Biometry issues turn from ‘should we’ to ‘which one,’ surgeon says

LISBON, Portugal — The latest debate anterior segment surgeons must face is not whether biometry is useful preoperatively, but rather which of the numerous methods is the best for the surgeon and the procedure at hand, said Dan Z. Reinstein, MD, here at the European Society of Cataract and Refractive Surgeons meeting.

“Would an orthopedic surgeon operate on a broken bone without an X-ray? No. But until recently, ophthalmologists were content to operate on an unknown,” he said.

Dr. Reinstein said biometry can help surgeons to monitor lens position– something that he deems of utmost importance as more surgeons are implanting lenses for presbyopia.

“These lenses will be in patients’ eyes for 40 to 50 years,” and biometry is the key to success, he said.

Biometry can also help surgeons identify which candidates should undergo surgery and which should not. In some LASIK cases, surgeons need to use biometry to diagnose the cause of the undercorrection before heading into enhancement surgery, he said.

Dr. Reinstein opts to use the Artemis II to measure preoperative pachymetry, flap composition, irregular astigmatism and mechanical complications. He said in cases where he uses the Artemis for keratoconus screening, biometry can identify surface changes more easily.

“You’ll see back surface changes before you see front surface changes,” he said.

He added that in both hyperopes and myopes, white-to-white and sulcus-to-sulcus changes have no correlation to one another.