International Ophthalmology

, Volume 34, Issue 4, pp 869–875 | Cite as

Keratometry with five different techniques: a study of device repeatability and inter-device agreement

  • Shiva Mehravaran
  • Soheila Asgari
  • Sara Bigdeli
  • Ashkan Shahnazi
  • Hassan HashemiEmail author
Original Paper


The purpose of this study was to determine and compare the repeatability of keratometry measurements with the Javal manual keratometer, Topcon automated kerato-refractometer, IOLMaster, EyeSys Corneal Analysis System, and Pentacam Scheimpflug Topography System, and determine the agreement of measurements of the latter four devices with the Javal keratometer as the gold standard. In this cross-sectional study, 21 people with no history of ocular disease or surgery were examined twice with each device. Minimum, maximum, and average keratometry readings were recorded in diopters (D) for each eye and used in the analyses. For statistical analysis, we determined correlation coefficients and used the Bland–Altman method and calculated the 95 % limits of agreement (LoA). All repeatability coefficients were satisfactorily high. Best repeatability for minimum keratometry and maximum keratometry readings was seen with IOLMaster (95 % LoA −0.23 to 0.19 D and −0.31 to 0.32 D, respectively). Agreement with Javal manual keratometry was best with Topcon and IOLMaster for minimum keratometry readings (95 % LoA −0.67 to 0.28 D and −0.57 to 0.38 D, respectively), and with Topcon for maximum keratometry readings (95 % LoA −0.85 to 0.63 D). In our series of normal eyes, keratometry readings with Topcon, IOLMaster, and Pentacam showed very good agreement with Javal measurements, and inter-device agreements were better than the repeatability of the manual gold standard. However, differences between Javal and EyeSys may not be clinically acceptable, and these two devices should not be used interchangeably. Further studies are needed to investigate these issues in non-virgin eyes.


Keratometry Javal manual keratometer Topcon automated kerato-refractometer IOLMaster EyeSys Corneal Analysis System Pentacam Scheimpflug Topography System 


Conflict of interest

No conflicting relationship exists for any author.


  1. 1.
    Sahin A, Yildirim N, Basmak H (2008) Two-year interval changes in Orbscan II topography in eyes with keratoconus. J Cataract Refract Surg 34:1295–1299PubMedCrossRefGoogle Scholar
  2. 2.
    Kohnen T, Koch DD (2009) Cataract and refractive surgery: Progress III. Springer, HeidelbergCrossRefGoogle Scholar
  3. 3.
    Haigis W (2008) Intraocular lens calculation after refractive surgery for myopia: Haigis-L formula. J Cataract Refract Surg 34:1658–1663PubMedCrossRefGoogle Scholar
  4. 4.
    Aristodemou P, Knox Cartwright NE, Sparrow JM, Johnston RL (2011) Formula choice: Hoffer Q, Holladay 1, or SRK/T and refractive outcomes in 8,108 eyes after cataract surgery with biometry by partial coherence interferometry. J Cataract Refract Surg 37:63–71PubMedCrossRefGoogle Scholar
  5. 5.
    Hosny M, Alio JL, Claramonte P, Attia WH, Perez-Santonja JJ (2000) Relationship between anterior chamber depth, refractive state, corneal diameter, and axial length. J Refract Surg 16:336–340PubMedGoogle Scholar
  6. 6.
    Holzer MP, Mamusa M, Auffarth GU (2009) Accuracy of a new partial coherence interferometry analyser for biometric measurements. Br J Ophthalmol 93:807–810PubMedCrossRefGoogle Scholar
  7. 7.
    Tennen DG, Keates RH, Montoya C (1995) Comparison of three keratometry instruments. J Cataract Refract Surg 21:407–408PubMedCrossRefGoogle Scholar
  8. 8.
    Tsilimbaris MK, Vlachonikolis IG, Siganos D, Makridakis G, Pallikaris IG (1991) Comparison of keratometric readings as obtained by Javal Ophthalmometer and Corneal Analysis System (EyeSys). Refract Corneal Surg 7:368–373PubMedGoogle Scholar
  9. 9.
    Santodomingo-Rubido J, Mallen EA, Gilmartin B, Wolffsohn JS (2002) A new non-contact optical device for ocular biometry. Br J Ophthalmol 86:458–462PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Mihaltz K, Kovacs I, Takacs A, Nagy ZZ (2009) Evaluation of keratometric, pachymetric, and elevation parameters of keratoconic corneas with pentacam. Cornea 28:976–980PubMedCrossRefGoogle Scholar
  11. 11.
    Hashemi H, Mehravaran S, Rezvan F (2010) Changes in corneal thickness, curvature, and anterior chamber depth during the menstrual cycle. Can J Ophthalmol 45:67–70PubMedCrossRefGoogle Scholar
  12. 12.
    Muller R, Buttner P (1994) A critical discussion of intraclass correlation coefficients. Stat Med 13:2465–2476PubMedCrossRefGoogle Scholar
  13. 13.
    Kramer MS, Feinstein AR (1981) Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 29:111–123PubMedCrossRefGoogle Scholar
  14. 14.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRefGoogle Scholar
  15. 15.
    Khurana AK (2008) Theory and practice of optics and refraction. Elsevier India, ChennaiGoogle Scholar
  16. 16.
    Fowler CW (1989) Assessment of toroidal surfaces by the measurement of curvature in three fixed meridians. Ophthalmic Physiol Opt 9:79–80PubMedCrossRefGoogle Scholar
  17. 17.
    Roy H, Hill WE (2012) IOLMaster for determining the IOL power at the time of surgery. In: Agarwal A, Jacob S (eds) Phacoemulsification. Jaypee Brothers Medical Publications, New Delhi, p 62Google Scholar
  18. 18.
  19. 19.
    Koch DD, Foulks GN, Moran CT, Wakil JS (1989) The Corneal EyeSys System: accuracy analysis and reproducibility of first-generation prototype. Refract Corneal Surg 5:424–429PubMedGoogle Scholar
  20. 20.
    Dave T, Ruston D, Fowler C (1998) Evaluation of the EyeSys model II computerized videokeratoscope. Part II: the repeatability and accuracy in measuring convex aspheric surfaces. Optom Vis Sci 75:656–662PubMedCrossRefGoogle Scholar
  21. 21.
    Swart TC (2010) Pentacam. In: Agarwal A, Agarwal A, Jacob S (eds) Dr Agarwal’s textbook on corneal topography: including Pentacam and anterior segment OCT. Jaypee Highlights Medical Publishers, New Delhi, pp 117–136Google Scholar
  22. 22.
    Sunderraj P (1992) Clinical comparison of automated and manual keratometry in pre-operative ocular biometry. Eye (Lond) 6:60–62CrossRefGoogle Scholar
  23. 23.
    Kim EC, Cho K, Hwang HS, Hwang KY, Kim MS (2013) Intraocular lens prediction accuracy after corneal refractive surgery using K values from 3 devices. J Cataract Refract Surg 39:1640–1646PubMedCrossRefGoogle Scholar
  24. 24.
    Thebpatiphat N, Hammersmith KM, Rapuano CJ, Ayres BD, Cohen EJ (2007) Cataract surgery in keratoconus. Eye Contact Lens 33:244–246PubMedCrossRefGoogle Scholar
  25. 25.
    Shirayama M, Wang L, Weikert MP, Koch DD (2009) Comparison of corneal powers obtained from 4 different devices. Am J Ophthalmol 148(528–35):e1PubMedGoogle Scholar
  26. 26.
    Pardhan S, Douthwaite WA (1998) Comparison of videokeratoscope and autokeratometer measurements on ellipsoid surfaces and human corneas. J Refract Surg 14:414–419Google Scholar
  27. 27.
    Kawamorita T, Nakayama N, Uozato H (2009) Repeatability and reproducibility of corneal curvature measurements using the Pentacam and Keratron topography systems. J Refract Surg 25:539–544PubMedCrossRefGoogle Scholar
  28. 28.
    McEwan JR, Massengill RK, Friedel SO (1990) The effect of keratometer and axial length measurements on primary implant power calculations. J Cataract Refract Surg 16:61–70PubMedCrossRefGoogle Scholar
  29. 29.
    Olsen T (2007) Calculation of intraocular lens power: a review. Acta Ophthalmol Scand 85:472–485PubMedCrossRefGoogle Scholar
  30. 30.
    Giraldez MJ, Yebra-Pimentel E, Parafita MA, Escandon S, Cervino A, Perez MV (2000) Comparison of Keratometric Values of Healthy Eyes Measured by Javal Keratometer, Nidek Autokeratometer, and Corneal Analysis System (EyeSys). Int Contact Lens Clin 27:33–40CrossRefGoogle Scholar
  31. 31.
    Davies LN, Mallen EA, Wolffsohn JS, Gilmartin B (2003) Clinical evaluation of the Shin-Nippon NVision-K 5001/Grand Seiko WR-5100 K autorefractor. Optom Vis Sci 80:320–324PubMedCrossRefGoogle Scholar
  32. 32.
    Sheppard AL, Davies LN (2010) Clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM-5500. Ophthalmic Physiol Opt 30:143–151PubMedCrossRefGoogle Scholar
  33. 33.
    Nemeth J, Fekete O, Pesztenlehrer N (2003) Optical and ultrasound measurement of axial length and anterior chamber depth for intraocular lens power calculation. J Cataract Refract Surg 29:85–88PubMedCrossRefGoogle Scholar
  34. 34.
    McAlinden C, Khadka J, Pesudovs K (2011) A comprehensive evaluation of the precision (repeatability and reproducibility) of the Oculus Pentacam HR. Invest Ophthalmol Vis Sci 52:7731–7737PubMedCrossRefGoogle Scholar
  35. 35.
    Chang M, Kang S, Kim HM (2012) Which Keratometer is Most Reliable for Correcting Astigmatism with Toric Intraocular Lenses? Korean J Ophthalmol 26:10–14PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Whang WJ, Byun YS, Joo CK (2012) Comparison of refractive outcomes using five devices for the assessment of preoperative corneal power. Clin Experiment Ophthalmol 40:425–432PubMedCrossRefGoogle Scholar
  37. 37.
    Holladay JT, Hill WE, Steinmueller A (2009) Corneal power measurements using scheimpflug imaging in eyes with prior corneal refractive surgery. J Refract Surg 25:862–868PubMedCrossRefGoogle Scholar
  38. 38.
    Varssano D, Rapuano CJ, Luchs JI (1997) Comparison of keratometric values of healthy and diseased eyes measured by Javal keratometer, EyeSys, and PAR. J Cataract Refract Surg 23:419–422PubMedCrossRefGoogle Scholar
  39. 39.
    Moura RC, Bowyer BL, Stevens SX, Rowsey JJ (1998) Comparison of three computerized videokeratoscopy systems with keratometry. Cornea 17:522–528PubMedCrossRefGoogle Scholar
  40. 40.
    Read SA, Collins MJ, Iskander DR, Davis BA (2009) Corneal topography with Scheimpflug imaging and videokeratography: comparative study of normal eyes. J Cataract Refract Surg 35:1072–1081PubMedCrossRefGoogle Scholar
  41. 41.
    Elbaz U, Barkana Y, Gerber Y, Avni I, Zadok D (2007) Comparison of different techniques of anterior chamber depth and keratometric measurements. Am J Ophthalmol 143:48–53Google Scholar
  42. 42.
    Huynh SC, Mai TQ, Kifley A, Wang JJ, Rose KA, Mitchell P (2006) An evaluation of keratometry in 6-year-old children. Cornea 25:383–387PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Shiva Mehravaran
    • 1
  • Soheila Asgari
    • 1
  • Sara Bigdeli
    • 1
  • Ashkan Shahnazi
    • 1
  • Hassan Hashemi
    • 1
    Email author
  1. 1.Noor Ophthalmology Research CenterNoor Eye HospitalTehranIran

Personalised recommendations