Axial length acquisition success rates and agreement of four optical biometers and one ultrasound biometer in eyes with dense cataracts

BACKGROUND: To evaluate the axial length acquisition success rates and agreement between various biometric parameters obtained with different biometers in dense cataracts. METHODS: Fifty-one eyes were measured using Anterion®, Argos® and IOLMaster® 700 swept-source optical coherence tomography (SS-OCT) biometers, a Pentacam® AXL partial coherence interferometry (PCI) biometer, and an OcuScan® RxP ultrasound biometer. We measured keratometry (K1, flattest keratometry and K2, steepest keratometry), white-to-white (WTW), anterior chamber depth (ACD), lens thickness (LT) and axial length. Cataracts were classified according to the Lens Opacities Classification System III grading system, the dysfunctional lens index (DLI) and Pentacam® nucleus staging (PNS) metrics. Percentage of acquisition success rate and a Bland–Altman analysis for the agreement between biometers were calculated. RESULTS: The mean LOCS III score was 3.63 ± 0.92, the mean DLI was 2.95 ± 1.30 and the mean PNS was 2.36 ± 1.20. The acquisition success rates for the Anterion®, Argos®, IOLMaster® 700, Pentacam® AXL and OcuScan® RxP biometers were 94.12%, 100%, 98.04%, 60.78% and 100%, respectively. There were significant differences in the success rates between biometers (P = 0.014). There were statistically significant differences between biometers for all parameters evaluated (P < 0.05). The range of the limit of agreement (LoA) for all comparisons of K1 and K2 were > 1.00 D. The LoA for WTW ranged from 0.095 to 1.050 mm. The LoA for ACD and LT ranged from 0.307 to 0.114 mm and from 0.378 to 0.108 mm, respectively. The LoA for axial length ranged from 0.129 to 2.378 mm. CONCLUSIONS: Among optical biometers, those based on SS-OCT technology are more successful at measuring axial length in eyes with dense cataracts. Trial Registration: The study was registered with the National Institutes of Health (clinical trial identifier NCT05239715, http://www.clinicaltrials.gov). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40662-023-00352-3.