Publication Exclusive: Which device do surgeons prefer for optical biometry?

Welcome to CEDARS-ASPENS Debates, a monthly feature in Ocular Surgery News.

CEDARS (Cornea, External Disease, and Refractive Surgery Society) and ASPENS (American Society of Progressive Enterprising Surgeons) is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

As surgical techniques and technology continue to improve, cataract surgeons are obtaining unprecedented success. This has led to increased patient demands, which in turn has led to surgeons trying to find every avenue possible to achieve success. While most of the attention has been paid to IOL selection, phaco and femto technology, and imaging, perhaps the most important aspect is the preoperative biometry. This month, David A. Goldman, MD, and P. Dee Stephenson, MD, FACS, ABES, FSEE, discuss the two most common devices currently being used, the Lenstar and the IOLMaster. We hope you enjoy the discussion.

Kenneth A. Beckman

Kenneth A. Beckman, MD, FACS, OSN CEDARS-ASPENS Debates Editor

Lenstar is best for optical biometry

Although traditional A-scan and immersion technology can be quite accurate, over time ophthalmologists have moved toward optical biometry systems. They offer not only non-contact measurements of axial length and corneal curvature, but also provide additional data allowing advanced IOL calculations to be performed. For most of my career, the IOLMaster (Carl Zeiss Meditec) has been the reigning champion. However, when it came time to purchase a device for my practice 2.5 years ago, there was no question I wanted the Lenstar (Haag-Streit).

There were multiple reasons for this choice. To begin, my history with Zeiss equipment was frustrating. Although most devices Zeiss makes are excellent, the constant recurrent charges for upgrades are brutal. Case in point is the Atlas topographer. I purchased the device at the end of 2012, and at that time the device was running Windows XP (for those Mac users, I will explain that even in 2012, XP was seriously outdated). The machine cost approximately $12,000. Recently I received a notice that I could upgrade the device to Windows 7, which would include a new DVD drive (not sure why this is necessary because it already has a DVD drive) for about $3,000. Again, for the Mac users out there, Windows 7 is already outdated, and Microsoft is giving away Windows 10 for free.

With the Lenstar, there was one purchase in 2012. Since then, I have received multiple upgrades to improve algorithms for measurements in dense cataracts and IOL formulas at absolutely no cost.

Besides service, I believe the technology of the Lenstar is simply better. For keratometry, 32 points are measured as opposed to six on the IOLMaster. I have been so impressed with keratometry that I do not perform any manual keratometry readings and routinely hit 20/20 uncorrected outcomes. In cases of toric IOLs, I find myself trusting the axis and magnitude of the astigmatism measurement of my Lenstar over my topographer in most cases. Furthermore, the Lenstar optically measures lens thickness, giving it a clear advantage for the newer-generation multivariable formulas. Finally, the anterior chamber depth measurement on the Lenstar is acquired using the superluminescent diode, as opposed to the slit lamp illumination from the side that the IOLMaster uses.

Click here to read the full publication exclusive, CEDARS ASPENS Debates, published in Ocular Surgery News U.S. Edition, August 25, 2015.