Experimental Eye Research 140 (2015) 190e192

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Experimental Eye Research

journal homepage: www.elsevier.com/locate/yexer

Methods in eye research

A rapid method for measuring intraocular lens power in vitro with a

focimeter
Mari Carmen García-Domene a, b, *, María Amparo Díez-Ajenjo a, b,
 María Artigas b
Cristina Peris-Martínez a, Amparo Navea a, Jose
a
FISABIO-Oftalmología M n Pío Baroja-General Aviles, s/n, 46015 Valencia, Spain
edica, Bifurcacio
b
Universitat de Val
encia, C/Dr. Moliner, 50, 46100 Burjassot, Valencia, Spain

a r t i c l e i n f o a b s t r a c t

Article history: In this paper we describe a new method for measuring the intraocular lens (IOL) power using a focimeter,
Received 7 May 2015 a negative ophthalmic lens and a saline solution (0.9% NaCl). To test this we measured the power of 58
Received in revised form different IOLs and we compared them with the power stated by the manufacturer. Despite the limita-
11 September 2015
tions, the results show a good correlation.
Accepted in revised form 15 September
© 2015 Elsevier Ltd. All rights reserved.
2015
Available online 18 September 2015

Keywords:
Power
Intraocular lens
Method
Focimeter
Ophthalmic lens

1. Introduction on the IOL. The EFL can be measured with a nodal slide bench.
These methods are better for conditions in the air and are suitable
The ISO 11979-2:2014 Annex A (normative) recommends some for all IOLs.
procedures to ascertain an IOL power which depend on the design
of the IOL: monofocal, toric, or multifocal. 1.3. Measuring magnification
These methods are:
Magnification can be determined by using an optical bench, a
1.1 Determining the radius over a 3 mm diameter using a radius target with a measurable linear dimension, and an eye-piece that
meter, interferometer, or optical coherence tomography, can measure the corresponding linear dimension on the image at
measuring the lens thickness with a micrometer. This pro- the EFL position. This method can be used for all IOLs.
cedure can be used for monofocal and toric IOLs (measuring The literature reports how to ascertain the IOL power by
in the principal meridians). measuring the focal length with a confocal fiber-optic laser (Ilev,
1.2 Measuring back focal/effective focal length 2007) or the radius of the IOL surfaces using optical coherence
tomography (Huang et al., 2011). In addition, there are some de-
To obtain the back focal length (BFL), the distance from the back vices that can measure the IOL power automatically, for example
vertex of the IOL to the focal point is measured with a parallel light the PMTF (Lambda-X, Nivelles, Belgium) or NIMO TR0815 (Lambda-
incident on-axis on the IOL. X, Nivelles, Belgium).
The effective focal length (EFL) is the distance from the second Furthermore, we know that some authors have used a wet cell
principal plane to the focal point with parallel light incident on-axis and a focimeter to determine the power of contact lenses (Pearson
and Evans, 2012). For these reasons, in the present study, we
describe a fast and inexpensive method for measuring the IOL
* Corresponding author. FISABIO-Oftalmología Medica, Bifurcacio
n Pío Baroja- power using a focimeter.
General Aviles, s/n, 46015 Valencia, Spain.
E-mail address: m.carmen.garcia-domene@uv.es (M.C. García-Domene).

http://dx.doi.org/10.1016/j.exer.2015.09.009
0014-4835/© 2015 Elsevier Ltd. All rights reserved.
 M.C. García-Domene et al. / Experimental Eye Research 140 (2015) 190e192 191

2. Materials and supplies Table 1

Distribution and power of the different measured IOLs.

The material used in our method is a focimeter (Magnon LM-350, Monofocal Toric Multifocal
Nidek Co. Aichi, Japan) with source of 546 nm, a negative ophthalmic Number Power (D) Number Power (D) Number Power (D)
lens (meniscus form,
10 D, with a refraction index of 1.7), and saline
Positive 44 þ20 ± 5 2 19 ± 1 8 þ22 ± 2
solution (NaCl 0.9% B.Braun, Melsungen AG, Germany). To validate
Negative 3
7 ± 1 1
8D 0
this method, we measured the lens power of 58 different IOLs. Each
Statistical analysis to determine the concordance was made with a Passing-Bablock
IOL power was measured three times and by the same person.
test since the distribution of the sample wasn't normal (Passing and Bablok, 1983).

3. Detailed methods

Previous to the measurements, the focimeter was calibrated

measuring 8 ophthalmic lenses of different power (±14D ±10D ±5D
and ±0.5D).
For the experimental procedure the focimeter was placed in a
vertical position (Fig. 1a) with the negative lens with its concave
surface facing upward and the saline solution inside the lens to
make a “wet cell” where we placed the IOL, we have centered the
target of the focimeter as accurately as possible (Fig. 1 b). Tradi-
tional focimeters can measure powers from þ25 D to
25 D in steps
of 0.25 D. An IOL power is usually more than þ25 D, so using a
negative lens of
10 D plus saline solution we added þ4.5 D to the
power range, since, if we focused on the focimeter target with the
negative lens immersed in saline solution, a power reading of
4.5
D was obtained instead of zero.
The usual measurement procedure for a focimeter was used.
First we have to center the target just with the divergent lens plus Fig. 2. Linear fit between the measured IOL power and the labeled power stated by the
manufacturer.
saline solution, then we introduce the IOL and we center again the
target by moving the IOL, this way lenses are aligned. The real IOL
power is the result of subtracting 4.5 D from the focimeter reading. mean difference from the stated power was þ0.3 ± 0.3D. The error
In order to check this method, we measured the power of 58 made in the three measurements of the power of each IOL was
IOLs of different designs and materials e spherical, aspheric, toric smaller than the minimum step in the lensmeter scale (0.25 D). We
and multifocal, phakic and aphakic (see Table 1). The mean IOL obtained the same value in all cases for the three measures except
power was þ19 ± 9 D and we compared the results with the IOL in the near focus of one multifocal lens since to having two focus
power stated by the manufacturer. We used the mean power for far (one out defocused) the measurement was more difficult with an
and near focus for multifocal IOLs and the mean power of the two standard deviation of 0.14 D. So the repeatability of the measure-
principal meridians for toric IOLs. ment was practically 100%.
Fig. 2 shows the result of comparing both powers (measured
4. Results and labeled). As we can observe, there was a good linear correlation
(r ¼ 0.99) as well as a slope of nearly 1. The sample was normal, so
The mean of the experimental power was þ19 ± 9 D and the we carried out a T-test. Statistics showed that the mean was

Fig. 1. Experimental device: focimeter in a vertical position (a) and negative lens with saline solution (b).
192 M.C. García-Domene et al. / Experimental Eye Research 140 (2015) 190e192

A previous study uses a focimeter to measure the power of the

contact lens (Pearson and Evans, 2012), and here in this study we
present a modified method to measure an IOL power. With an
ophthalmic lens of
10 D and saline solution we can increase the
range power by þ4.5 D, which is necessary for high IOL powers.
However, with a more powerful ophthalmic lens we can extend this
range.
The results show a good linear fit between the measured and
labeled IOL powers assuming that both are similar since the slope is
practically 1 (Fig. 2). We have also a good concordance between the
measured and labeled power. Although they are statistically
different (p < 0.05), the ISO normative regarding IOL power allows
an error ranging between 0.3 D (in IOLs with a power of under 15 D)
and 1 D (in IOLs of over 30 D). The error in our measurements
is þ0.3 ± 0.3 D, so we can conclude that our method is sufficiently
accurate since the power stated is not exact. In any case, these re-
sults are promising.

Financial disclosure
Fig. 3. Result for Passing-Bablock test to analyze the concordance between the labeled
and measured IOL power.
The authors have no relevant financial interests in this study.

significantly different (p ¼ 0.04).

In order to evaluate the concordance we have used the Passing- Acknowledgment
Bablock test. In Fig. 3 we can see the result, we have a good
concordance since the ideal and regression lines are inside the We wish to thank the C
atedra Alcon-Universitat de Valencia for
confidence limits. As we can observe for high powers the error is their support.
higher than for the rest. By other hand we have some negative
powers outside the limits, that could be due because we have a few References
lens with negative power.
Huang, Y., Zhang, K., Kang, J.U., Calogero, D., James, R.H., Ilev, I.K., 2011. Noncontact
common-path Fourier domain optical coherence tomography method for
5. Potential pitfalls and trouble shooting in vitro intraocular lens power measurement. J. Biomed. Opt. 16, 126005.
Ilev, I.K., 2007. A simple confocal fibre-optic laser method for intraocular lens power
measurement. Eye 21, 819e823.
In this paper we describe a new, accurate, inexpensive, fast, and
Pearson, R.M., Evans, B.J., 2012. A comparison of in-air and in-saline focimeter
easy-to-carry-out IOL power measurement method for any type of measurement of the back vertex power of spherical soft contact lenses.
intraocular lens using a focimeter. With this method, it is easy to Ophthalmic Physiol. Opt. 32, 508e517.
find the principal meridians in an astigmatic IOL, or a far and near Passing, H., Bablok, W., 1983. A new biometrical procedure for testing the equality
of measurements from two different analytical methods. Application of linear
focus in a multifocal IOL, of an either symmetric or asymmetric regression procedures for method comparison studies in Clinical Chemistry,
design. Part I. J. Clin. Chem. Clin. Biochem. 21, 709e720.