675

ARTICLE

Evaluation of total corneal power

measurements with a new
Downloaded from https://journals.lww.com/jcrs by IJFFeEaHn1fAmUjQu206yff+8ovkWFQvnpnPNd9og3pPkoW3tT9tX/tRPn3V6aa7wAulI58LSnRfQEIksSCtuXVn3YbotFMXHmKOu3UKtRZQrzgUA7VCQQWUCNiTAsNWmuQ/nMhjfBKwFlVdV5gh3njvmC2BCiJw82h8bDjeeqM3R6mHu/BWmnLI5Hco1HDV on 05/03/2020

optical biometer
Mehdi Shajari, MD, FEBO, Ruven Sonntag, Michaela Ramsauer, MD, Thomas Kreutzer, MD, FEBO,
Efstathios Vounotrypidis, MD, FEBO, Thomas Kohnen, MD, PhD, FEBO, Siegfried Priglinger, MD, PhD, FEBO,
Wolfgang J. Mayer, MD, PhD, FEBO

Purpose: To evaluate the repeatability and validity of total corneal
power measurements (total keratometry [TK]) obtained with a re-
cently introduced optical biometer (IOLMaster 700, Carl Zeiss
Meditec AG) to a Scheimpflug device (Pentacam, Oculus).
Setting: Department of Ophthalmology, Ludwig-Maximilians-
University, Munich, Germany.
Design: Prospective randomized controlled trial.
0.43 for true net power (TNP), and 0.39 for simulated K. Bland–
Altman analysis showed no significant difference between the
optical biometer’s TK compared with standard K and the
Scheimpflug device’s simulated K, TNP, and TCRP, the P value
exceeding .05 in each case. A difference of >0.50 diopters
between astigmatism measurements between TK and TCRP
was found in 10 cases compared with standard K and TNP
with 0 and 2 cases.

Methods: The inclusion criteria were a corneal astigmatism of
3.00 diopters (D) or less, no previous ocular surgery, no known
corneal irregularities, and no known dry eyes. All eyes were
measured 3 times using the optical biometer and the Scheimp-
flug device. The results were statistically compared using
Bland–Altman, within-subject SD, and astigmatism vector
analysis.
Results: Ninety-three eyes of 93 subjects were included. Over-
all, the repeatability of all eyes measured was 0.42 for standard
K, 0.40 for TK, 0.45 for total corneal refractive power (TCRP),
Conclusions: Repeatability of both devices was high, although
measurements of meridian showed a great variability, suggesting
that numerous measurements are needed to enhance accuracy.
TCRP measurements between recently introduced TK and TCRP
cannot be used interchangeably. Future studies are necessary to
evaluate which measurement will result in a better outcome when
respective measurements are used for toric intraocular lens
calculations.
J Cataract Refract Surg 2020; 46:675–681 Copyright © 2020 Published by
Wolters Kluwer on behalf of ASCRS and ESCRS

I
ntraocular lens (IOL) power calculation plays a vital
role in recovering a patient’s visual acuity by cataract
surgery. Different formulas can be used for IOL power
calculation, all depending strongly on the axial length and
the corneal power. Hence, a device that accurately and
reliably measures these variables will generate a superior
outcome for the patient.
One optical biometer capable of measuring the dis-
cussed variables is the Pentacam (Oculus), using
Scheimpflug technology. It measures the total corneal
refractive power (TCRP) using the ray-tracing method,
applying Snell’s law of refraction to calculate the re-
fractive power at any given point on the cornea; the
manufacturer states that TCRP should realistically reflect
the actual refractive power. The Scheimpflug device also
measures the true net power (TNP), incorporating the
curvature of the anterior and posterior corneal surface,
and the refractive indices of the different media.1,2
Simulated keratometry (K) is an estimate of the total
corneal power based on the assumption that the cornea is
a single refracting surface. The anterior corneal curvature
and refractive index are used for its calculation.3
Although older optical biometers by Zeiss, such as the
IOLMaster 500, only measured the anterior corneal curva-
ture, the Pentacam also takes the posterior corneal curvature
into consideration. Studies have shown that the

Submitted: June 24, 2019 | Final revision submitted: December 9, 2019 | Accepted: January 11, 2020
From the Department of Ophthalmology, Ludwig-Maximilians University (Shajari, Sonntag, Ramsauer, Kreutzer, Vounotrypidis, Priglinger, Mayer), Munich, Department of
Ophthalmology (Shajari, Kohnen), Goethe University, Frankfurt, Germany.
M. Shajari and R. Sonntag contributed equally to this work.
Corresponding author: Wolfgang J. Mayer, MD, PHD, FEBO, Department of Ophthalmology, Ludwig-Maximilians University, Mathildenstrasse 8, Munich 80336,
Germany. Email: wolfgang.j.mayer@med.uni-muenchen.de.

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS 0886-3350/$ - see frontmatter
Published by Wolters Kluwer Health, Inc. https://doi.org/10.1097/j.jcrs.0000000000000136

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
676 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS
measurement of the posterior corneal curvature reduces
systematic measurement error and improves the refractive
accuracy, suggesting that patients could benefit from taking
the posterior corneal curvature into consideration when
measuring the total corneal astigmatism.4,5 The newer op-
tical biometer IOLMaster 700 includes the posterior corneal
curvature, and can incorporate the influence of the posterior
corneal curvature with the measurement of the total corneal
power (total K [TK]).6
The recently introduced IOLMaster 700 measures axial
length and corneal power using swept-source optical co-
herence tomography (SS-OCT) technology. SS-OCT scans
the eye with a rapid-cycle, tunable wavelength laser, which
is known to give a better signal-to-noise ratio and has
improved tissue penetration and image quality.7 Several
published studies have shown good results for agreement
between the IOLMaster 700 and other devices, as well as
high repeatability; however, comparison so far has only
looked at the anterior corneal surface and not the total
corneal power. In addition, the IOLMaster 700 showed
a higher success rate in obtaining measurements in eyes
with posterior subscapular and dense nuclear cataracts.8–10
The purpose of this study was to evaluate the re-
peatability and validity of the corneal power measurements
compared with the corresponding variables of both optical
biometers. The main focus was on the comparison of TK
(IOLMaster 700) with TCRP and TNP (Pentacam).
METHODS
This prospective controlled study included 93 eyes of 93 volun-
teers, acquiring proper informed consent for participation of every
patient enrolled. All patients were examined in the Department of
Ophthalmology, Ludwig-Maximilians-University, Munich, Ger-
many. The study was performed in conduct with the principles of
the Declaration of Helsinki and was approved by the local in-
stitutional review board.
Exclusion criteria included previous ocular surgery, known
corneal irregularities, previous corneal pathology, dry eyes, and
a corneal astigmatism above 3.00 diopters (D). In addition, only
measurements were included, which achieved the image quality
recommended by the manufacturer (for the IOLMaster 700,
measurements marked with an exclamation mark were excluded;
for the Pentacam, it needed to be marked “OK” by the automated
quality check).
One of 3 trained optometrists performed 3 complete auto-
mated measurements with each of the 2 devices. The order of
measurement was chosen randomly. In between each finished
measurement, the patient was asked to stand up, and the po-
sition of the device’s joystick and chin rest was changed to
ensure that the measurements were independent of one
another.
For the Pentacam, the patients were asked to fixate on the
light, and Scheimpflug pictures were taken as soon as the correct
alignment was achieved. For the IOLMaster 700, the patients
positioned their chin on the headrest and looked at the fixation
light.
The repeatability of the devices used to collect 3 measurements
of each eye was determined by calculating the within-subject SD
(Sw) according to Bland and Altman.11 In addition, pffiffiffithe re-
peatability was calculated by multiplying the Sw with 2 × 1.96
(=2.77). This value indicates that the difference between 2
measurements for the same patient is expected to be less than
2.77 × Sw for 95% of pairs of measurements.11
Volume 46 Issue 5 May 2020
Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
The total refractive power TK (IOLMaster 700) was compared
with standard K (IOLMaster), simulated K (Scheimpflug), TCRP
(Scheimpflug), and TNP (Scheimpflug). In addition, total corneal
curvature TR (IOLMaster) was compared with standard R (IOL-
Master), simulated R (Scheimpflug), and TNP (Scheimpflug). For
each comparison, the validity was evaluated with the Bland–Altman
analysis.12 The difference between 2 measurements is plotted over the
mean of those 2 measurements to obtain a Bland–Altman diagram.
The graph indicated any systematic error, showing how far 2 readings
are separated from each other. The coefficient of repeatability (CoR)
and the relative CoR (CoR/average measurement) were calculated.
Furthermore, limits of agreement (LOA = mean ± CoR) were re-
corded, which define the variability of the values measured. The
analysis of the refractive power also included an independent 2-
sample t-test. A P value of less than 0.05 was considered statistically
significant.
Another analysis of validity for the comparison mentioned above
was performed, emphasizing clinical significance rather than sta-
tistical significance. The difference between the first measurement of
each of the 2 variables compared was calculated, and all values were
highlighted, exceeding a defined limit. For the comparison with TK,
any difference in the total corneal astigmatism greater than 0.50
diopters (D) was highlighted, and for the comparison of the axis, any
difference greater than 20 degrees, respectively. The sum of cases
where a value was highlighted would therefore show which variables
when compared had a difference greater than the defined clinically
significant limit.
Vector analysis was performed to evaluate the corneal astig-
matism, according to Abulafia et al.13 Double-angle plots were
generated with the Astigmatism Double Angle Plot Tool.14
RESULTS
The study evaluated 93 healthy volunteers (43 men and 50
women). The mean age was 52.35 ± 19.1 (SD) years (range
18 to 85 years).
Repeatability
Table 1 shows the within-subject SD (Sw) and repeatability
(2.77 × Sw) for each variable measured, where a smaller
value indicates a better repeatability.
Comparability
Table 2 shows the P value, CoR, relative CoR, and the limits
of agreement of the comparison between the true values
(TR and TK measured with the IOLMaster 700) and the
corresponding variables. Figure 1 and Figure 2 show the
corresponding Bland-Altman plots for each comparison
mentioned in Table 2.
The 2-sample t-test for the comparison of astigmatism
measured using TK and the astigmatism measured with
standard K, simulated K, TNP, and TCRP showed no
significant difference between any of the mentioned vari-
ables (P = .125 for standard K, P = .153 for simulated K, P =
.167 for TNP, and P = .557 for TCRP).
The test we conducted to analyze in how many cases the
difference between 2 variables exceeded a clinically signifi-
cant limit we defined beforehand showed a certain trend. For
the difference in astigmatism, 0.50 D was exceeded in 0 cases
for the comparison with standard K and in 2 cases for TNP
out of the 93 eyes examined. Simulated K exceeded this limit
in 4 cases, TCRP in 10. For the difference in meridian, 20
degrees was exceeded in 8 and in 9 cases for standard K and
 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS 677

Table 1. Repeatability of the variables measured.

Pentacam IOLMaster 700

Repeatability Repeatability
Variable SW (SW × 2.77) Variable SW (SW × 2.77)
CCT (µm) 2.47 6.83 CCT (µm) 3.45 9.55
ACD (mm) 0.08 0.21 ACD (mm) 0.03 0.09
Simulated K Standard K
R1 (mm) 0.03 0.07 R1 (mm) 0.06 0.17
R2 (mm) 0.02 0.06 R2 (mm) 0.02 0.07
Asti (D) 0.14 0.39 Asti (D) 0.15 0.42
Meridian (°) 7.45 20.63 Meridian (°) 8.65 23.95
TCRP TK
K1 (D) 0.16 0.44 R1 (mm) 0.02 0.06
K2 (D) 0.57 1.59 R2 (mm) 0.06 0.18
Asti (D) 0.16 0.45 Asti (D) 0.14 0.40
Meridian (°) 9.37 25.95 Meridian (°) 12.44 34.47
Posterior cornea
K1 (D) 0.04 0.11 WzW (mm) 0.23 0.65
K2 (D) 0.04 0.11 AL (mm) 0.11 0.30
Asti (D) 0.04 0.12 LD (mm) 0.02 0.05
Meridian (°) 5.73 15.86
TNP
R1 (mm) 0.03 0.08
R2 (mm) 0.02 0.06
Asti (D) 0.16 0.44
Meridian (°) 10.68 29.58

ACD = anterior chamber depth; AL = axial length; Asti = astigmatism; CCT = central corneal thickness; IOL = intraocular lens; K = refractive power; LD = lens
thickness; R = corneal curvature; SW = within-subject SD; TCRP = total corneal refractive power; TK = total keratometry; TNP = true net power; WzW =
horizontal corneal diameter

TNP, respectively. In contrast, simulated K exceeded this DISCUSSION

limit 14 times and TCRP 19 times.
Table 3 shows the astigmatism vector mean of each
variable measured with SD and its meridian in degrees.
Table 4 shows the difference in the vectors obtained when
comparing the different variables, similar to the Bland–
Altman analysis. Figure 3 shows the vector analysis with
double-angle plots, representing astigmatism measure-
ments obtained using the different corneal power param-
eters evaluated. Looking at the 95% confidence ellipse of the
dataset, standard K and TK look very much alike. This is
also the case for the Pentacam’s simulated K, TNP, and
TCRP.
In this study, we tested the repeatability of variables
measured by both the Pentacam and the IOLMaster 700.
This analysis was performed, calculating the within-subject
SD (Sw). Looking at astigmatism measured with both de-
vices, the repeatability (Sw × 2.77) is very similar
throughout, with 0.42 for standard K, 0.40 for TK, 0.45 for
TCRP, 0.43 for TNP, and 0.39 for simulated K.
Srivannabonn et al. showed that the repeatability of the
IOLMaster 700 was excellent, and compared with the
IOLMaster 500, agreement was high. Furthermore, the lens
penetration of the IOLMaster 700 was superior compared
with its older predecessor.7 Other studies have come to

Table 2. Comparison of true corneal curvature and TK astigmatism with the corresponding variables measured.
Mean Upper Lower LOA
Variable Eyes (n) P Value Difference CoR rCoR LOA LOA Range R2
CCD vs CCD 93 .003 3.495 16.035 2.853 19.529 12.540 32.069 0.099
ACD vs ACD 93 .005 0.004 0.209 6.506 0.213 0.205 0.418 0.083
TR vs standard R 93 .839 0.006 0.048 0.626 0.042 0.054 0.096 0.001
TR vs SimR 93 .895 0.056 0.111 1.439 0.055 0.166 0.222 0.0002
TR vs TNP R 93 .174 0.289 0.104 1.335 0.185 0.394 0.209 0.202
TK Asti vs stan Asti 93 .080 0.481 0.330 39.516 0.378 0.282 0.660 0.033
TK Asti vs SimK Asti 93 .466 0.047 0.629 65.155 0.676 0.581 1.258 0.006
TK Asti vs TNP Asti 93 .089 0.430 0.584 60.561 0.541 0.627 1.169 0.0002
TK Asti vs TCRP Asti 93 .896 0.226 0.725 71.469 0.748 0.703 1.451 0.031

ACD = anterior chamber depth; Asti = astigmatism; CCT = central corneal thickness; CoR = coefficient of repeatability; LOA = limit of agreement; R = corneal
curvature; rCoR = relative CoR; stan = standard; TCRP = total corneal refractive power; TK = total keratometry; TNP = true net power

Volume 46 Issue 5 May 2020

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
678 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS

Figure 1. Bland–Altman plots of comparison between astigmatism measured using TK with astigmatism measured using (a) standard K,
(b) simulated K, (c) TNP, and (d) TCRP (K = keratometry; TCRP = total corneal refractive power; TK = total keratometry; TNP = true net power).

a similar conclusion, demonstrating the high repeatability
of both the IOLMaster 700 and the Pentacam.7,8,15 The
within-subject SD for standard K found by Kunert et al.16
was slightly larger, where the Sw was 0.20 D compared with
0.15 D in this study. Another study from 2017 also reported
a higher within-subject SD for standard K with 0.24 D.17
Reasons for this might be a higher number of patients
tested, in addition to 3 measurements of the same eye
conducted in comparison to 2 measurements per eye in the
study from 2017.
A study from 2016 showed that the highest re-
peatability of corneal astigmatism measurements was
achieved by TCRP measurements with the Pentacam in
comparison with various topographers, including the
IOLMaster 500. The IOLMaster 700 seems to have closed
the gap because our results suggested a slightly better
repeatability using TK compared with TCRP.18 However,
the results shown in Table 1 also suggest that the re-
peatability is not given when measuring the meridian of
the astigmatism for any of the variables evaluated.
Therefore, before calculating a patient’s toric IOL cyl-
inder power, repeated measurements of the astigmatism
meridian should be taken into consideration to ensure an
acceptable outcome.

Figure 2. Bland–Altman plots of comparison between true corneal curvature (TR) with corneal curvature measured using (a) standard R,
(b) simulated R and (c) TNP (TNP = true net power).

Volume 46 Issue 5 May 2020

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS 679

Table 3. Comparison of the astigmatism vector mean of

compared with TK in a clinical setting. The differences in
each variable measured. meridian show more cases where the limit of 20 degrees
Comparability was exceeded, no matter the variable compared with TK.
This is probably due to the fact that the repeatability of
Astigmatism Vector
Device Variable (Mean ± SD at Degrees)
meridian measurements was rather poor, as suggested by
the analysis of the within-subject SD. The bigger range in
IOLMaster 700 TK 0.43 ± 0.75 at 177
K 0.62 ± 0.74 at 179
measurements would therefore lead to larger differences
Pentacam SimK 0.65 ± 0.77 at 180 in the test conducted. Once again, this would imply that
TCRP 0.57 ± 0.79 at 001 the meridian of the astigmatism should be measured
TNP 0.45 ± 0.76 at 177 more than once in a clinical setting to enhance the ac-
IOL = intraocular lens; K = keratometry; TCRP = total corneal refractive curacy of treatment.
power; TK = total keratometry; TNP = true net power Analysis of the vectors, as shown in Tables 3 and 4,
showed great agreement between the astigmatism vector
This study also evaluated the validity of the IOLMaster mean of TK and TNP, with a mean difference of 0.01 ±
corneal power measurements (TK and TR) compared 0.32 D. Comparison between TK and TCRP (difference of
with simulated K, TNP, and TCRP. The Bland–Altman 0.15 ± 0.36 D) and between TK and standard K (difference
analysis has shown no significant difference between the of 0.19 ± 0.09 D) showed weaker agreement. Together
IOLMaster 700’s TR and TK compared with the corre- with the results summarized above, this would suggest that
sponding Pentacam measurements of simulated K, TNP, TK and TNP are most comparable.
and TCRP, the P value exceeding .05 in each case. Visser et al.19 compared various topographers using
The Bland–Altman graphs in Figures 1 to 2 show vector analysis and found a mean difference in corneal
a mean difference near zero, implying that the meas- astigmatism of 0.03 ± 0.29 between standard K with
urements are somewhat comparable. The mean difference the IOLMaster 500 and simulated K. When we com-
was lowest for the comparison between the IOLMaster pared standard K with simulated K, we found the same
700’s TK and the Pentacam’s simulated K with 0.047. The mean difference of 0.03 ± 0.29, although we used the
comparison between TK and standard K, TNP, and TCRP newer IOLMaster 700 and had different mean astig-
showed a higher mean difference with 0.481, 0.430, and
matism vectors. This would suggest a similar compa-
0.226, respectively. This suggests that the IOLMaster 700
rability and agreement of the measurements made with
measurements are most comparable to the Pentacam’s
simulated K followed by TCRP. both devices.
The test to evaluate the differences in total corneal As the concept of a measured TK is fairly new, there
astigmatism exceeding 0.50 D showed a clear trend. are a few things to consider. Zeiss claims that TK can be
Differences between astigmatism measured with TK incorporated in classic IOL power calculations, using
compared with standard K (0 cases) and TNP (2 cases) optimized IOL constants, such as User Group for Laser
did not exceed the limit as often as it was the case with Interference Biometry (ULIB) constants, which was
simulated K and TCRP (4 and 10 cases). Differences in verified by Haigis et al.20 So far, ULIB constants are
astigmatism measurements exceeding a clinically sig- based on keratometry measurements of the anterior
nificant limit are concealed in a calculation for the mean corneal curvature and fixed ratios, rather than the total
difference, as in the Bland–Altman analysis. This test corneal power, considering the actually measured pos-
reveals these cases and suggests a different conclusion terior corneal curvature. Therefore, the question arises
that standard K and TNP show a higher validity how TK can still be used with standard ULIB lens
constants and whether TK has been adjusted to do so.
Because standard K and TK show no significant dif-
ference in astigmatism measured (P = 0.125), it can be
Table 4. Difference between the astigmatism vector
mean of the variables compared. assumed that Zeiss has adjusted TK to some degree. The
Mean Difference
growing use of optical biometers capable of measuring
the posterior corneal curvature could affect the ULIB
Astigmatism Vector
constants in the future, shifting them toward meas-
Variables Compared (Mean ± SD at Degrees)
urements considering both the anterior and posterior
TK vs TCRP 0.15 ± 0.36 at 12
corneal curvature. Although the repeatability of both
TK vs TNP 0.01 ± 0.32 at 03
TK vs K 0.19 ± 0.09 at 03 devices has been discussed in several studies, the
K vs SimK 0.03 ± 0.29 at 21 comparability of total corneal power measurements,
TCRP = total corneal refractive power; TK = total keratometry; TNP = true such as TK, needs to be explored further, especially in
net power a clinical setting.

Volume 46 Issue 5 May 2020

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
680 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS
Figure 3. Double-angle plots visualizing the astigmatism measurements measured with (a) standard K, (b) TK, (c) SimK, (d) TNP, and (e) TCRP
(TCRP = total corneal refractive power; TK = total keratometry; TNP = true net power).
WHAT WAS KNOWN
 Because of variability in the posterior corneal curvature,
a significant difference exists between measuring the anterior
surface alone and simulating the total corneal power com-
pared with measuring the total corneal refractive power
(TCRP) directly.
 Scheimpflug devices can measure with a high repeatability
the anterior and posterior corneal curvature and TCRP.
WHAT THIS PAPER ADDS
 A recently introduced software update allows a widely used
optical biometer to measure the TCRP with high repeatability.
 There is a significant difference between total corneal
measurements of the optical biometer and the Scheimpflug
device.
REFERENCES
1. Tonn B, Klaproth OK, Kohnen T. Anterior surface–based keratometry
compared with Scheimpflug tomography–based total corneal astigmatism.
Invest Ophthalmol Vis Sci 2015;56:291–298
2. Savini G, Barboni P, Carbonelli M, Hoffer KJ. Comparison of methods to
measure corneal power for intraocular lens power calculation using a rotat-
ing Scheimpflug camera. J Cataract Refract Surg 2013;39:598–604
3. Herrmann C, Ludwig U, Duncker G. [Corneal topography; analysis of the
corneal surface]. Opthalmologe 2008;105:193–206
4. Rydström E, Westin O, Koskela T, Behndig A. Posterior corneal astigmatism
in refractive lens exchange surgery. Acta Ophthalmol (Copenh) 2016;94:
295–300
5. Koch DD, Ali SF, Weikert MP, Shirayama M, Jenkins R, Wang L. Contri-
bution of posterior corneal astigmatism to total corneal astigmatism.
J Cataract Refract Surg 2012;38:2080–2087
6. Abulafia A, Hill WE, Koch DD, Wang L, Barrett GD. Accuracy of the Barrett
True-K formula for intraocular lens power prediction after laser in situ
Volume 46 Issue 5 May 2020
Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.
keratomileusis or photorefractive keratectomy for myopia. J Cataract Re-
fract Surg 2016;42:363–369
7. Srivannaboon S, Chirapapaisan C, Chonpimai P, Loket S. Clinical com-
parison 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
8. Kurian M, Negalur N, Das S, Puttaiah NK, Haria D, J TS, Thakkar MM.
Biometry with a new swept-source optical coherence tomography bio-
meter: repeatability and agreement with an optical low-coherence reflec-
tometry device. J Cataract Refract Surg 2016;42:577–581
9. Akman A, Asena L, Güngör SG. Evaluation and comparison of the new
swept source OCT-based IOLMaster 700 with the IOLMaster 500. Br J
Ophthalmol 2016;100:1201–1205
10. Hirnschall N, Varsits R, Doeller B, Findl O. Enhanced penetration for axial
length measurement of eyes with dense cataracts using swept source
optical coherence tomography: a consecutive observational study. Oph-
thalmol Ther 2018;7:119–124
11. Bland JM, Altman DG. Measurement error. BMJ 1996;313:744
12. Martin Bland J, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet 1986;327:307–310
13. Abulafia A, Koch DD, Holladay JT, Wang L, Hill W. Pursuing perfection in
intraocular lens calculations: IV. Rethinking astigmatism analysis for in-
traocular lens-based surgery: suggested terminology, analysis, and stand-
ards for outcome reports. J Cataract Refract Surg 2018;44:1169–1174
14. Astigmatism Double Angle Plot Tool. ASCRS. American Society of Cararact
and Refractive Surgery. Available at: https://ascrs.org/astigmatism-double-
angle-plot-tool. Accessed May 15, 2019
15. Sel S, Stange J, Kaiser D, Kiraly L. Repeatability and agreement of
Scheimpflug-based and swept-source optical biometry measurements.
Contact Lens Anterior Eye 2017;40:318–322
16. Kunert KS, Peter M, Blum M, Haigis W, Sekundo W, Schütze J, Büehren T.
Repeatability and agreement in optical biometry of a new swept-source optical
coherence tomography–based biometer versus partial coherence interferometry
and optical low-coherence reflectometry. J Cataract Refract Surg 2016;42:76–83
17. Shajari M, Cremonese C, Petermann K, Singh P, Müller M, Kohnen T.
Comparison of axial length, corneal curvature, and anterior chamber depth
measurements of 2 recently introduced devices to a known biometer—
ScienceDirect. Am J Ophthalmol 2017;178:58–64
 EVALUATION OF TOTAL CORNEAL POWER MEASUREMENTS 681

18. Fityo S, Bühren J, Shajari M, Kohnen T. Keratometry versus total
corneal refractive power: analysis of measurement repeatability with
5 different devices in normal eyes with low astigmatism - journal of
Cataract & Refractive Surgery. J Cataract Refract Surg 2016;42:
569–576
19. Visser N, Berndschot TosTJM, Verbakel F, de Brabander J, Nujits RMMA.
Comparability and repeatability of corneal astigmatism measurements using
different measurement technologies - ScienceDirect. J Cataract Refract
Surg 2012;38:1764–1770
20. Haigis W, Sekundo W, Kunert KS, Blum M. Total keratometric power
(TKP) derived from corneal front and back surfaces using a full eye-length
SS-OCT scan biometer prototype in comparison to automated keratom-
etry. Presented at the annual meeting of the XXXII Congress ESCRS,
London, United Kingdom, September 2014
Disclosures: None of the authors has a financial or proprietary
interest in any material or method mentioned.

Volume 46 Issue 5 May 2020

Copyright © 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS. Unauthorized reproduction of this article is prohibited.