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toric IOL was measured. The difference between theangles measured at baseline and after 3 months would bethen the angle of rotation.The method used by Patel
.was somehowdifferent. They used a computerized system to capturea retroillumination image and then the processing wasperformed. A software tool within the capture systemmapped the optic zone and located its center. Thenanother cursor marks a peripheral point on the opticand, along with the center, deﬁnes a line. The subtendedangle between this line and the vertical is then comparedwith assess rotation. Repeatability values obtainedintraobserver for loop and plate haptic IOLs were 0.35
, respectively. This studyshows one of the best methods to estimate IOL stability usingretroillumination images.
Centration and stability of pseudophakic intraocularlenses
Using Scheimpﬂug imaging Hayashi and Hayashicompared stability of one-piece and three-piece acrylicIOLs (with soft acrylic loops and rigid polymethilmetha-crilate loops, respectively), reporting that there is nodifference between the two IOL types in tilt and centra-tion nor was there a difference throughout the follow-upperiod. Verbruggen
.reported predictable cen-tration with the bag-in-lens implantation technique,which was stable over time. They used digital photogra-phy analysis in which the position of the optical zone of the IOL with respect to both the dilated pupil center andlimbus was measured to assess centration.With regards to rotational stability, Weinand
.used retroillumination digital photography and sub-sequent image analysis to assess the rotational stabilityof a single-piece hydrophobic IOL ﬁnding a rotationbetween 0.5
in 47% of the patients studied(ranging from 0.1 to 1.8
.found clinicallysigniﬁcant levels of rotation with toric plate-haptic IOLsin 11% of the patients.
Centration and stability of IOLs are a matter of mostimportance and reliable methods of determination are amust. Up to now, many methodologies have been devel-oped to determine centration and rotation of the IOL,andadifferentmethodisdescribedinalmosteverystudy.Although the reasoning behind all these methods offers aclever approach, it would be desirable to establish thebest one, doing appropriate performance assessment stu-diesandusingitasagoldstandardforthenewmethodstocome. To the authors’ knowledge, the best documentedmethod for the assessment of lens position would be thatdescribed by Coppens
.using Scheimpﬂugimaging, and, for rotational stability, that described byPatel
.. Both methods proved to be repeatable,but the fact that they are the best documented ones doesnot imply necessarily that they are the best methodsto use.Beforeamethodisdevelopedfordeterminingtheclinicalimpact or the magnitude of lens position and stability,appropriate assessment of the methodology used shouldbe done. Then, both the author and the reader can assessthe full extent of the conclusion reached from the clinicalapplication of the methodology, to compare those resultswith other methods described, and to know its limita-tions.
This research has been supported in part by Red Tema´tica Optometrı´aMinisterio de Ciencia e Innovacio´n (Acciones ComplementariasSAF2008-01114-E).There are no conﬂicts of interest.
References and recommended reading
Papers of particular interest, published within the annual period of review, havebeen highlighted as:
of special interest
of outstanding interestAdditional references related to this topic can also be found in the CurrentWorld Literature section in this issue (p. 72).
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Intraocular lens centration and stability