Preoperative measurements for cataract surgery: a comparison of ultrasound and optical biometric devices



To evaluate differences in preoperative measurements and refractive outcomes between ultrasound and optical biometry when using the Barrett Universal II intraocular lens (IOL) power formula.


In this consecutive case series, cataract extraction and IOL implantation cases from two surgical centers in Toronto, Canada, were recruited between January 2015 and July 2017. Differences between ultrasound (applanation or immersion A-scan) and optical biometry (IOLMaster 500) were compared for axial length (AL), anterior chamber depth and refractive outcomes. The primary outcome was the percentage of cases in each cohort within ± 0.50D of refractive error.


In total, 527 cataract cases underwent IOLMaster testing. Of these, 329 eyes (62.4%) were also measured by applanation A-scan, and the other 198 eyes (37.6%) received immersion A-scan testing. Applanation ultrasound led to 5.8%, 16.0% and 46.4% of eyes within ± 0.25D, ± 0.50D and ± 1.00D of refractive error, respectively, whereas the IOLMaster 500 led to 48.5%, 77.1% and 94.9%, respectively (n = 293, ± 0.50D: p < 0.001). Immersion ultrasound led to 31.2%, 57.6% and 91.2% of eyes within ± 0.25D, ± 0.50D and ± 1.00D of refractive error, respectively, whereas the IOLMaster 500 led to 42.4%, 72.0% and 92.0%, respectively (n = 125, ± 0.50D: p = 0.001). Applanation (n = 329, A-scan AL: 23.64 ± 1.67 mm, IOLMaster AL: 24.20 ± 1.70 mm, p < 0.001) and immersion ultrasound (n = 198, A-scan AL: 25.01 ± 2.06 mm, IOLMaster AL: 25.08 ± 2.13 mm, p = 0.002) yielded significantly lower AL values compared to optical biometry measurements.


Optical biometry yielded a significantly larger percentage of cases within ± 0.50D of refractive error compared to ultrasound biometry when using the Barrett Universal II IOL power formula.

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Fig. 1
Fig. 2

Data availability

The data that support the findings of this study are available on request from the corresponding author.



Axial length


Intraocular lens


Anterior chamber depth (corneal epithelium to anterior lens surface)


Retinal pigment epithelium


Partial coherence interferometry


Best corrected visual acuity


User group for laser interference biometry


Corneal diameter


Mean absolute error


Median absolute error


Mean prediction error


95% Confidence interval


Odds ratio


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All authors contributed to the manuscript and have reviewed/approved its contents.

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Correspondence to Matthew B. Schlenker.

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Author A declares that he has no conflict of interest. Author B declares that he has no conflict of interest. Author C declares that he has no conflict of interest. Author D declares that he has no conflict of interest. Author E declares that he has no conflict of interest.

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Research Ethics Board approval was obtained from Sunnybrook Health Sciences Centre and the University of Toronto. Due to the retrospective nature of the study, no patient consent was required for this study.

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The Research Ethics Board approved our request to publish anonymized data for this study.

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All procedures performed in studies involving participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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No informed consent was obtained from participants as data collected were retrospective in nature and part of the standard of care examination. This was approved by the University of Toronto research ethics board and adhered to the Tenet’s of Helsinki for retrospective case series studies.

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Pereira, A., Popovic, M., Lloyd, J.C. et al. Preoperative measurements for cataract surgery: a comparison of ultrasound and optical biometric devices. Int Ophthalmol (2021).

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  • Cataract
  • Biometry
  • Optical
  • Ultrasound
  • IOLMaster
  • A-scan
  • Barrett