LASSO formulas improve ICL vault prediction accuracy
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The Least Absolute Shrinkage and Selection Operator formulas, or LASSO, showed “excellent” performance for predicting ICL vault after implantation.
Using a set of 115 eyes of 59 patients, three models were developed based on anterior segment OCT parameters (LASSO-OCT formula), optical biometry parameters (LASSO-Biometry formula) and a combination of both (LASSO-Full formula). In a study, the performance of these models was compared with the manufacturer’s nomogram, the STAAR Online Calculator and Ordering System, and with the Nakamura 1 and Nakamura 2 formulas on a matched separate test set of 37 eyes of 19 patients.
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All three LASSO models showed significantly lower mean absolute errors in the estimated vs. achieved postoperative vault.
“Postoperative vault is considered one of the most important risk factors for complications after ICL surgery,” the authors wrote. “Improving the process of ICL sizing is therefore of key importance to further improve the safety profile of ICL surgery.”
Importantly, the LASSO models were trained on a European data set, including a fair number of patients with low to moderate myopia. They are therefore optimally suited for patients of white ancestry. Most other formulas are trained on an Asian, more myopic population with smaller eyes, and racial differences in the anatomy of the anterior segment affect ICL sizing.
“The formulas can be accessed at http://icl.emmetropia.be. Based on the available equipment, refractive surgeons can easily implement one of the formulas in their clinical practice. By refining the postoperative vault prediction, the LASSO suite may ultimately help to further improve the safety profile of ICL surgery,” the authors said.
Perspective
Back to TopThis study suggests and provides access to a new method to predict ICL vault in non-Asian patients, using noninvasive equipment and a low operator dependency.
Theoretically, it could be helpful in our daily clinical practice, although we rely a lot on direct ultrasound biomicroscopy (UBM) measurements to choose the size of the ICL. This step is necessary to establish where the ICL footplate will rest. As we recently published, the place is not the same in every case, and this affects the postoperative vault. In addition, UBM allows us to detect anatomical abnormalities such as ciliary body cysts, which can give us unpredictable, unexpected vault results.
Studies with a larger number of eyes are necessary, with more heterogeneous samples in terms of race, refraction and ICL measurement. Different ICL diopters respond differently to compression. For instance, there are differences between the myopic and hyperopic ICL. It is also necessary to include eyes with extreme measures. Despite this, this study is a great leap into the future in terms of predicting postoperative vaulting.
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