ASCRS, March 25-29, 2011, San Diego
description
Transcript of ASCRS, March 25-29, 2011, San Diego
![Page 1: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/1.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Influence of Mydriatic Eye-drops
on Wavefront-sensing and Automated Refraction
Taneri S, Oehler S, MacRae S M, Yoon G
The authors have no financial interest in the subject matter of this poster.
ASCRS, March 25-29, 2011, San Diego
![Page 2: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/2.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Background and Purpose• Wavefront-guided ablations are based on wavefront
sensing: in a pupil dilated under mesopic conditions (in this poster entitled ‘miosis’)orafter the application of mydriatic eye-drops (in this poster entitled ‘mydriasis’)
• Question: Is there an influence of mydriatic eye-drops on wavefront-sensing in terms of the phoropter-predicted-refraction (PPR) of the Zywave aberrometer or on automated refraction?
![Page 3: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/3.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Methods• Prospective study of 200 myopic eyes, measured in
dim light and pharmacologically induced mydriasis with an aberrometer (Zywave) and with automated refraction
• Comparison of Predicted Phoropter Refraction (PPR) for a pupil diameter of 3.5 mm with and without pharmaceutical mydriasis, respectively
• 100 eyes dilated with tropicamide 0.5% + phenylephrine 2.5% eye-drops, 100 eyes with tropicamide 0.5% alone
![Page 4: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/4.jpg)
Augenabteilung am St. Franziskus Hospital Münster
MethodsRefractive Baseline of the 2 groups before pharmaceutical
mydriasis Tropicamide 0.5% + Phenylephrine 2.5% Tropicamide 0.5%
Mean SD Min Max Mean SD Min Max
AberrometerSphere(D) -4.02 2.49 -9.26 0.52 -3.85 2.75 -9.45 6.6
Cyl(D) -1.20 0.92 -4.21 -0.05 -1.25 0.98 -5.77 0.64
Axis (°) 1 180 2 180
SE (D) -4.62 2.46 -9.41 -0.32 -4.48 2.79 -9.84 6.16
AutorefractorSphere(D) -4.21 2.38 -9.0 -0.25 -4.04 2.30 -9.25 2.5
Cyl(D) -0.95 0.87 -4.0 0.0 -1.01 0.81 -4.00 0
Axis (°) 0 179 0 179
SE (D) -4.69 2.31 -9.38 -0.63 -4.54 2.30 -9.88 2.25
![Page 5: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/5.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Results: Aberrometer
• PPR values obtained in mydriasis were less myopic than in miosis
Mean ± SD
SE (D) Sphere (D) Cylinder (D)
Tropicamide 0.5% + Phenylephrine 2.5% -0.36 ± 0.36 * -0.33 ± 0.36 * -0.07 ± 0.27
Tropicamide 0.5% -0.24 ± 0.43 * -0.24 ± 0.35 * -0.00 ± 0.35
Difference between dim light pupil dilation and pharmacologically induced mydriasis
*: statistically significant
![Page 6: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/6.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Results: Sphere & Spherical Equivalent• Aberrometer and autorefractor displayed a hyperopic
shift of sphere and spherical equivalent in most eyes• Hyperopic shift of spherical equivalent with
tropicamide and tropicamide combined with phenylephrine was significant with both devices (aberrometer and autorefractor)
• No difference between the two mydriatic solutions were found
• Aberrometer was more affected by mydriatic eye drops than the autorefractor
• Age had no influence on the amount of the difference
![Page 7: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/7.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Z 3,-3 Z 3,-1 Z 3,1 Z 3,3 Z 4,-1 Z 4,-2 Z 4,0 Z 4,2 Z 4,4-0.05
0.00
0.05
0.03*
-0.01 -0.01 -0.01-0.01*
0.01
-0.02*
0.01 0.010.01
-0.01
-0.02*
0.010.00
0.01*
-0.01
0.000.00
group I group II
chan
ge o
f HO
A te
rms
[µm
]
Results: HOA
Group I: mydriasis with tropicamide 0.5% + phenylephrine 2.5%, n = 100Group II: mydriasis with tropicamide 0.5 %, n = 100
Applying tropicamide alone or combined with neosynephrine lead to significant inaccuracy in the determination of some HOA terms
Change of HOA after pharmacologic pupil dilation
Statistically significant
![Page 8: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/8.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Conclusion IEffect on lower order aberrations• There seems to be a cycloplegic effect from mydriatic
eye-drops as both aberrometer and autorefractor displayed a significant hyperopic shift of sphere and spherical equivalent in most eyes.
• The range of difference for the sphere component of the PPR was >1.5 D in both groups.
• This is much higher than the accuracy of modern excimer lasers and may partially account for clinically significant over- or undercorrection of defocus in laser vision correction.
![Page 9: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/9.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Conclusion II
The hyperopic shift after pharmaceutic pupil dilation should be taken into account when interpreting aberration measurements and
planning a wavefront-guided ablation.
Consequently, it seems ideal to avoid the wide-spread use of mydriatics prior to wavefront sensing by mathematical expansion of data
measured over a naturally dilated pupil.
![Page 10: ASCRS, March 25-29, 2011, San Diego](https://reader036.fdocuments.in/reader036/viewer/2022062302/56816620550346895dd9752a/html5/thumbnails/10.jpg)
Augenabteilung am St. Franziskus Hospital Münster
Thank you!