The Effect Of Eyelid Closure On The Quality Index Of Keratometric Measurements: A Non-Controlled Interventional Study

Keratometry is an important step in biometry before cataract surgery. Errors in keratometry can lead to postoperative deviations from target refraction and therefore to patient dissatisfaction. It has been shown that dry eye disease (DED) plays an important role in the precision of keratometry measurements. From our clinical observations, a possible strategy to improve the precision of keratometry is eyelid closure for some minutes before performing biometry. Eyelid closure is an easy and fast intervention and therefore easily integrable in clinical workflow. Therefore, this study aims to investigate the effect of 3-minute eyelid closure on the quality index of keratometry in patients with displayed warning indicators during biometry.

All study-related measures as well as data collection were performed at the Vienna Institute for Research in Ocular Surgery (VIROS), Karl-Landsteiner Institute, Vienna, Austria.

Patients undergoing biometry with a keratometrical warning index are included in this prospective study. Additional to the screening measurement, four biometric measurements using an optical biometer (IOLMaster700®, Carl Zeiss Meditec AG) are performed. The first two measurements are performed without prior lid closure at an interval of three minutes. Before the third and the fourth measurements, the patients are advised to close their eyes for three minutes. The main outcome of this study is the proportion of eyes that indicate a keratometrical warning index during the first measurement (without lid closure) as compared to the third measurement (after lid closure). As secondary outcome, the repeatability of the measurements is compared.

During a clinical observation in patients with DED, nine eyes of nine patients indicated a “warning” for the keratometry measurement. After eyelid closure for three minutes, there was a warning of the keratometry quality index in only one out of nine eyes (11.1%). Therefore, after lid closure, eight out of nine eyes (88.9%) showed “no warning”. Based on these clinical observations, we performed a prospective clinical trial that is currently under completion. Final data will be presented at the 43^rd Congress of the ESCRS in Copenhagen.

Our clinical observations indicate that lid closure may be a valuable tool to improve the precision of the preoperative keratometry in patients with tear film instability. However, this hypothesis has to be validated through a clinical trial that is currently under completion. The final data of this study will be presented at the 43^rd Congress of the ESCRS in Copenhagen.