A hand-held keratometer

Effect of instrument rotation on handheld keratometry

PURPOSE

To study the effect of instrument rotation on handheld automated keratometry.

SETTING

Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hong Kong SAR, China.

METHODS

In 33 recruited subjects, corneal curvature in 1 eye (randomly selected) was measured using a Medmont topographic keratometer and a Nidek handheld keratometer. In handheld keratometry, measurements were obtained holding the instrument in the upright position and rotating it anticlockwise 5 degrees, 10 degrees, and 15 degrees and then clockwise 5 degrees, 10 degrees, and 15 degrees. The sequence of measurements was randomly assigned. The steepest and flattest corneal curvatures as well as the axis along the flattest meridian were compared in different conditions. The corneal power was converted to vector representation (M, J0, J45) for a second comparison.

RESULTS

There was a significant difference in the steepest and flattest curvatures in different conditions (repeated-measures analysis of variation, P<.05). However, the mean difference between handheld and topographic keratometry was approximately 0.25 diopter (D) for the steepest curvature and 0.05 D for the flattest curvature regardless of the direction and amount of rotation. The intraclass correlation coefficients were nearly 1, which indicated good clinical reliability. The mean difference in axis determination followed the direction and amount of rotation. With vector representation, the difference between the devices increased with the amount of rotation, especially J0 and J45.

CONCLUSIONS

Handheld keratometry was in agreement with topographic keratometry. However, practitioners should adjust the axis manually according to the direction and amount of rotation. The difference between handheld and topographic keratometry increased with the rotational effect, which was seen with vector representation. Practitioners are advised to use the handheld keratometer in the upright position.

Effect of posture and artificial tears on corneal power measurements with a handheld automated keratometer

PURPOSE

To study the effect of posture and artificial tears on handheld automated keratometry.

SETTING

Department of Optometry and Radiography, Hong Kong Polytechnic University, Hong Kong, China.

METHODS

Thirty-five subjects were recruited to have corneal curvature measurement in 1 eye (randomly selected) by a Medmont topographic keratometer and a Nidek handheld keratometer. In handheld keratometry, the measurements were taken with the subject in a sitting and lying posture (both with and without the use of artificial tears). The sequence of measurements was randomly assigned, but the application of artificial tears was always the last. The steepest and flattest corneal curvatures were compared between the 4 conditions. The corneal power was converted to orthogonal power vector components and rectangular Fourier form (M, J(0), J(45)) for another comparison.

RESULTS

There was a significant difference in the steepest and flattest meridians between the 4 conditions (P<.01). However, the mean difference between the handheld keratometer and the topographic keratometer was less than 0.50 diopter, and the intraclass correlation coefficient (ICC) was very high (0.96), indicating good clinical reliability. When analyzed in rectangular Fourier form, the difference was also significant but the ICCs were lower (0.97, 0.89, and 0.64 for M, J(0), and J(45), respectively). The greatest difference was when subjects were in the lying posture and had received artificial tears.

CONCLUSIONS

Handheld keratometry provided different results from topographic keratometry. The difference was greatest with the use of artificial tears. Cataract surgeons should take this into consideration, especially when using the handheld keratometry in the operating theater in patients under general anesthesia. Results show that the power vector method is best for studying corneal shape.