You are on page 1of 60

Zeiss IOLMaster™

6/29/2014 2
Optical Coherence Biometry
 The Zeiss IOLMaster is a breakthrough in
measurement technology and patient care.
 It is the first single instrument solution to
precisely and quickly determine axial length,
corneal curvature, and anterior chamber
depth (ACD) without ever touching the
6/29/2014 3
Optical Coherence Biometry
 The increased measurement precision and
postoperative refractive accuracy achieved
with the IOLMaster translates into enhanced
patient quality of vision and life.
6/29/2014 4
Problems with Acoustical
Biometry (ultrasound)
 Inaccuracy
 High Technician Variance
 Many error sources (subjective)
 Anesthetic required
 Time consuming
 Transmission of Infectious Agents
6/29/2014 5
The New Standard
 The performance of the IOLMaster far
exceeds that of Conventional Biometry in the
following most important criteria:
 Accuracy and Objectivity
 Speed and Ease of Use
 Patient Convenience
 Doctor or Practice Convenience
 The Axial Length Measurement error is smaller than
ultrasound biometry because the IOLMaster always
measures along the visual axis with proper patient
– The ultrasound biometry measurement may be off the
visual axis from -3° to +8°.
– When a staphyloma(elongated globe) is not coincident
with the visual axis ultrasound biometry is measuring the
off axis axial length erroneously. Staphylomas do not
affect Axial Length results with the IOLMaster.
Features / Benefits
Features / Benefits
 Accuracy of the Axial length measurement with the IOLMaster is better
than 0.05 mm and more around 0.03 mm. Ultrasound has at best an
accuracy of 0.1mm and typically it is 0.12 to 0.20 mm. We are at least a
factor of 2 upwards to about a factor of 5 times more accurate than
typical ultrasound.
 The IOLMaster does not produce a corneal applanation error as seen in
contact ultrasound biometry. This ultrasound corneal applanation error is
a result of the subjective nature of ultrasound measurement. Technician
error may produces shorter axial lengths of about 0.2mm which
corresponds to an error in the postoperative refractive result by
approximately -0.50D.
 The IOLMaster delivers reliable & repeatable readings independent of
technician technique.
6/29/2014 8
IOLMaster Repeatability Analysis
 Conducted at University of Mainz in
 Determined the reproducibility of
 Intra- and Inter-Observer Variability.
6/29/2014 9
Intra-Observer Variability
 1 investigator measured on each of 10 eyes
– 20 times Axial Length
– 20 times ACD
– 20 times Corneal Curvature
 Variability found:
– AL .0256 mm (this corresponds to < 0.10D
– ACD .0334 mm
– K’s .0129mm
– Significance- negligible effects on the target
6/29/2014 10
Inter-Observer Variability
 20 eyes measured by 5 investigators
 Variability found:
– AL .0215 mm (also < 0.10D)
– ACD .0298 mm
– K’s .0159 mm
6/29/2014 11
“Optical Biometry is a highly
precise and reliable
measurement method that
delivers results that are
essentially independent of the
investigator (technician).”
Ease of use
 No corneal applanation/No pupil dilation.
 Operational under all lighting conditions.
 Measurement procedure learned very quickly
 Automatic R/L eye detection.
 Intuitive and familiar Windows® interface.
 Option of data transfer or printout.
Features / Benefits
Practice Efficiency and Patient Flow
 Three measurements on a single instrument
reduces prep and exam time.
 Minimal operator training.
 Measure Axial Length, Corneal Curvature,
and ACD on one eye in about 1 minute.
Features / Benefits
6/29/2014 14
Features / Benefits
Patient Safety and Compliance
 No anesthetic required.
 A quick and easy procedure.
 Non-contact technique precludes corneal
lesions and transmission of infectious agents.
Mulitple user operation
 Storage of user related constants and
defaults. Each doctor (at least ten) can input
his or her own personalized lens constants for
multiple lenses (about 20) in his or her own
Features / Benefits
Data for IOL power calculation
 Measurement data for determination of IOL
power to implant:
Axial Length - required
Corneal Curvature - required
Anterior Chamber Depth (ACD) - optional (formula
Sources of Errors in IOL power
 Measurement inaccuracy of these parameters
has been shown to contribute to deviations
from target refractions by the following
50% of the deviations are due to an Inaccurate
Axial Length measurement
30% of the deviations are due to an Inaccurate
Corneal Curvature measurement
20% of the deviations are due to an Inaccurate
Anterior Chamber Depth measurement
6/29/2014 18
 The Accuracy of the IOL Master combined with
surgeon personalization of lens constants for use
with this new measuring device minimizes these
deviations from target refractions. This leads to less
patient dependence on spectacles postoperatively
and hence an increased quality of life (better visual
outcome). Evaluation and Personalization of lens
constants is critical for any device from which
surgical technique is determined!
 The IOL Master is a non-contact optical
coherence biometry instrument which quickly
and accurately measures the following
parameters of the human eye:
Axial Length(AL)
Corneal Curvature(K)
Anterior Chamber Depth(ACD)
“It is much, much more than a non-contact A-
 The Intraocular Lens (IOL) calculation window
applies these measured parameters to one of
five international IOL calculation formulas to
offer the cataract surgeon with up to 4 IOL
implant options with corresponding powers to
reach the target refraction (desired
postoperative refractive result).
Biometrical Formulas
 The following empirical or geometric-optical
formulas for IOL calculation are available in
the IOL Master:
Haigis (requires optical ACD measured value)
Hoffer Q
(Note: Holladay 2 is not available on the
New Patient

6/29/2014 23
New Patient Window Tips
 Always enter date of birth as mm/dd/yyyy (the
instrument will only recognize slashes “/” between the
 Double clicking on a patient name is the same as single
clicking on it and then clicking on new. However, do not
double click on a name unless you plan to take a
measurement on that date because the instrument will
create a file for that date as an exam date.
 To review a previous examination result: 1. type in a few
letters of the patient’s last name in the search box. 2. Click
on the small plus icon to the left of the patient’s name. 3.
Double click on the desired exam date.
Screen Layout

Overview Mode

AL Measurement
 Partial Coherence Interferometry(PCI)
A semi diode laser emits light (780nm) of short
coherence length that is split up into two beams
in a Michelson Interferometer. Both beams
illuminate the eye through a beam-splitting prism
and reflect at both the cornea and retina. The
light reflected from the cornea interferes with that
reflected by the retina if the optical paths of both
beams are equal.

AL Measurement
 PCI continued
The interference is detected by a photodetector.
The signals are amplified, filtered and recorded
as a function of the position of the interferometer
mirror(high accuracy). From this mirror the
system determines the axial length as the path
difference between the cornea and the retinal
pigment epithelium (RPE).
6/29/2014 28

6/29/2014 29
Retinal Structures
 The axial length as measured with a ultrasound
biometrical instrument is that distance from the
cornea to the inner limiting membrane (ILM). Since
the IOLMaster measures to the RPE it is important
to know that the system internally takes into account
the distance difference between the ILM and the
RPE. Thus the displayed AL values with the
IOLMaster are directly comparable to those
measured acoustically using the immersion
ultrasound technique.
AL Measurement Alignment

AL Measurement Tips
 Instruct the patient to look at the red fixation light.
 Note: in all other modes the fixation light is yellow.
 Take 5 measurements (maximum allowable is 20 /
eye / day)
 If error measurements occur- keep trying! (20
 If unsuccessful: Vary the location of fixation light
within green circular cross hair on display to find
window of opportunity through the opacity.
AL Measurement Tips
 After each measurement a new average is
usually displayed. When one or more
measurements varies by >0.1mm from the
mean no average will be displayed, but the
word Evaluate! This alerts the operator to
evaluate the AL measurement results(more
AL Measurement Tips

6/29/2014 34
AL Setings
 The AL Settings may be selected for
conversion to proper axial length for different
eye types.
 May be selected before or any time after the
 The default setting after switching eyes is
AL Measurement
Technical Data
 Measuring Range 14 - 39 mm
 Accuracy on Test Eye ±0.01mm
 Display Resolution 0.01mm
 Reproducibility on eye <±0.03mm
This reproducibility corresponds to a mean
postoperative error < 0.10 D.
K Measurement
 Autokeratometer-The Corneal Curvature is
determined by measuring the distance
between 6 reflected IR light images. A CCD
camera captures the image.
 Recommend blinking to replenish tear film to
improve image quality.
 The displayed result is an average of 5
measurements taken within 0.5 seconds.
K Measurement
 With each new measurement the previous
result is overwritten.
 For measurement errors as well as limitations
(dry eye, corneal scarring) see “Tips for
keratometer measurement” in user’s manual.
K Measurement
– Alignment: Focus the 6 peripheral lights so that they are
lying concentric between the two auxiliary circles on the
display. The center point is used only for alignment and
is usually dimmer and smaller than the peripheral lights.
K Measurement

K Measurement
 In the Options menu it is necessary under the
Setup then Program Settings submenu to
input the Refractive Index of the practice
Keratometer(see owner’s manual). In the U.S.
this value is typically 1.3375. This value is
used to convert corneal radii into refractive
K Measurement
Technical Data (Human Eye)
Measuring Range of Cornea 33-67D
Astigmatism Range up to 10D
Repeatability ±0.02mm
Display Resolution 0.01mm
Diameter of measuring area < 3.0 mm

ACD Measurement
 The ACD is determined as the distance
between the optical sections of the cornea
and the crystalline lens produced by lateral
slit illumination of approximately 30° to the
optical axis. Facilitated via a CCD Camera.
 The lateral slit illumination flickers during
measurement and it always originates from
the temporal field of the eye being measured.
ACD Measurement
 With each measurement 5 readings are taken
and displayed along with their average on
the monitor. After each measurement there is
a 15 second processing time( have patient sit
back to avoid excess illumination).
 The K Measurement must be done prior to
the ACD Measurement. If K Readings were
not possible with this instrument they must be
entered manually prior to the ACD
ACD Measurement Alignment
1. Focus the fixation point image in screen rectangle by
making it small with sharp borders . It should be
near the optical section of the lens but not in it.
2. The corneal optical section should not be disturbed
by reflections
3. The anterior crystalline lens is optimally visible.
Note: Due to system design the corneal section is
unclear. See handout “Tips”.
ACD Measurement
ACD Measurement
Technical Data (Human Eye)
Measuring Range 1.5 to 6.5 mm
Display Resolution 0.01 mm
Repeatability ±0.1 mm

Evaluation of AL Measurements
 The IOL Master is capable of resolving fine
structures on the fundus of the eye. Depending on
the anatomical conditions of the measured eye, it
may also happen that the measuring beam
produces interference not only at the RPE but at the
inner limiting membrane of the retina and/or at the
choroid. Verification is necessary when multiple
peaks are present and/or significant variance
between results exists such that Evaluate! is
present instead of an average value.
Evaluation of AL Measurement
 The results of AL measurements are to be
interpreted on the basis of signal-to-noise
ratio(SNR) and the appearance of the graphs.
 The SNR value is an indicator of the quality of the
 A SNR value < 2.0 may be due to:
Strong ocular opacities, poor fixating patients, high
refractive error( > 6D), pathological retinal changes.
(Note: In some case of high refractive error,
measurement through the patients spectacle
lenses may be needed).
SNR Values
 If SNR is > 2.0 then the measured value is
 If SNR is in the range 1.6 to 2.0 then the
measured value is not reliable or borderline
(!). It still may be usuable!
 If SNR is < 1.6 then the measured value is
unusable (Error)
Evaluation of AL Measurement

AL Graph Analysis
 The measuring cursor (circle) is automatically placed on the
center of the signal peak with the highest amplitude. By
variance among measurement values in a series such that
no average is present and Evaluate! is present, the graphs
must be analyzed to determine if the signal peak is the true
axial length( RPE ) or if another fundus structure has
produced the highest peak (and hence the wrong axial
length). To achieve this, one must zoom in on the graph. If a
structure other than the RPE has the circle above it that
result may be 1) deleted or 2) corrected by shifting the circle
above the RPE (manipulation). When the cursor has been
shifted the result will always have an asterisk* next to it
to denote its manipulation. See user’s manual to learn how
to shift cursor.
For optimal AL graph analysis
use the zooming feature:
 Move the arrow cursor on the length axis (x-
axis) to the position that should be in the
center of the zoomed image.
 Press the left mouse button up to 4 times for
sequential zooming.
 Press the right mouse button to return to
original view of graph.

Triple peak
Double peak with RPE > ILM
(Correct Axial Length Value)
 Distance between peaks is .15 to .35 mm.
Double peak with ILM > RPE
(Incorrect Axial Length Value)
 AL value would be .15 to .35 mm shorter than
other values from that eye. Delete reading or
move cursor to RPE (manipulate).
Triple peak ILM, RPE, Choroid
(Incorrect Axial Length Value)
IOL Calculation
IOL Database
Clinical Evaluation
The following specialists have overwhelmingly
endorsed the IOLMaster:
 Dr. Holladay (Houston, TX)
 Dr. Wallace (Alexandria, LA)
 Dr. Hoffer (Santa Monica, CA)
 Dr. Haigis (Germany)
 Dr. Fine (Eugene, OR)
 Dr. Gills (Tarpon Springs, FL)
6/29/2014 60
 Haigis showed that between 5-10% of patients are not
measurable with the IOL Master.
– tremor or poor fixating patients
– significant ocular opacities (scars, vitreous hemorrhages,
dense nuclear or posterior subcapsular cataracts )
– Corneal ablations
 Visual Acuity alone is not predictive of measurement
 Better said: 90-95% of patients will have a more precise
postoperative refractive result because of the accuracy and
ease of use of the IOLMaster. Practice efficiency will be
greatly improved using the IOLMaster.