

With no changes in workflow, the ZEISS IOLMaster 700 provides anterior and total axial power maps designed to detect visually relevant central corneal asymmetries.6

Gain critical insights about corneal performance to make appropriate toric and multifocal IOL recommendations.

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2. Comprehensive Treatment Planning

Integrate ZEISS IOLMaster 700 measurements seamlessly into the ZEISS Cataract Workflow via ZEISS VERACITY Surgery Planner to create your surgical plans.

  • Direct measurements of the anterior and posterior corneal surface account for the patient's individual anatomy instead of eye model assumptions.
  • Measurements can be analyzed in a range of IOL power calculation formulas within the ZEISS IOLMaster 700 software or via ZEISS VERACITY Surgery Planner.
  • Compatible IOL power calculation formulas include:

Updated Surgeon Printout

Designed with input from over 40 cataract surgeons, an updated 2 page print out allows for efficient IOL selection and review of biometry measurements.

Page 1:

  • Mix and Match IOLs and formulas
  • New display of toric calculation results designed for an easier selection of cylinder power

Page 2:

  • All ZEISS IOLMaster 700 measurements
  • Both eyes on one page

Optional additional pages can be created for more IOL power calculations.

The printout was designed to quickly find and easily read relevant information.

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3. In the Operating Room

In the operating room, biometric data obtained preoperatively by the ZEISS IOLMaster 700 are transmitted directly to ZEISS CALLISTO eye to generate an intraoperative guidance overlay and to the ZEISS QUATERA 700 phacoemulsification system to provide patient data.

Guidance overlays are visible though the eyepiece or on the heads-up displays with both the ZEISS OPMI LUMERA 700 or ZEISS ARTEVO 800 microscopes.

A physician's perspective

Trattler headshot

Modern surgeons are lucky enough to live in an age with advanced biometers that allow surgeons to improve the precision of their presurgical IOL calculations. My clinic leverages the power of the ZEISS IOLMaster 700 to reduce the risk of refractive surprises, optimize workflow, and improve refractive outcomes.

Let's explore each of those benefits in detail.

Reduced risk of refractive surprises. Traditional IOL power calculation relies on an exact measurement (ie, that of the anterior corneal surface) and an estimate of total corneal power (ie, a nomogram). The ZEISS IOLMaster 700 features Total Keratometry, a technology that accounts for the posterior corneal surface when making IOL power calculations, thereby replacing the assumption made by a nomogram with a precise anatomic measurement acquired via swept-source OCT. Patients with atypical corneal geometries can now have their unique anatomy accounted for in the presurgical period.

Total Keratometry on the ZEISS IOLMaster 700 has proven to be particularly effective when managing cases of patients with astigmatism. In my estimation, 40% of the patients who visit my clinic have astigmatism. With Total Keratometry, I can rest assured that my total corneal power calculations are as accurate as possible for these patients.

Optimized workflow. Assessment with the ZEISS IOLMaster 700 is part of my clinic's routine cataract evaluation for new patients. Patients with dense cataracts can be assessed using the ZEISS IOLMaster 700, which allows my staff to stick with an efficient, easy-to-use platform rather than move that patient to ultrasound imaging.

In my opinion, surgeons who use the ZEISS VERACITY Surgery Planner platform will maximize their experience with the ZEISS IOLMaster 700. Calculations captured by the ZEISS IOLMaster 700 are at a surgeon’s fingertips in the OR when employing ZEISS VERACITY Surgery Planner.

Improved refractive outcomes. A surgical practice that includes technology such as the ZEISS IOLMaster 700 may experience reduced rates of postsurgical enhancements thanks to the more exact nature of IOL calculations. At my practice, I have noticed a marked decline in the rate of requested enhancements from astigmatic patients, which I credit in part to the precise presurgical measurements I am empowered to obtain via the ZEISS IOLMaster 700. This, in turn, has made my practice more efficient, as I am able to spend more time with new patients in need of cataract surgery.

Surgeons who wish to embrace cutting-edge innovations in their practice should consider adding the ZEISS IOLMaster 700 to their preoperative routine. The easy integration of the platform into a clinic means that workflow and patient throughput will not be disrupted, and more precise total corneal calculations may mean higher rates of patient satisfaction and reduced rates of surgical enhancements—all of which leads to increased clinical efficiency and more satisfied patients.

William Trattler, MD

Dr. Trattler is a consultant for Carl Zeiss Meditec, Inc.

References:

1. Jack T. Holladay, MD, Hidden Figures, Cataract & Refractive Surgery Today Europe, April 2018

2. Depending on experience of operator and eye conditions.

3. R. Varsits, N. Hirnschall, B. Doeller, O. Findl; Increasing the number of successful axial eye length measurements using swept-source optical coherence tomography technology compared to conventional optical biometry; presented at ESCSR 2016.

4. Srivannaboon S, Chirapapaisan C. Comparison of refractive outcomes using conventional keratometry or total keratometry for IOL power calculation in cataract surgery. Graefe's Arch Clin Exp Ophthalmol. 2019;257(12):2677-2682.

5. Yeo TK, Heng WJ, Pek D, Wong J, Fam HB. Accuracy of intraocular lens formulas using Total Keratometry in eyes with previous myopic laser refractive surgery. Eye. 2020.

6. ZEISS IOLMaster 700 Central Topography does not replace a full topography. For any further diagnosis please use a topographer.


The statements of the doctor in this insert reflect only his personal opinions and do not necessarily reflect the opinions of any institution with which he is affiliated. The doctor shown in this insert has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.


Not all products and services are available in all countries.


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Sponsored by ZEISS

Angle Kappa

Angle kappa (or Chang-Waring chord (CWC))

Why is this important?

Angle kappa is the difference between the center of the pupil and the visual axis. If angle kappa (or chord µ 1 ) value is greater than 0.6 mm, patients with diffractive lenses may have more halo and glare.1