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Pan X, Wang Y, Li Z, Ye Z. Intraocular Lens Power Calculation in Eyes After Myopic Laser Refractive Surgery and Radial Keratotomy: Bayesian Network Meta-analysis. Am J Ophthalmol 2024; 262:48-61. [PMID: 37865389 DOI: 10.1016/j.ajo.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/17/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To compare the accuracy of formulas for calculating intraocular lens power in eyes after myopic laser refractive surgery or radial keratotomy. DESIGN Bayesian network meta-analysis. METHODS PubMed, Embase, the Cochrane Data Base of Systematic Reviews, and the Cochrane Central Register of Controlled Trials databases were searched for retrospective and prospective clinical studies published from January 1, 2012, to August 24, 2022. The outcome measurement was the percentage of eyes with a predicted error within the target refractive range (±0.50 diopter [D] or ±1.00 D). RESULTS Our meta-analysis includes 24 studies of 1172 eyes after myopic refractive surgery that use 12 formulas for intraocular lens power calculation. (1) A network meta-analysis showed that Barrett true-K no history, the optical coherence tomography (OCT) formula, and the Masket formula had a significantly higher percent of eyes within ±0.50 D of the goal than the Haigis-L formula, whereas the Wang-Koch-Maloney formula showed the poor predictability. Using an error criterion of within ±1.00 D, the same 3 formulas performed slightly better than the Haigis-L formula. Based on performance using both prediction error criteria, the Barrett true-K no history formula, OCT formula, and Masket formula showed the highest probability of ranking as the top 3 among the 12 methods. (2) A direct meta-analysis with a subset of 4 studies and 5 formulas indicated that formulas did not differ in percent success for either the ±0.5 D or ±1.0 D error range in eyes that had undergone radial keratotomy. CONCLUSIONS The OCT, Masket, and Barrett true-K no history formulas are more accurate for eyes with previous myopic laser refractive surgery, whereas no significant difference was found among the formulas for eyes that had undergone radial keratotomy.
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Affiliation(s)
- Xiaoying Pan
- From the School of Medicine, Nankai University, Tianjin (X.P.); Department of Ophthalmology, the Chinese People's Liberation Army General Hospital, Beijing (X.P., Y.W., Z.L., Z.Y.), China
| | - Yuyao Wang
- Department of Ophthalmology, Medical School of Chinese People's Liberation Army, Beijing (Y.W.); Department of Ophthalmology, the Chinese People's Liberation Army General Hospital, Beijing (X.P., Y.W., Z.L., Z.Y.), China
| | - Zhaohui Li
- Department of Ophthalmology, the Chinese People's Liberation Army General Hospital, Beijing (X.P., Y.W., Z.L., Z.Y.), China
| | - Zi Ye
- Department of Ophthalmology, the Chinese People's Liberation Army General Hospital, Beijing (X.P., Y.W., Z.L., Z.Y.), China.
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Kato Y, Kojima T, Tamaoki A, Tanaka Y, Yamamoto N, Ichikawa K. Accuracy of the Majority Voting Method with Multiple IOL Power Formulae. Clin Ophthalmol 2024; 18:1341-1351. [PMID: 38765457 PMCID: PMC11100961 DOI: 10.2147/opth.s457627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose This study aimed to evaluate the efficacy of a majority decision algorithm that integrates intraoperative aberrometry (IA) and two intraocular lens (IOL) frequency formulas. The primary objective was to compare the accuracy of three formulas (IA; Sanders, Retzlaff, and Kraff/Theoretical (SRK/T); and Barrett Universal II (BUII)), in achieving emmetropia in eyes implanted with TFNT lenses (Alcon). Patients and Methods A total of 145 eyes of 145 patients were included in the evaluation. Preoperative data were obtained from IOLMaster 700, while intraoperative data were collected from ORA SYSTEMTM. Visual acuity ≥0.8 at the 3-month post-surgery mark was confirmed. We assessed refractive prediction error (RPE), which is the difference between predicted refraction (PR) and postoperative subjective refraction. This evaluation aimed to identify the optimal IOL power with the implemented algorithm. Results Among the 145 eyes evaluated, 55.9%, 78.7%, and 97.2% achieved postoperative subjective refraction within ±0.13 Diopters (D), ±0.25 D, and ±0.50 D, respectively. The percentages of eyes within ±0.25 D of PR varied by formula type, with values of 57%, 57%, and 54% for IA, BUII, and SRK/T, respectively. For eyes with short to medium axial length (AL<26.00 mm), the percentages within ±0.25 D of RPE were 52%, 58%, and 58% for IA, SRK/T, and BUII, respectively. In contrast, for eyes with long axial length (≥26.00 mm) the percentages were 68%, 52%, and 45% for IA, BUII, and SRK/T, respectively. Conclusion The proposed majority decision algorithm incorporating IA and two IOL frequency formulas was effective in reducing postoperative refractive error. IA was particularly beneficial for eyes with long axial length. These findings suggest the algorithm has potential to optimize IOL power selection to improve quality of life of patients and clinical practice outcomes.
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Affiliation(s)
| | - Takashi Kojima
- Chukyo Eye Clinic, Nagoya, Aichi, Japan
- Nagoya Eye Clinic, Nagoya, Aichi, Japan
| | - Akeno Tamaoki
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | | | - Naoki Yamamoto
- Center for Society-Academia Collaboration, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
- International Center for Cell and Gene Therapy, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
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Helaly HA, Elhady AM, Elnaggar OR. Accuracy of Traditional and Modern Formulas for Intraocular Lens Power Calculation After Radial Keratotomy Using Standard Keratometry. Clin Ophthalmol 2023; 17:2589-2597. [PMID: 37671334 PMCID: PMC10476658 DOI: 10.2147/opth.s417336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To compare the accuracy of multiple traditional and modern intraocular lens (IOL) power calculation formulas in post-radial keratotomy (RK) patients undergoing cataract surgery. Methods This retrospective case series included 50 eyes with prior RK who underwent routine phacoemulsification surgery with single-piece acrylic IOL implantation (A constant = 118.8). Outcomes of multiple formulas were calculated. Included formulas were SRK/T, Holladay 1, Holladay 2, Haigis, Barrett True-K, Haigis and Barrett True-K (target refraction of 0.50 D), Barrett Universal II, Kane, PEARL-DGS, Shammas no history, DK SRK/T, DK SRK/T (target refraction of 0.50 D), Double K (DK) Holladay 1, and DK Holladay 1 (target refraction of 0.50 D). Averages of multiple combinations of best-performing single formulas were calculated. Primary outcome is mean absolute error (MAE). Results Haigis (with -0.50 D target refraction) and DK SRK/T showed the lowest mean and median absolute errors (MedAE) followed by Haigis, Barrett True-K, and Barrett True-K (with -0.50 D target refraction). Combinations of 3, 4, or 5 of best performing single formulas yielded good results with >60% of cases within +0.50 D of intended refraction and MAE around 0.50 D. The best performing formulas with flatter K readings were PEARL-DGS and Haigis (with additional -0.50 D target refraction) with MAE of 0.72 + 0.71 D and 0.70 + 0.70 D, respectively, followed by Barrett True-K (with intended -0.50 D target refraction) with MAE of 0.75 + 0.63 D. Conclusion Using an average of three or more Haigis (with -0.50 D target refraction), the Barrett True-K, DK Holladay 1, and DK SRK/T formulas showed better outcomes than using a single formula for IOLMaster 700 standard K readings. The PEARL-DGS formula showed better accuracy in eyes with flatter K readings (<38 D).
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Affiliation(s)
- Hany Ahmed Helaly
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Mohamed Elhady
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Li M, Wang JD, Zhang JS, Mao YY, Cao K, Wan XH. Comparison of the accuracy of three intraocular lens power calculation formulas in cataract patients with prior radial keratotomy. Eur J Med Res 2023; 28:20. [PMID: 36631867 PMCID: PMC9832763 DOI: 10.1186/s40001-023-00998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To compare the accuracy of three intraocular lens (IOL) formulas in Chinese cataract patients with prior radial keratotomy (RK). METHODS Medical records of cataract patients with prior RK at Beijing Tongren Hospital were retrospectively analysed. The absolute error (AE) was calculated as the absolute difference between the actual postoperative spherical equivalent and the predicted spherical equivalent. The AE and percentages of eyes with AE within 0.5D, 1.0D, and 2.0D for three formulas [Barrett True-K, Holladay 1 (D-K), Haigis] were calculated and compared. RESULTS Forty-seven eyes of 28 cataract patients were included. The Median AE (MedAE) was significantly different among the three formulas (P < 0.001). The MedAE was lowest for the Barrett True-K formula (0.62), followed by the Haigis (0.76), and Holladay 1 (D-K) (1.16). The percentages of eyes with AE within 0.5D, and 1.0D were significantly different among the 3 formulas (P = 0.009, and P < 0.001). The Barrett True-K formula achieved the highest percentages (46.8%) of eyes with AE within 0.5D. Haigis achieved the highest percentages (70.21%) of eyes with AE within 1.0 D. CONCLUSIONS Barrett True-K is the most accurate IOL power calculation formula among the 3 formulas and Haigis is an alternative choice. Considering the relatively lower accuracy of IOL formulas in cataract patients with prior RK, newer and more accurate IOL formulas are desirable.
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Affiliation(s)
- Meng Li
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
| | - Jin-Da Wang
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
| | - Jing-Shang Zhang
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
| | - Ying-Yan Mao
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
| | - Kai Cao
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
| | - Xiu-Hua Wan
- grid.414373.60000 0004 1758 1243Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730 China
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Kaufman AR, Pineda R. Intraoperative aberrometry: an update on applications and outcomes. Curr Opin Ophthalmol 2023; 34:48-57. [PMID: 36484210 DOI: 10.1097/icu.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW There is now a large body of experience with intraoperative aberrometry. This review aims to synthesize available data regarding intraoperative aberrometry applications and outcomes. RECENT FINDINGS The Optiwave Refractive Analysis (ORA) System utilizes Talbot-moiré interferometry and is the only commercially available intraoperative aberrometry device. There are few studies that include all-comers undergoing intraoperative aberrometry-assisted cataract surgery, as most studies examine routine patients only or atypical eyes only. In non-post-refractive cases, studies have consistently shown a small but statistically significant benefit in spherical equivalent refractive outcome for intraoperative aberrometry versus preoperative calculations. In studies examining axial length extremes, most studies have shown intraoperative aberrometry to perform similarly to preoperative calculations. Amongst post-refractive cases, post-myopic ablation cases appear to benefit the most from intraoperative aberrometry. For toric intraocular lenses (IOLs), intraoperative aberrometry may be used for refining IOL power (toricity and spherical equivalent) and alignment, and most studies show intraoperative aberrometry to achieve low postoperative residual astigmatism. SUMMARY Intraoperative aberrometry can be utilized as an adjunct to preoperative planning and surgeon's judgment to optimize cataract surgery refractive outcomes. Non-post-refractive cases, post-myopic ablation eyes, and toric intraocular lenses may have the greatest demonstrated benefit in intraoperative aberrometry studies to date, but other eyes may also benefit from intraoperative aberrometry use.
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Affiliation(s)
- Aaron R Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Soare C, Patel DS, Ionides A. Cataract surgery outcomes in eyes with previous radial keratotomy. Eye (Lond) 2022; 36:1804-1809. [PMID: 34376819 PMCID: PMC9391422 DOI: 10.1038/s41433-021-01716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study shows the visual and refractive outcomes of cataract surgery in patients with previous radial keratotomy (RK). SUBJECTS/METHODS This is a retrospective case series of 100 eyes (65 patients) with previous RK who had undergone routine cataract surgery with a monofocal intraocular lens implant (IOL) at Moorfields Eye Hospital, London, United Kingdom, between January 2004 and December 2018. RESULTS Mean age at the time of surgery was 59.8 years; 39% eyes had ocular copathology. Best-corrected visual acuity (LogMAR; median, interquartile range) improved from 0.30 (0.22, 0.55) to 0.06 (-0.02, 0.21) in eyes without copathology, and from 0.56 (0.30, 1.00) to 0.20 (0.00, 0.20) in eyes with copathology. Haigis formula (19 eyes) resulted in a median prediction error of -0.31 D (-1.07, +0.05), versus -0.55 D (-1.23, +0.22) for Double-K SRK/T (55 eyes) and +0.93 D (0.20, 2.31) for SRK/T (18 eyes). At the final follow-up, 52.6% eyes were within 0.5 D and 68.4% within 1 D of the predicted spherical equivalent for Haigis, versus 32.7% and 52.7% for Double-K SRK/T, and 27.8% and 38.9% for SRK/T. The most frequent complication was RK incision dehiscence (8%). CONCLUSIONS Although the best-corrected visual acuity outcomes compare with the UK national benchmarks, significantly fewer eyes with previous RK achieved the level of unaided distance visual acuity to allow spectacle independence. Surgeons should be aware of the increased likelihood of wound dehiscence and plan surgery accordingly. Haigis formula tended to have a better predictability of the postoperative spherical equivalent and, since introduced, was the preferred choice for IOL calculation in this group of patients.
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Affiliation(s)
- Cristina Soare
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Gasparian SA, Nassiri S, You H, Vercio A, Hwang FS. Intraoperative aberrometry compared to preoperative Barrett True-K formula for intraocular lens power selection in eyes with prior refractive surgery. Sci Rep 2022; 12:7357. [PMID: 35513494 PMCID: PMC9072433 DOI: 10.1038/s41598-022-11462-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Abstract
To compare the predictive refractive accuracy of intraoperative aberrometry (ORA) to the preoperative Barrett True-K formula in the calculation of intraocular lens (IOL) power in eyes with prior refractive surgery undergoing cataract surgery at the Loma Linda University Eye Institute, Loma Linda, California, USA. We conducted a retrospective chart review of patients with a history of post-myopic or hyperopic LASIK/PRK who underwent uncomplicated cataract surgery between October 2016 and March 2020. Pre-operative measurements were performed utilizing the Barrett True-K formula. Intraoperative aberrometry (ORA) was used for aphakic refraction and IOL power calculation during surgery. Predictive refractive accuracy of the two methods was compared based on the difference between achieved and intended target spherical equivalent. A total of 97 eyes (69 patients) were included in the study. Of these, 81 eyes (83.5%) had previous myopic LASIK/PRK and 16 eyes (16.5%) had previous hyperopic LASIK/PRK. Median (MedAE)/mean (MAE) absolute prediction errors for preoperative as compared to intraoperative methods were 0.49 D/0.58 D compared to 0.42 D/0.51 D, respectively (P = 0.001/0.002). Over all, ORA led to a statistically significant lower median and mean absolute error compared to the Barrett True-K formula in post-refractive eyes. Percentage of eyes within ± 1.00 D of intended target refraction as predicted by the preoperative versus the intraoperative method was 82.3% and 89.6%, respectively (P = 0.04). Although ORA led to a statistically significant lower median absolute error compared to the Barrett True-K formula, the two methods are clinically comparable in predictive refractive accuracy in patients with prior refractive surgery.
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Affiliation(s)
- Suzie A Gasparian
- Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA, 92354, USA
| | - Saman Nassiri
- Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA, 92354, USA
| | - Hyelin You
- Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA, 92354, USA
| | - Abby Vercio
- Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA, 92354, USA
| | - Frank S Hwang
- Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA, 92354, USA.
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Intraocular lens calculations in patients with prior sequential radial keratotomy and LASIK/PRK. J Cataract Refract Surg 2022; 48:971-973. [PMID: 35171141 DOI: 10.1097/j.jcrs.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
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Gouvea L, Sioufi K, Brown CE, Waring Iv G, Chamon W, Rocha KM. Refractive Accuracy of Barrett True-K vs Intraoperative Aberrometry for IOL Power Calculation in Post-Corneal Refractive Surgery Eyes. Clin Ophthalmol 2021; 15:4305-4315. [PMID: 34737545 PMCID: PMC8558044 DOI: 10.2147/opth.s334489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the refractive predictability of intraoperative aberrometry (IA, ORA, Alcon) and Barrett True-K/Universal II formulas for intraocular lens (IOL) power calculations in post-corneal refractive surgery and normal eyes. Methods Retrospective study of normal and post-corneal refractive surgery eyes that underwent cataract surgery with IA at tertiary academic center. Preoperatively, IOL power calculations were performed using Barrett Universal II (normal eyes) or Barrett True-K (post-corneal refractive surgery eyes) formulas. Intraoperatively, aphakic IA measurements were used for IOL power calculations. Mean absolute refractive prediction error (MAE) and the percentage of eyes with prediction error within ±0.50, ±0.75 and ±1.00 D were calculated. Refractive predictability was also evaluated in short, normal, and long eyes. Results Two hundred and seventy-three eyes were included in the analysis. No statistically significant differences were observed between the MAE of preoperative formulas and IA for post-hyperopic laser vision correction (LVC), post-myopic LVC, post-radial keratotomy (RK) and normal eyes. For prediction error within ±0.5 D in post-corneal refractive surgery eyes, range of agreement between Barrett True-K and IA ranged from 28% (7/25) of the time in post-RK eyes to 49% (40/81) of the time in post-hyperopic LVC; the corresponding value for Barrett Universal II/IA was 62% (64/103) in normal eyes. When there was disagreement, IA outperformed Barrett True-K in post-hyperopic LVC eyes and Barrett formula outperformed IA in post-myopic LVC, post-RK, and normal eyes. Conclusion IA appears to be comparable to Barrett formulas for IOL power calculations in post-corneal refractive surgery and normal eyes. In post-hyperopic LVC, IA yields better results compared to Barrett True-K formula; in real-life scenarios, IA reveals statistical advantage over the Barrett True-K no history formula for eyes post-hyperopic LVC.
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Affiliation(s)
- Larissa Gouvea
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Kareem Sioufi
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Colin E Brown
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | | | - Wallace Chamon
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
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