Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2025, 169(1):56-65 | DOI: 10.5507/bp.2024.017

Comparison of toric intraocular lens tilt and decentration measurement using dynamic Purkinje-meter and anterior segment optical coherence tomography

Eliska Palkovicova1, Jiri Cendelin1, 2, Jiri Novak1, 3
1 Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
2 Department of Ophthalmology, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
3 Department of Physics, Faculty of Civil Engineering, Czech Technical University in Prague, Prague, Czech Republic

Aims: To present a new method of dynamic Purkinje-metry and to verify it by comparison with a commercially available anterior segment optical coherence tomography CASIA2.

Patients and Methods: A dynamic Purkinje-meter with a movable fixation target was assembled. A coaxial circular pattern formed by infrared LEDs was projected onto the eye and evoked Purkinje images (1st, 3rd, 4th = P1, P3, P4). The measurement was performed on 29 eyes with an implanted toric IOL (intraocular lens), under mydriatic conditions, with reference to the visual axis. The IOL tilt was calculated from the position of a fixation target at the moment of P3 and P4 superposition. The IOL decentration was determined based on the relative position of P1 during on-axis fixation and of P3 and P4 superposition during off-axis fixation. A custom-developed software was used for distance measurements. Using CASIA2, the IOL position was fully calculated by the device.

Results: The mean absolute difference between CASIA2 and Purkinje-meter values was 0.6° ± 0.4° for the tilt magnitude and 10° ± 10° for the tilt direction, and 0.11 mm ± 0.08 mm for the decentration magnitude and 16° ± 14° for the decentration direction. There was no statistically significant difference between the values determined by the two methods for the tilt and decentration direction. The differences were statistically significant for the tilt and decentration magnitude.

Conclusion: The values of IOL tilt and decentration direction are similar for both devices. The values of IOL tilt and decentration magnitude measured by Purkinje-meter are higher than those from CASIA2, but overall, they correspond to the values presented in other published studies.

Keywords: intraocular lens position, intraocular lens decentration, intraocular lens tilt, Purkinje images, anterior segment optical coherence tomography, CASIA2

Received: March 7, 2024; Revised: April 30, 2024; Accepted: May 15, 2024; Prepublished online: June 11, 2024; Published: March 5, 2025  Show citation

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Palkovicova, E., Cendelin, J., & Novak, J. (2025). Comparison of toric intraocular lens tilt and decentration measurement using dynamic Purkinje-meter and anterior segment optical coherence tomography. Biomedical papers, 169(1), 56-65. doi: 10.5507/bp.2024.017
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    References

    1. Hayashi K, Hayashi H, Nakao F, Hayashi F. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens. Ophthalmology 2001;108(11):2011-17. doi: 10.1016/s0161-6420(01)00756-4 Go to original source... Go to PubMed...
    2. Erickson P. Effects of intraocular lens position errors on postoperative refractive error. J Cataract Refract Surg 1990;16(3):305-11. doi: 10.1016/s0886-3350(13)80699-2 Go to original source... Go to PubMed...
    3. Korynta J. Stabilita nitrooèní èoèky v oku [Stability of the intraocular lens in the eye; habilitation work]. Second Faculty of Medicine, Charles University, Prague; 1996. (In Czech)
    4. Fujikado T, Saika M. Evaluation of actual retinal images produced by misaligned aspheric intraocular lenses in a model eye. Clin Ophthalmol 2014;8:2415-23. doi: 10.2147/OPTH.S72053 Go to original source... Go to PubMed...
    5. Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. Vision 2020;4(3):41. doi: 10.3390/vision4030041 Go to original source... Go to PubMed...
    6. Altmann GE, Nichamin LD, Lane SS, Pepose JS. Optical performance of 3 intraocular lens designs in the presence of decentration. J Cataract Refract Surg 2005;31(3):574-85. doi: 10.1016/j.jcrs.2004.09.024 Go to original source... Go to PubMed...
    7. Lawu T, Mukai K, Matsushima H, Senoo T. Effects of decentration and tilt on the optical performance of 6 aspheric intraocular lens designs in a model eye. J Cataract Refract Surg 2019;45(5):662-8. doi: 10.1016/j.jcrs.2018.10.049 Go to original source... Go to PubMed...
    8. Soda M, Yaguchi S. Effect of decentration on the optical performance in multifocal intraocular lenses. Ophthalmologica 2012;227(4):197-204. doi: 10.1159/000333820 Go to original source... Go to PubMed...
    9. Jó¼wik A, Siedlecki D, Zajac M. Verification of numerical algorithm for crystalline lens location in the eyeball basing on Purkinje images. Optik 2013;124(13):1581-4. doi: 10.1016/j.ijleo.2012.04.029 Go to original source...
    10. Jó¼wik A, Siedlecki D, Zajac M. Analysis of Purkinje images as an effective method for estimation of intraocular lens implant location in the eyeball. Optik 2014;125(20):6021-5. doi: 10.1016/j.ijleo.2014.06.130 Go to original source...
    11. Li L, Wang K, Yan Y, Song X, Liu Z. Research on calculation of the IOL tilt and decentration based on surface fitting. Comput Math Methods Med 2013;2013:572530. doi: 10.1155/2013/572530 Go to original source... Go to PubMed...
    12. Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha Dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018;66:132-56. doi: 10.1016/j.preteyeres.2018.04.002 Go to original source... Go to PubMed...
    13. Kimura S, Morizane Y, Shiode Y, Hirano M, Doi S, Toshima S, Fujiwara A, Shiraga F. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS One 2017;12(9):1-12. doi: 10.1371/journal.pone.0184066 Go to original source... Go to PubMed...
    14. Tomey Corporation. Instruction Manual Cornea/Anterior Segment OCT CASIA2. Available from: https://www.manualslib.com/download/3082299/Tomey-Casia2.html. Accessed August 22, 2023.
    15. Hirnschall N, Buehren T, Bajramovic F, Trost M, Teuber T, Findl O. Prediction of postoperative intraocular lens tilt using swept-source optical coherence tomography. J Cataract Refract Surg 2017;43(6):732-6. doi: 10.1016/j.jcrs.2017.01.026 Go to original source... Go to PubMed...
    16. Nishi Y, Hirnschall N, Crnej A, Gangwani V, Tabernero J, Artal P, Findl O. Reproducibility of intraocular lens decentration and tilt measurement using a clinical Purkinje meter. J Cataract Refract Surg 2010;36(9):1529-35. doi: 10.1016/j.jcrs.2010.03.043 Go to original source... Go to PubMed...
    17. Tabernero J, Benito A, Nourrit V, Artal P. Instrument for measuring the misalignments of ocular surfaces. Opt Express 2006;14(22):10945-56. doi: 10.1364/OE.14.010945 Go to original source... Go to PubMed...
    18. Tabernero J, Piers P, Benito A, Redondo M, Artal P. Predicting the optical performance of eyes implanted with IOLs to correct spherical aberration. Invest Ophthalmol Vis Sci 2006;47(10):4651-8. doi: 10.1167/iovs.06-0444 Go to original source... Go to PubMed...
    19. Schaeffel F. Binocular lens tilt and decentration measurements in healthy subjects with phakic eyes. Invest Ophthalmol Vis Sci 2008;49(5):2216-22. doi: 10.1167/iovs.07-1022 Go to original source... Go to PubMed...
    20. Guyton DL, Uozato H, Wisnicki HJ. Rapid determination of intraocular lens tilt and decentration through the undilated pupil. Ophthalmology 1990;97(10):1259-64. doi: 10.1016/s0161-6420(90)32422-3 Go to original source... Go to PubMed...
    21. Cendelin J, Korynta J, Bok J. Neue Methode für die IOL-Positions­bestimmung im Auge [New method for determining IOL position in the eye]. In: 6. Kongreß Der Deutschsprachigen Gesellschaft Für Intraokularlinsen Implantation. Springer Berlin Heidelberg 1993:460-3. doi: 10.1007/978-3-642-50268-2_68 Go to original source...
    22. Rayner. T-flex Aspheric Toric IOL. Worthing, West Sussex, UK; 2023. Available from: https://rayner.com/en/iol/toric/t-flex-aspheric-toric/ Accessed November 17, 2023.
    23. Atchison D, Smith G. Optics of the Human Eye. 1st ed. Butterworth-Heinemann; 2000. Go to original source...
    24. Liang C, Yan H. Methods of Corneal Vertex Centration and Evaluation of Effective Optical Zone in Small Incision Lenticule Extraction. Ophthalmic Res 2023;66(1):717-26. doi: 10.1159/000529922 Go to original source... Go to PubMed...
    25. Liu Q, Yang X, Lin L, Liu M, Lin H, Liu F, Xie Y, Lam DSC. Review on Centration, Astigmatic Axis Alignment, Pupil Size and Optical Zone in SMILE. Asia Pac J Ophthalmol 2019;8(5):385-90. doi: 10.1097/01.APO.0000580144.22353.46 Go to original source... Go to PubMed...
    26. Liu M, Sun Y, Wang D, Zhang T, Zhou Y, Zheng H, Liu Q. Decen­tration of optical zone center and its impact on visual outcomes following SMILE. Cornea 2015;34(4):392-7. doi: 10.1097/ICO.0000000000000383 Go to original source... Go to PubMed...
    27. Statistics Kingdom. Available from: https://www.statskingdom.com/ Accessed October 16, 2023.
    28. Calzetti G, Bellucci C, Tedesco SA, Rossi M, Gandolfi S, Mora P. Tilt and decentration of posterior and anterior iris-claw intraocular lenses: a pilot study using anterior segment optical coherence tomography. BMC Ophthalmol 2022;22(1):233. doi: 10.1186/s12886-022-02430-x Go to original source... Go to PubMed...
    29. Ale JB. Intraocular lens tilt and decentration: a concern for contemporary IOL designs. Nepal J Ophthalmol 2011;3(1):68-77. Go to original source... Go to PubMed...
    30. Xiao Z, Wang G, Zhen M, Zhao Z. Stability of Intraocular Lens with Different Haptic Design: A Swept-Source Optical Coherence Tomography Study. Front Med 2021;8:705873. doi: 10.3389/fmed.2021.705873 Go to original source... Go to PubMed...
    31. Rosales P, De Castro A, Jiménez-Alfaro I, Marcos S. Intraocular lens alignment from purkinje and Scheimpflug imaging. Clin Exp Optom 2010;93(6):400-8. doi: 10.1111/j.1444-0938.2010.00514.x Go to original source... Go to PubMed...
    32. de Castro A, Rosales P, Marcos S. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation study. J Cataract Refract Surg 2007;33(3):418-29. doi: 10.1016/j.jcrs.2006.10.054 Go to original source... Go to PubMed...
    33. Jó¼wik A, Siedlecki D, Zajac M. Evaluation of intraocular lens implant location in the eyeball basing on the Purkinje images. Proceedings of SPIE vol. 8697, 18th Czech-Polish-Slovak Optical Conference on Wave and Quantum Aspects of Contemporary Optics; 2012. doi: 10.1117/12.2009985 Go to original source...
    34. Crnej A, Hirnschall N, Nishi Y, Gangwani V, Tabernero J, Artal P, Findl O. Impact of intraocular lens haptic design and orientation on decentration and tilt. J Cataract Refract Surg 2011;37(10):1768-74. doi: 10.1016/j.jcrs.2011.04.028 Go to original source... Go to PubMed...
    35. Rosales P, Marcos S. Phakometry and lens tilt and decentration using a custom-developed Purkinje imaging apparatus: validation and measurements. J Opt Soc Am 2006;23(3):509-20. doi: 10.1364/JOSAA.23.000509 Go to original source... Go to PubMed...
    36. Wang L, de Souza RG, Weikert MP, Koch DD. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg 2019;45(1):35-40. doi: 10.1016/j.jcrs.2018.08.025 Go to original source... Go to PubMed...
    37. Wang X, Dong J, Wang X, Wu Q. IOL Tilt and Decentration Estimation from 3 Dimensional Reconstruction of OCT Image. PLoS One 2013;8(3):1-10. doi: 10.1371/journal.pone.0059109 Go to original source... Go to PubMed...
    38. Fus M, Pitrova S. Evaluation of Decentration, Tilt and Angular Orientation of Toric Intraocular Lens. Clin Ophthalmol 2021;15:4755-61. doi: 10.2147/OPTH.S346968 Go to original source... Go to PubMed...
    39. Maedel S, Hirnschall N, Bayer N, Markovic S, Tabernero J, Artal P, Schaeffel F, Findl O. Comparison of intraocular lens decentration and tilt measurements using 2 Purkinje meter systems. J Cataract Refract Surg 2017;43(5):648-55. doi: 10.1016/j.jcrs.2017.01.022 Go to original source... Go to PubMed...

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