BIOMETRY

A SCAN
BIOMETRY
• APPLYING MATHEMATICS TO BIOLOGY.

• Measuring various parameters to calculate ideal iol power.

• REFRACTIVE POWER OF EYE DEPENDS ON – CORNEA, LENS, OCULAR

MEDIA AND AXIAL LENGTH.

• INCLUDES – AL MEASUREMENT, KERATOMETRY, EFFECTIVE IOL

POSITION
 AXIAL LENGTH

• FROM CORNEAL SURFACE TO RPE.

• Aligned to optical axis of eye.

• NORMAL ADULT  22-25mm.

• 1mm error in value = error of 2.5D – 3D in IOL power calculation

METHODS OF AL MEASUREMENT
• ULTRASOUND MEASUREMENT
o Immersion technique
o Contact technique (applanation method)

• OPTICAL MEASUREMENT (non contact)

o IOL master
o Lenstar
 Ultrasound measurement aka A-
Scan
• Ultrasound first used for ocular diagnosis – Mundt and Hughes.

• Amplitude modulation scan (1 dimensional time amplitude display)

• Commonly used to determine AL

• Can also be used along with b scan

• Principle- calculates time for sound waves to travel from cornea to retina
and converts into linear vector through a velocity formula
Frequency used for ophthalmic usg – 7.5 - 12 Mhz
 A SCAN
• X axis – time, spikes – echoes
• Strength of echo – amplitude of spike
• ECHOES produced by acoustic interfaces at junction of media with different
sound velocities.
• Greater the difference greater the echoes
 INSTRUMENTATION
• Ultrasound unit composed of four basic elements:
i. PULSER,

ii.RECEIVER,

iii.TRANSDUCER,

iv.DISPLAY SCREEN
Instrumentation
• PULSER – Electric impulses Excite piezo-electric quartz of
TRANSDUCER SOUND WAVES ECHOES
TRANSDUCER electric signals processed by
RECEIVER DISPLAYED ON SCREEN
 IMMERSION METHOD
• Non contact method => probe is not in contact
• Coupling fluid is in contact with cornea
• 1% methyl cellulose (coupling fluid)
• Scleral shell used – prager / Hansen type
Immersion method
Pt position – supine

Topical anaesthesia instilled

Scleral shell placed in within palpebral aperture

Coupling fluid filled in shell (free of air bubbles)

Probe inserted in shell , 5-10mm away from cornea

Pt asked to look at ceiling at a fixation point with other eye

Probe moved until aligned with optical axis of eye

 IMMERSION METHOD
• IS – initial spike probe tip
• C1-C2 – ant and post corneal surface
• L1 – ant lens surface
• L2 – post lens surface
• R – Retinal spike
• S – Scleral spike
• O – orbit spike
 CONTACT / APPLANATION METHOD
• Probe in contact with cornea
• Risk of error – since corneal indentation
• Probe can be hand held or attached to slit lamp
 Contact method
• Patient asked to sit 

• Topical anaesthesia instilled 

• Probe is placed on cornea 

• Precautions –
o Probe should point towards macula
o No fluid bridge between probe and cornea
o Cornea should not be depressed
o Avoid hurry
 Contact method
• C – Cornea spike
• A – ant lens spike
• P – post lens spike
• R – retina spike
• S – sclera spike
Immersion v/s contact
IMMERSION CONTACT
• Pt supine • Pt in sitting position
• Scleral lens and coupling fluid (+) • Not used here
• More accurate • Relatively more errors
• Fixation point – for other eye at • For same eye in probe or for
ceiling other eye at a target point on
• Variability is low wall
• Variability due to individual
scanner
• More time taking
• Less time taking
 GAIN
• Electronic amplification of sound waves received by transducer

• Amplification factor called a decibel (dB)

• Normal setting – 70%

• Increase gain required – very dense cataracts, other ocular opacities, high
myopia

• Decrease gain required when artefacts are seen near retinal spikes e.g.
pseudophakic eyes , silicone filled eyes etc.
 Characteristics of a good A-scan
• Tall corneal echo

• No aq chamber echo

• Ant and post lens capsules – tall echoes

• Vitreous cavity – few to no echoes

• Retina – tall sharply rising with no staircase echoes

• Orbital fat – medium to low echoes

 Errors in AL measurement
• Immersion v/s contact – 0.24mm

• Misalignment

• Methylcellulose or thick tear film

• Post staphyloma

• Refractive errors – Myopia  underestimation , Hypermetropia 

overestimation
 Technicalities
• Probe placed perpendicular to cornea

• Take at least 8-10 readings for accuracy

• Avg value with SD of <0.05 should be taken

• Both eyes should be tested

• In case of abnormal reading repeat scan should be done preferably by

another
Optical method of AL measurement
• Non contact

• Gold standard as highly accurate

• Based on laser

• Have multiple advantages

 IOL MASTER
• ZEISS – HUMPHREY SYSTEM

• IOL MASTER 500 – partial coherence interferometry (time required for

infrared light to travel to retina)

• Infrared diode laser (780nm)

• IOL MASTER 700 – Swept source OCT.

 IOL master Can measure
• AL

• CORNEAL CURVATURE (K)

• ACD

• WHITE TO WHITE DIAMETER

• CALCULATION OF IOL POWER

(SRK II , SRK/T , HOLLADAY 1 & 2 , HOFFER Q , HAIGIS)

• IOL power after LASIK / LASEK / PRK – HAIGIS-L

 IOL master 700

• Can additionally
o Identify irregular eye geometries

o Measure Lens thickness and central corneal thickness

o Measure Acd in pseudophakic eyes

o Accurate AL measurement in dense cataracts/psc , pts with poor fixation.

 OPERATIVE ADVANTAGES
• Pt comfort

• User friendly

• Single instrument – multiple measurements

• No cross-infection
 TECHNICAL ADVANTAGES
• LCD DISPLAY

• SAFETY FEATURES INTEGRATED

• MORE ACCURATE

• INCORPORATES 5 IOL POWER FORMULAE IN AN INTEGRATED MANNER

• BIOMETRY IN PTS UNDERGONE REFRACTIVE SX

• AND IOL POWER IN THEM

 LENSTAR LS900

• HAAG-STREIT DIAGNOSTICS

• Optical low-coherence reflectometry

• Superluminescent diode laser (820nm)

 MEASURES
• CCT , LT , ACD , AL

• KERATOMETRY

• WHITE TO WHITE DIAMETER

• PUPILLOMETRY
 LENSTAR (in addition to iol master)
• Power for toric contact lens (Barrett toric calculator)

• Topography of cornea, pupillometry

• Newer formulae – barrett universal II , barrett true-K , Olsen formula ,

Hill-RBF , masket , modified masket , shammas no-history

• Software runs on external pc

A SCAN V/S OPTICAL BIOMETRY

A scan Optic
• ULTRASOUND • LASER
• From corneal apex to internal • From corneal apex to Retinal
limiting membrane Pigment Epithelium
• Measures along anatomical axis • Measures along visual axis
• Contact • Contact
• Less resolution • Better resolution and more
accurate
THANK YOU