OBJECTIVES

Prediction error is an important concern in cataract surgery, as it may impact visual outcomes. Intraoperative aberrometry (IOA) provides real-time information during cataract surgery, and addresses several issues related to intraocular lens (IOL) calculation to reduce prediction error. A literature review was conducted comparing IOA with preoperative biometry and planning (PEP).

METHODS

A literature review of MEDLINE and Google Scholar was undertaken over the last 15 years (01/2004 to 09/2019) using the following terms: IOA, PEP, brand names. Study inclusion was limited to randomized, non-randomized comparative studies and systematic reviews in English. Articles were excluded if IOA procedure was not followed or did not have sufficient detail to understand how IOA was used. Outcomes were absolute prediction error and postoperative astigmatism. Values of <0.5 diopters (D) and <1.0D were considered as good and acceptable levels, respectively.

RESULTS

Fifteen studies comparing IOA to PEP were included. Absolute prediction error ranged from 0.24–1.19D for IOA and 0.31–1.69D for PEP. The proportion of patients with <0.5D of target was significantly (6/21 comparisons) or numerically (13/21) higher in the IOA group. PEP was numerically higher only when AL-optimized Holladay 1 or Hill-RBF formula was used (1/21 each). IOA consistently showed improvement over PEP in postoperative astigmatism and the proportion of patients with <0.5D refractive cylinder. Results were similar for the proportion of patients within <1.0D. The use of IOA consistently showed lower mean absolute prediction error compared to PEP used in conjunction with a variety of formulas.

CONCLUSIONS

The use of IOA appears to offer several advantages in accuracy and astigmatism-related outcomes, and may be an asset in addressing heightened patient expectations for excellent postoperative visual outcomes.