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Intraoperative toric IOL alignment using a novel augmented reality system

Session Details

Session Title: Intraoperative Biometry and Correction of Astigmatism

Session Date/Time: Monday 07/10/2013 | 08:00-10:00

Paper Time: 08:06

Venue: Main Lecture Hall (Ground Floor)

First Author: : A.Harrer AUSTRIA

Co Author(s): :    N. Hirnschall   S. Maedel   M. Weber   O. Findl     

Abstract Details


To evaluate a dedicated operating microscope with augmented reality technology to allow intra-operative toric IOL alignment without pre-operative corneal marking.


Vienna Institute for Research in ocular surgery VIROS, Hanusch Hospital, Vienna,Austria


In this randomised patient- and examiner-masked study consecutive patients who were scheduled for cataract surgery were included. Patients were randomly allocated to the study and control group (2:1 ratio). In the study group, a prototype operating microscope was used for cataract surgery that allowed superposition of a display onto the live image in one eyepiece. An automated matching of limbal vessels from pre-operative photographs taken with a modified IOL-Master 500 was used to track and follow the eye during surgery (OPMI Lumera 700 and Callisto, Carl Zeiss Meditec AG, Germany). In the control group, pre-operative corneal marking was performed conventionally using the manual corneal marking at the slit lamp. IOL position and rhexis size were assessed postoperatively from standardised retroillumination photographs.


In total 75 patients were included in the study. Fifty patients in the study group and 25 patients in the control group. Preliminary results showed a mean absolute difference between the intended meridian and the automated system of 1.7° (SD: 3.1°) and the conventional marking of 0.4° (SD: 2.3°), respectively. Some of the challenges with this new technology will be illustrated with case studies such as with conjunctival ballooning or intra-operative conjunctival haemorrhage.


Intra-operative alignment of the IOL axis as well as planning of capsulorhexis size may enhance outcomes for patients after cataract surgery. Furthermore augmented reality system allows implantation of toric IOLs more quickly and efficiently.

Financial Interest:


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