Theoretical evaluation of the cataract extraction-refraction-implantation techniques for intraocular lens power calculation

PURPOSE: To evaluate theoretically three previously published formulae that use intra-operative aphakic refractive error to calculate intraocular lens (IOL) power, not necessitating pre-operative biometry. The formulae are as follows: IOL power (D) = Aphakic refraction x 2.01 [Ianchulev et al., J. Cataract Refract. Surg.31 (2005) 1530]; IOL power (D) = Aphakic refraction x 1.75 [Mackool et al., J. Cataract Refract. Surg.32 (2006) 435]; IOL power (D) = 0.07x(2) + 1.27x + 1.22, where x = aphakic refraction [Leccisotti, Graefes Arch. Clin. Exp. Ophthalmol.246 (2008) 729]. METHODS: Gaussian first order calculations were used to determine the relationship between intra-operative aphakic refractive error and the IOL power required for emmetropia in a series of schematic eyes incorporating varying corneal powers, pre-operative crystalline lens powers, axial lengths and post-operative IOL positions. The three previously published formulae, based on empirical data, were then compared in terms of IOL power errors that arose in the same schematic eye variants. RESULTS: An inverse relationship exists between theoretical ratio and axial length. Corneal power and initial lens power have little effect on calculated ratios, whilst final IOL position has a significant impact. None of the three empirically derived formulae are universally accurate but each is able to predict IOL power precisely in certain theoretical scenarios. The formulae derived by Ianchulev et al. and Leccisotti are most accurate for posterior IOL positions, whereas the Mackool et al. formula is most reliable when the IOL is located more anteriorly. CONCLUSION: Final IOL position was found to be the chief determinant of IOL power errors. Although the A-constants of IOLs are known and may be accurate, a variety of factors can still influence the final IOL position and lead to undesirable refractive errors. Optimum results using these novel formulae would be achieved in myopic eyes.

Advances in cataract surgery

Cataract surgery is a technique described since recorded history, yet it has greatly evolved only in the latter half of the past century. The development of the intraocular lens and phacoemulsification as a technique for cataract removal could be considered as the two most significant strides that have been made in this surgical field. This review takes a comprehensive look at all aspects of cataract surgery, starting from patient selection through the process of consent, anaesthesia, biometry, lens power calculation, refractive targeting, phacoemulsification, choice of intraocular lens and management of complications, such as posterior capsular opacification, as well as future developments. As the most common ophthalmic surgery and with the expanding range of intraocular lens options, optometrists have an important and growing role in managing patients with cataract.

Validity and repeatability of the Aladdin ocular biometer

Aim To assess the accuracy and reproducibility of biometry undertaken with the Aladdin (Topcon, Tokyo, Japan) in comparison with the current gold standard device, the IOLMaster 500 (Zeiss, Jena, Germany). Setting University Eye Clinic, Birmingham, UK and Refractive Surgery Centre, Kiel, Germany. Methods The right eye of 75 patients with cataracts and 22 healthy participants were assessed using the two devices. Measurements of axial length (AL), anterior chamber depth (ACD) and keratometry (K) were undertaken with the Aladdin and IOLMaster 500 in random order by an experienced practitioner. A second practitioner then obtained measurements for each participant using the Aladdin biometer in order to assess interobserver variability. Results No statistically significant differences ( p≥0.05) between the two biometers were found for average difference (AL)±95% CI=0.01±0.06 mm), ACD (0.00 ±0.11 mm) or mean K values (0.08±0.51 D). Furthermore, interobserver variability was very good for each parameter (weighted κ≥0.85). One patient's IOL powers could not be calculated with either biometer measurements, whereas a further three could not be analysed by the IOLMaster 500. The IOL power calculated from the valid measurements was not statistically significantly different between the biometers (p=0.842), with 91% of predictions within±0.25 D. Conclusions The Aladdin is a quick, easy-to-use biometer that produces valid and reproducible results that are comparable with those obtained with the IOLMaster 500.

Fast response static var generator for improving the power system performance of an electric arc furnace (EAF)

Cascaded multilevel inverters-based Static Var Generators (SVGs) are FACTS equipment introduced for active and reactive power flow control. They eliminate the need for zigzag transformers and give a fast response. However, with regard to their application for flicker reduction in using Electric Arc Furnace (EAF), the existing multilevel inverter-based SVGs suffer from the following disadvantages. (1) To control the reactive power, an off-line calculation of Modulation Index (MI) is required to adjust the SVG output voltage. This slows down the transient response to the changes of reactive power; and (2) Random active power exchange may cause unbalance to the voltage of the d.c. link (HBI) capacitor when the reactive power control is done by adjusting the power angle d alone. To resolve these problems, a mathematical model of 11-level cascaded SVG, was developed. A new control strategy involving both MI (modulation index) and power angle (d) is proposed. A selected harmonics elimination method (SHEM) is taken for switching pattern calculations. To shorten the response time and simplify the controls system, feed forward neural networks are used for on-line computation of the switching patterns instead of using look-up tables. The proposed controller updates the MI and switching patterns once each line-cycle according to the sampled reactive power Qs. Meanwhile, the remainder reactive power (compensated by the MI) and the reactive power variations during the line-cycle will be continuously compensated by adjusting the power angles, d. The scheme senses both variables MI and d, and takes action through the inverter switching angle, qi. As a result, the proposed SVG is expected to give a faster and more accurate response than present designs allow. In support of the proposal there is a mathematical model for reactive powered distribution and a sensitivity matrix for voltage regulation assessment, MATLAB simulation results are provided to validate the proposed schemes. The performance with non-linear time varying loads is analysed and refers to a general review of flicker, of methods for measuring flickers due to arc furnace and means for mitigation.

Analysis of power jitter induced by interchannel interactions in dispersion-managed optical soliton transmission systems

Collision-induced power jitter is theoretically and numerically examined in dispersion-managed wavelength-division-multiplexed optical soliton transmission systems. The variational method is mainly used to develop a time efficient jitter calculation approach. The power jitter causes a serious problem for a singly periodic dispersion managed line having almost zero average dispersion, which can be reduced by applying doubly periodic dispersion management.

Statnote 8: statistical power and sample size

Statistical software is now commonly available to calculate Power (P') and sample size (N) for most experimental designs. In many circumstances, however, sample size is constrained by lack of time, cost, and in research involving human subjects, the problems of recruiting suitable individuals. In addition, the calculation of N is often based on erroneous assumptions about variability and therefore such estimates are often inaccurate. At best, we would suggest that such calculations provide only a very rough guide of how to proceed in an experiment. Nevertheless, calculation of P' is very useful especially in experiments that have failed to detect a difference which the experimenter thought was present. We would recommend that P' should always be calculated in these circumstances to determine whether the experiment was actually too small to test null hypotheses adequately.

Evaluation of modern intraocular lenses

Accommodating Intraocular Lenses (IOLs), multifocal IOLs (MIOLs) and toric IOLs are designed to provide a greater level of spectacle independency post cataract surgery. All of these IOLs are reliant on the accurate calculation of intraocular lens power determined through reliable ocular biometry. A standardised defocus area metric and reading performance index metric were devised for the evaluation of the range of focus and the reading ability of subjects implanted with presbyopic correcting IOLs. The range of clear vision after implantation of an MIOL is extended by a second focal point; however, this results in the prevalence of dysphotopsia. A bespoke halometer was designed and validated to assess this photopic phenomenon. There is a lack of standardisation in the methods used for determining IOL orientation and thus rotation. A repeatable, objective method was developed to allow the accurate assessment of IOL rotation, which was used to determine the rotational and positional stability of a closed loop haptic IOL. A new commercially available biometry device was validated for use with subjects prior to cataract surgery. The optical low coherence reflectometry instrument proved to be a valid method for assessing ocular biometry and covered a wider range of ocular parameters in comparison with previous instruments. The advantages of MIOLs were shown to include an extended range of clear vision translating into greater reading ability. However, an increased prevalence of dysphotopsia was shown with a bespoke halometer, which was dependent on the MIOL optic design. Implantation of a single optic accommodating IOL did not improve reading ability but achieved high subjective ratings of near vision. The closed-loop haptic IOL displayed excellent rotational stability in the late period but relatively poor rotational stability in the early period post implantation. The orientation error was compounded by the high frequency of positional misalignment leading to an extensive overall misalignment of the IOL. This thesis demonstrates the functionality of new IOL lens designs and the importance of standardised testing methods, thus providing a greater understanding of the consequences of implanting these IOLs. Consequently, the findings of the thesis will influence future designs of IOLs and testing methods.

Reliability estimation of second life battery system power electronic topologies for grid frequency response applications

This paper is part of a project which aims to research the opportunities for the re-use of batteries after their primary use in low and ultra low carbon vehicles on the electricity grid system. One potential revenue stream is to provide primary/secondary/high frequency response to National Grid through market mechanisms via DNO's or Energy service providers. Some commercial battery energy storage systems (BESS) already exist on the grid system, but these tend to use costly new or high performance batteries. Second life batteries should be available at lower cost than new batteries but reliability becomes an important issue as individual batteries may suffer from degraded performance or failure. Therefore converter topology design could be used to influence the overall system reliability. A detailed reliability calculation of different single phase battery-to-grid converter interfacing schemes is presented. A suitable converter topology for robust and reliable BESS is recommended.

Permanent magnet synchronous generator based wind power generation system fault protection schemes

The PMSG-based wind power generation system protection is presented in this paper. For large-scale systems, a voltagesource converter rectifier is included. Protection circuits for this topology are studied with simulation results for cable permanent fault conditions. These electrical protection methods are all in terms of dumping redundant energy resulting from disrupted path of power delivery. Pitch control of large-scale wind turbines are considered for effectively reducing rotor shaft overspeed. Detailed analysis and calculation of damping power and resistances are presented. Simulation results including fault overcurrent, DC-link overvoltage and wind turbine overspeed are shown to illustrate the system responses under different protection schemes to compare their application and effectiveness.