Bridging the Gap Between Biometric Systems: Agreement and Adjustment of Key Anterior Segment Parameters

Bridging the Gap Between Biometric Systems: Agreement and Adjustment of Key Anterior Segment Parameters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Bridging the Gap Between Biometric Systems: Agreement and Adjustment of Key Anterior Segment Parameters Armin Doostparast, Farbod Semnani, Maryam Ghandhari, Mohammadreza Ghandhari, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7864944/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Mar, 2026 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract We aimed to evaluate the absolute agreement, consistency, and the potential of arithmetic adjustment for measurements across a swept-source optical coherence tomography biometer (IOLMaster 700), a single Scheimpflug-based tomographer (Pentacam HR), and a combined Scheimpflug-Placido disc-based tomographer (Sirius). This cross-sectional study analyzed the corneal keratometry parameters (Sim-K1, Sim-K2, and Sim-Km, corneal astigmatism (CA), and its Jackson power vectors (J0 and J45), central corneal thickness (CCT), anterior chamber depth (ACD), and the horizontal white-to-white distance (WTW) of 111 healthy eyes. The inter-device agreement was assessed using the Bland-Altman and two types of intraclass correlation coefficient (ICC) analyses. A mean difference (MD) translating to less than 0.25D in refractive outcomes was considered clinically acceptable. Except for the WTW (ICC(2,1) = 0.52, ICC(3,1) = 0.65), the inter-device agreement was excellent for all parameters (ICC(2,1) and ICC(3,1) > 0.90), with the CA and its power vectors (ICC(2,1) and ICC(3,1): 0.87–0.90) being slightly inferior. WTW values varied substantially across devices, but applying a constant adjustment (MD = 0.36) between Pentacam HR and Sirius improved agreement (ICC(2,1) rising from 0.59 to 0.90), whereas adjustment was not feasible with IOLMaster 700. CCT and ACD may be considered interchangeable across the three, particularly in intraocular lens (IOL) power calculation. Keratometry values exhibited clinically relevant MDs, limiting their direct interchangeability. Although WTW showed the greatest variability, the agreement between Pentacam HR–Sirius could be improved through an arithmetic adjustment. These findings highlight the potential of arithmetic adjustment of WTW, an important variable in implantable collamer lens sizing, similar to constant optimization in the IOL power formulas. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research IOLMaster 700 Pentacam HR Sirius WTW agreement ICL sizing Phakic IOL Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Achieving desirable outcomes in cataract and refractive surgeries heavily depends on the precise measurement of corneal and anterior segment parameters, as minor disparities in these measurements can heavily influence surgical outcomes and the effectiveness of lens implantations 1 . In this sense, various imaging technologies have been developed to improve the accuracy of these measurements, including corneal topography, ocular biometry, or more recently, optical coherence tomography (OCT). Imaging systems even combine various technologies to enhance the diagnostic accuracy. The Scheimpflug camera is one of the most accurate and widely used technologies, which was developed to precisely measure the corneal parameters. Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Germany) is one of the most commonly used devices in clinics that uses a single rotating Scheimpflug camera to capture detailed images from different angles while a monochromatic 475 nm slit-light source illuminates the cornea. These data are further analyzed to construct a three-dimensional model from up to 138,000 elevation points of the cornea, allowing the clinicians to make a fully precise assessment of the anterior segment 2 , 3 . Sirius (CSO, Florence, Italy) employs a combination of a single Scheimpflug camera and a Placido disc-based topographer of 22 rings, along with a 475-nm blue LED light. The Scheimpflug system can capture 25 radial sections of the cornea with one Placido top-view image in approximately a 5 to 6-second acquisition period, covering a 12mm area of the cornea. The anterior corneal surface data from both the Placido and Scheimpflug images are merged using a proprietary method. Additionally, all measurements for the internal structures are derived exclusively from the Scheimpflug data. 4 – 8 . The IOLMaster 700 (Carl Zeiss, Jena, Germany) is a non-invasive optical biometer that uses swept Source Optical Coherence Tomography (SS-OCT) to produce two-dimensional OCT cross-sectional eye scans. It operates at wavelengths ranging from 1035 to 1080 nm, with a scanning rate of 2 kHz and a scan depth of 44 mm. The images are generated based on the longitudinal information from the cornea to the retina in six meridians: 0°, 30°, 60°, 90°, 120°, and 150°. Each meridional scan is created by averaging three individual scans, and it is used to obtain all essential axial biometry measurements 9 . The keratometry parameters, along with pachymetry and biometric indices, including ACD anterior chamber depth (ACD), central corneal thickness (CCT), and horizontal white-to-white distance of cornea (WTW), are among the most widely used anterior segment parameters in intraocular lens (IOL) power calculation formulas, refractive, and implantable collamer lens (ICL) surgeries planning 10 – 12 . It is necessary that the agreement of measurement obtained from different systems be assessed to ensure the interpretation of their data is valid and whether their measurements could be used interchangeably, particularly across visits. Pentacam HR, Sirius, and IOL master 700 imaging devices were investigated in the current study due to their widespread use in clinics. Although the agreement of measurements derived from these devices has already been widely investigated, to the best of our knowledge, the current literature on agreement studies largely lacks a universal and robust methodology; the interpretations of findings are sometimes flawed, the distinction between clinical and statistical significance is often unclear, and the potential for arithmetic adjustment in cases of poor agreement has been rarely explored. Hence, we aimed to conduct a comprehensive agreement analysis to shed light on the different aspects of the measurements’ agreement between these devices and address their clinical interchangeability. Study Design and Ethics This cross-sectional study was conducted at the Noorafarin Eye Clinic from December 2023 to February 2024. The institutional review board of Mashhad University of Medical Sciences approved the study protocol, and the permission was registered under the following number: IR.MUMS.MEDICAL.REC.1403.238. All procedures in the study were performed in accordance with the principles of the Declaration of Helsinki of 1975 (revised in 1983). After fully explaining the study procedures and goals, written informed consent was gathered from all of the participants. Methods This study involved 111 left virgin eyes of 111 individuals who were candidates for keratorefractive surgery. To closely align patients based on their demographic profiles, all participants were selected from the same ethnicity. The exclusion criteria included the following: poor fixation, any corneal pathology (e.g., a history of confirmed or suspected keratoconus), previous ocular surgery, corneal scarring, glaucoma, confirmed macular pathology, severe ocular trauma, use of rigid contact lenses within the past month, or use of soft contact lenses within the week preceding the examination. All of the participants underwent a full optometric examination, followed by a complete set of anterior segment imaging using the Pentacam HR (software version 1.21r.65), Sirius (phoenix v3.7.01.08), and ZEISS IOLMaster 700 (software version 1.50) devices. The imaging protocol for each device was as follows: The participants were asked to put their chin on the chin rest and slightly push their forehead against the forehead strap. Afterward, they were asked to blink fully to establish a proper tear film on the cornea. They were instructed not to move their head or blink while the device was operating, staring directly at the center of the light source while keeping their eyes wide open. Meanwhile, a cover was placed on their head to provide a fully dark environment, which was only disturbed by the light beams emitted during the device's operation to ensure proper and equal lighting conditions for measuring the pupil diameter. All measurements were device-automated only after the operator had manually positioned the screen marker of each device at the center of the cornea and initiated the automatic operation. The same professional operator performed the imaging protocol, with at least five-minute intervals between acquisitions to prevent visual asthenopia. All participants were examined between 10 am and 12 pm. The operator performed daily calibrations according to the manufacturer's instructions to ensure the measurement’s precision and reliability. Keratometry parameters, WTW, CCT, and ACD were recorded for each patient. Keratometry measurements consisted of simulated flat keratometry (Sim-K1), simulated steep keratometry (Sim-K2), simulated mean keratometry (Sim-Km), and corneal astigmatism (CA). Moreover, power vector analysis was conducted for the CA to obtain the regular component at 0 °/90 ° and the oblique component at 45 °/135 °, known as J0 and J45, respectively. The Sim-K1 and Sim-K2 were calculated solely based on the radii of the anterior curvature of the cornea and the customary refractive index of 1.3375. To calculate the simulated values, the Pentacam HR and Sirius measure the radii of the anterior surface of the cornea in a 3mm circular zone centered at the corneal vertex, while the IOLMaster 700 covers an approximately 2.5mm circular zone 13,14 . The other keratometry parameters were derived based on the following formulas (θ stands for the astigmatic axis): The ACD was defined as the distance measured from the corneal epithelium to the anterior surface of the crystalline lens 15 . It is worth noting that Sirius employs a different convention to display some parameters, as WTW is marked as HVID (Horizontal Visible Iris Diameter), and ACD is not shown directly but as the arithmetic sum of the aqueous depth and CCT (AD + CCT). Moreover, Pentacam HR reports two different ACD values, ACD(int) and ACD(ext), which align with our definition of aqueous depth and ACD, respectively. Statistical Analysis Data analysis and visualization were carried out in Python 3.11, utilizing the following libraries: Pandas (version 2.3.2), Numpy (version 1.24.0), Matplotlib (version 3.7.2), Pingouin (version 0.5.4), and Seaborn (version 0.12.2). Initially, the data were examined to detect and handle missing values and outliers. Then, we conducted agreement analysis between the devices using two types of intraclass correlation coefficient (ICC), according to the convention of McGraw and Wong 16 . ICC(2,1) (absolute agreement) was used to assess the absolute agreement (interchangeability), considering both systematic and random measurement errors. ICC(2,1), which is based on the assumption of two-way random effects, absolute agreement, and single rater/measurement, evaluates whether the measurements from one set align perfectly with those from the other set. On the other hand, ICC(3,1) (consistency) is based on a two-way mixed effects, consistency, single rater/measurement assumption and examines the consistency of measurements, emphasizing the correlation between the measurements rather than the absolute agreement. If two sets of measurements show disparity in their values through a constant mean difference (MD), but the ranking of observations is preserved, ICC(3,1) remains high 16-18 . A large discrepancy between these two types of ICCs indicates a fixed systematic bias and suggests the potential for adjustment 19,20 . Although the interpretation of ICC values is contextual, this study categorized ICC values of < 0.50, 0.50 to 0.74, 0.75 to 0.89, and 0.90 to 1 as representative of poor, moderate, good, and excellent agreement, respectively 17 . Whenever a large discrepancy between ICC(2,1) and ICC(3,1) was present (an excellent ICC(3,1) and a sub-optimal ICC(2,1)), we explored the feasibility of an adjustment between the two devices. First, we checked for the presence of potential proportional bias (varying bias considering different ranges of the variable of interest). It was done through fitting a simple regression line to the scatter-plot of pair-wise measurement differences and checking whether its slope (beta coefficient) is significantly different from zero. If not (proportional bias precluded), a constant (equal to MD) was added to each individual measurement of the device with the lower mean measurement, and the Bland-Altman plot and the LoAs were regenerated 21 . The coefficient of determination of simple linear regression (R 2 ) was also calculated to represent the correlation of measurements. A similar interpretation to that of ICCs could also be applied to R 2 values. Furthermore, we compared the means of the measurements across the three systems using the repeated-measures analysis of variances (ANOVA) and pairwise paired-samples t-tests, followed by calculating the effect size (Hedges’ g) to shed light on the magnitude of the difference 22 . Thresholds of 0.8 were chosen to represent negligible, small, medium, and large magnitudes of effect, respectively 23 . A P-value less than 0.05 was considered statistically significant. Eventually, the 95% limits of agreement (LoA) and confidence intervals of the upper and lower limits of agreement in the reference population are demonstrated through the Bland-Altman analysis. Results This study included 111 healthy left eyes of 111 participants, with an average age of 41.4 ± 5.1 years, consisting of 34 men (31%) and 77 women (69%). The mean subjective spherical refraction and ocular astigmatism were − 1 ± 2.4 D (diopters) and 1.3 ± 1.1 D, respectively. The logMAR (Logarithm of the Minimum Angle of Resolution) visual acuity was 0.01 ± 0.03. According to Table 1 , which demonstrates the agreement of measurements across the three systems, except for the WTW, the agreement was excellent for all of the parameters (ICC(2,1) and ICC(3,1) > 0.90). Notably, the inter-device agreement for CA and its power vectors was still good yet slightly inferior compared to the other parameters (ICC(2,1) and ICC(3,1): 0.87–0.90). On the other hand, the absolute agreement (ICC(2,1) = 0.52, 95% CI = [0.24–0.69]) and consistency of measurements (ICC(3,1) = 0.65, 95% CI = [0.56–0.73]) were revealed to be considerably poorer for the WTW. This indicated a relatively moderate inter-device agreement, with no notable improvement in the ICC(3,1) compared to the ICC(2,1). Table 1 The agreement of the measurements between the IOLMaster 700, Pentacam HR, and Sirius Measurement a ICC(2,1) CI 95% b ICC(3,1) CI 95% c WTW 0.52 (0.24–0.69) 0.65 (0.56–0.73) ACD 0.97 (0.96–0.98) 0.98 (0.97–0.98) CCT 0.95 (0.90–0.97) 0.96 (0.95–0.97) Sim-K1 0.95 (0.92–0.96) 0.95 (0.93–0.96) Sim-K2 0.97 (0.96–0.98) 0.98 (0.97–0.98) Sim-Km 0.97 (0.95–0.98) 0.97 (0.96–0.98) CA 0.90 (0.86–0.92) 0.90 (0.86–0.92) CA (J0) 0.87 (0.82–0.90) 0.87 (0.82–0.90) CA (J45) 0.88 (0.83–0.91) 0.88 (0.84–0.91) a Each measurement; ACD: Anterior Chamber Depth, WTW: White-to-White diameter of cornea, CCT: Central Corneal Thickness, Sim-K1: Flat Keratometry, Sim-K2: Steep Keratometry, Sim-Km: Mean Keratometry, CA: Corneal Astigmatism, CA (J0): Regular component of Corneal Astigmatism (0 °/90 °), CA (45): Oblique component of Corneal Astigmatism (45 °/135 °) b ICC(2,1): Intraclass correlation coefficient (2,1) shows the absolute agreement of measurements across the three systems (CI: 95% confidence Interval) c ICC(3,1): Intraclass correlation coefficient (3,1) shows the consistency of measurements across the three systems (CI: 95% confidence Interval) * The P-value was < 0.001 for all of the ICC values. According to Figs. 1 – 3 , the Bland-Altman analysis showed narrow LoA for most parameters, suggesting good absolute agreement across systems. For Pentacam HR-Sirius, the LoA ranged from − 12.9 to 20.5 µm for CCT, − 0.2 to 0.16 mm for ACD, − 0.66 to − 0.06 mm for WTW, − 1.1 to 0.7 D for Sim-K1, − 0.8 to 0.4 D for Sim-K2 and Sim-Km, − 1.0 to 0.9 D for CA, − 0.7 to 0.7 D for CA (J0), and − 0.4 to 0.3 D for CA (J45). For IOLMaster 700-Sirius, the LoA ranged from − 11.0 to 25.4 µm for CCT, − 0.2 to 0.1 mm for ACD, − 0.86 to 0.64 mm for WTW, − 1.1 to 1.1 D for Sim-K1, − 0.7 to 0.7 D for Sim-K2, − 0.8 to 0.8 D for Sim-Km, − 1.0 to 1.0 D for CA, − 0.6 to 0.7 D for CA (J0), and − 0.3 to 0.4 D for CA (J45). For IOLMaster 700-Pentacam HR, the LoA ranged from − 10.4 to 17.3 µm for CCT, − 0.16 to 0.1 mm for ACD, − 0.41 to 0.91 mm for WTW, − 0.6 to 1.0 D for Sim-K1, − 0.4 to 0.8 D for Sim-K2, − 0.3 to 0.7 D for Sim-Km, − 0.9 to 0.9 D for CA, − 0.5 to 0.5 D for CA (J0), and − 0.3 to 0.4 D for CA (J45). Table 2 represents more details regarding the pairwise agreement analysis of WTW across the devices. The ICC(2,1) values were generally close in all pairwise comparisons, ranging from 0.47 to 0.59, representing a relatively moderate absolute agreement. However, the ICC(3,1) values differed significantly across the comparisons, ranging from a still moderate 0.49 for IOLMaster 700-Sirius and 0.58 for IOLMaster 700-Pentacam HR to an excellent agreement of 0.90 for Pentacam HR-Sirius. This huge gap between the ICC values of Pentacam HR-Sirius, in contrast to IOLMaster 700-Sirius and IOLMaster 700-Pentacam HR, disclosed the fact that there could be a fixed or linear systematic bias between their WTW measurements. After ruling out the presence of proportional bias (beta-coefficient = -0.08, P value > 0.05) and adding a constant of 0.36 mm to each Pentacam HR WTW measurement, the LoAs reached from [-0.66, -0.06] to [-0.30, 0.30] mm (Fig. 4 ). Moreover, lCC(2,1) rose from 0.59 to 0.90. Table 2 The pairwise agreement analysis of the white-to-white diameter of the cornea between the IOLMaster 700, Pentacam HR, and Sirius Devices ICC(2,1) CI 95% a ICC(3,1) CI 95% b R 2 c Pentacam HR- Sirius 0.59 (-0.07–0.86) 0.90 (0.86–0.93) 0.82 IOLMaster 700- Sirius 0.48 (0.31–0.61) 0.49 (0.34–0.62) 0.24 IOLMaster 700- Pentacam HR 0.47 (0.13–0.68) 0.58 (0.44–0.69) 0.34 a ICC(2,1): Intraclass correlation coefficient (2,1) shows the absolute agreement of measurements between the two systems (CI: 95% confidence Interval) b ICC(3,1): Intraclass correlation coefficient (3,1) shows the consistency of measurements between the two systems (CI: 95% confidence Interval) c The coefficient of determination of simple linear regression * The P-value was < 0.001 for all of the ICC and R2 values. Table 3 presents a detailed device-by-device pairwise comparison for all measurements. A minor disparity was noted in the keratometry and CA parameters among the devices, with the difference being minimal and negligible (Hedges' g < 0.2). Moreover, slightly more pronounced differences were observed in the CCT and ACD measurements between the IOLMaster 700 and Sirius (Hedges' g = 0.24 and − 0.14, respectively) compared to Pentacam HR-Sirius and IOLMaster 700-Pentacam HR comparisons. However, a substantial significant disparity was identified in the WTW measurements between the Pentacam HR and Sirius (11.57 ± 0.34 vs 11.93 ± 0.36; P < 0.001, Hedges' g = -1.03), previously highlighted as potentially adjustable. Additionally, moderate to large disparities were observed in the WTW measurements between the IOLMaster 700 and the other two devices; however, no practical arithmetic adjustments could be proposed due to the ICC(3,1) values (Table 2 ). Table 3 The pairwise comparison of the measurements between the IOLMaster 700, Pentacam HR, and Sirius Measurement a Devices (A - B) A mean ± SD b B mean ± SD b MD ± SE c P-value d Hedges e WTW P - S 11.57 ± 0.34 11.93 ± 0.36 -0.36 ± 0.01 < 0.001* -1.03 I – S 11.82 ± 0.40 11.93 ± 0.36 -0.11 ± 0.04 < 0.01* -0.29 I - P 11.82 ± 0.40 11.57 ± 0.34 0.25 ± 0.03 < 0.001* 0.68 ACD P - S 3.39 ± 0.36 3.41 ± 0.36 -0.02 ± 0.01 0.04* -0.06 I – S 3.36 ± 0.36 3.41 ± 0.36 -0.05 ± 0.01 < 0.001* -0.14 I - P 3.36 ± 0.36 3.39 ± 0.36 -0.03 ± 0.01 < 0.001* -0.07 P - S 536.04 ± 28.07 532.25 ± 29.79 3.79 ± 0.81 < 0.001* 0.13 CCT I – S 539.47 ± 30.55 532.25 ± 29.79 7.21 ± 0.88 < 0.001* 0.24 I - P 539.47 ± 30.55 536.04 ± 28.07 3.42 ± 0.67 < 0.001* 0.12 P - S 43.23 ± 1.53 43.41 ± 1.55 -0.18 ± 0.04 < 0.001* -0.12 Sim-K1 I – S 43.41 ± 1.57 43.41 ± 1.55 0.00 ± 0.05 1 0.00 I - P 43.41 ± 1.57 43.23 ± 1.53 0.19 ± 0.04 < 0.001* 0.12 P - S 44.64 ± 1.53 44.80 ± 1.54 -0.16 ± 0.03 < 0.001* -0.11 Sim-K2 I – S 44.83 ± 1.56 44.80 ± 1.54 0.03 ± 0.03 1 0.02 I - P 44.83 ± 1.56 44.64 ± 1.53 0.19 ± 0.03 < 0.001* 0.12 P - S 43.92 ± 1.45 44.11 ± 1.45 -0.19 ± 0.03 < 0.001* -0.13 Sim-Km I – S 44.12 ± 1.48 44.11 ± 1.45 0.02 ± 0.04 1 0.01 I - P 44.12 ± 1.48 43.92 ± 1.45 0.20 ± 0.03 < 0.001* 0.14 P - S -1.43 ± 1.06 -1.39 ± 1.05 -0.04 ± 0.05 1 -0.04 CA I – S -1.42 ± 1.11 -1.39 ± 1.05 -0.03 ± 0.05 1 -0.03 I - P -1.42 ± 1.11 -1.43 ± 1.06 0.01 ± 0.04 1 0.01 P - S 0.53 ± 0.62 0.49 ± 0.63 0.04 ± 0.03 0.75 0.06 CA (J0) I – S 0.52 ± 0.63 0.49 ± 0.63 0.03 ± 0.03 1 0.04 I - P 0.52 ± 0.63 0.53 ± 0.62 -0.01 ± 0.03 1 -0.02 P - S -0.05 ± 0.36 -0.03 ± 0.35 -0.02 ± 0.02 0.81 -0.05 CA (45) I – S 0.01 ± 0.39 -0.03 ± 0.35 0.04 ± 0.02 0.06 0.11 I - P 0.01 ± 0.39 -0.05 ± 0.36 0.06 ± 0.02 < 0.001* 0.16 a Each measurement; ACD: Anterior Chamber Depth, WTW: White-to-White diameter of cornea, CCT: Central Corneal Thickness, Sim-K1: Simulated Flat Keratometry, Sim-K2: Simulated Steep Keratometry, Sim-Km: Simulated mean Keratometry, CA: Corneal Astigmatism, CA (J0): Regular component of Corneal Astigmatism (0 °/90 °), CA (45): Oblique component of Corneal Astigmatism (45 °/135 °); all keratometry values are reported as diopter, ACD, and WTW values are reported as mm, and CTT values are reported as micrometer. b mean ± SD (standard deviation) measured by each device c Mean Difference ± Standard Error d Bonferroni corrected P-values; asterisk (*) indicates a significant P-value (< 0.05). (The repeated-measures ANOVA tests were initially conducted for all of the measurements, obtaining a significant P-value < 0.001. As a result, the pairwise comparisons were subsequently performed using the paired-samples t-test) e effect size Discussion The levels of agreement and possible interchangeability of measurements derived from various imaging systems are of great importance to ensure the validity of planning and to avoid repetition of scans. However, limited evidence exists on the possibility of arithmetic adjustments in the case of poor inter-device agreement. Our results showed that, from a clinical perspective, Pentacam HR, Sirius, and IOLMaster 700 measurements of CCT and ACD may be used interchangeably, particularly for IOL power calculation purposes. However, WTW showed greater variability, with poor to moderate consistency across devices. However, applying an arithmetic adjustment for WTW between Pentacam HR and Sirius yielded excellent agreement, unlike IOLMaster 700–Pentacam HR and IOLMaster 700–Sirius. This could be a leap forward towards increasing the level of agreement between WTW measurements and the robustness of using either of these two devices for tasks like phakic IOL size estimation. Caution is warranted for deciphering the interchangeability of keratometry measurements. Notwithstanding their excellent consistency across any pair-wise device comparisons, the pair-wise LoAs are relatively large and may thus render individual measurements not interchangeable. This great variability in unadjusted WTW measurements has been well-documented in the literature 24 . Horizontal WTW was traditionally used as the main estimator of horizontal sulcus-to-sulcus (STS) distance, which is the most critical parameter in phakic IOL size estimation. Although internal distances, like STS and angle-to-angle (ATA) distances, were always preferred over WTW for this purpose, WTW is still widely used owing to its widely available reports and its employment, along with internal ACD, in STAAR Surgical Online Calculation and Ordering System (OCOS™, Staar Surgical, USA) to predict the best lens size 12 , 25 . Most complications following ICL surgery occur due to inappropriate sizing of the ICL. Oversizing may lead to inadequate vaulting and hence pupillary block, angle closure, elevated intraocular pressure (IOP), and malignant glaucoma, whereas implantation of an undersized lens is a risk factor for developing anterior subcapsular cataract or zonular damage combined with ICL dislocation 26 , 27 . The estimation of ICL size usually involves adding a constant value, ranging from 0.5 to 1mm, to WTW 28 . Nonetheless, previous studies raised concern regarding the inter-device variability of WTW measurements and the weaker correlation between WTW and STS among particular populations 24 , 29 . A recent study by Huang et al. demonstrated that the correlation between WTW and STS becomes less reliable in patients with an AL > 28.5mm, suggesting that the anterior chamber width (ACW) is a better predictor than WTW or ATA 29 . Furthermore, there is growing evidence that automated systems provide a larger WTW compared to surgical calipers 12 , 25 . Still, there are discrepancies in WTW measurements across various imaging systems, utilizing a wide range of different technologies 25 . For instance, Salouti and colleagues reported WTW measurements of 11.72 ± 0.45 mm and 11.41 ± 0.42 mm for the IOLMaster 700 and Pentacam HR, respectively (P-value < 0.001; LoA range = [-0.17: 0.78]) 30 . Ferrer-Blasco and associates reported that IOLMaster 700 recorded significantly higher WTW measurements compared to Sirius (12.18 ± 0.40 vs 11.90 ± 0.37 mm; LoA range = [-0.10: 0.65]) 31 . Abdi and associates demonstrated that Sirius presented significantly higher WTW values than Pentacam (12.26 ± 0.39 vs. 12.03 ± 0.41), revealing an MD of 0.23 ± 0.12 (ICC = 0.95; LoA range: [-0.47: 0.01]) 32 . A recent systematic review by Muzyka-Woźniak and associates investigating the agreement of WTW measurements across 41 studies involving 19 ocular biometers and 4595 eyes also revealed that the MD in WTW measurements between devices differed from 0.01 mm to 0.96 mm, and the LoA ranges varied between 0.31 and 2.45 mm (median: 0.65 mm), requiring significant consideration when planning for phakic IOL surgeries 24 . These discrepancies in WTW measurement across automated systems may arise from the inherent difficulty in precisely identifying the cornea–sclera boundary 25 ; however, we hypothesized that these disparities may follow a fixed systematic bias that could be adjusted through adding a constant, as was shown between Pentacam HR and Sirius, according to our findings. Interestingly, a similar practice was traditionally used to predict ICL size based on WTW (typically 0.5 to 1 mm) and could partly address inter-device agreement and internal distance correlation issues. Nevertheless, larger studies across different systems and populations are needed to confirm this observation. Other than WTW, our findings indicated nearly excellent inter-device agreement for CCT and ACD. Song and associates recently conducted a study on the consistency of CCT measurement in 269 healthy myopic patients using the same devices as the current study and found that the mean CCT measurements were reported as 541.63 ± 31.67 µm, 541.74 ± 33.36 µm, and 548.90 ± 34.19 µm by Pentacam, Sirius, and IOLMaster 700, respectively 33 . Unlike the Pentacam-Sirius pairwise comparison, significant differences were detected when comparing IOLMaster 700-Sirius and IOLMaster 700-Pentacam. However, they also reported that the measurements were excellently correlated, demonstrating Pearson’s r greater than 0.96 across all pairwise correlations. Their findings align with ours, as IOLMaster 700 produced slightly higher CCT values compared with the other devices. Excellent pairwise correlations also existed between the measurements. However, it’s imperative to highlight that there are some considerations when interpreting the statistical findings. The absolute agreement was evaluated in their study through the pairwise comparison of the mean measurements, leading to significant differences when comparing IOLMaster 700 measurements with other devices. As a principle, the statistical tests tend to detect even minor differences as significant when the sample size grows larger. Therefore, it is recommended to provide the effect size to give a better understanding of practical rather than statistical significance. Our results regarding the agreement of ACD values align with the current scholarly literature. Another study by Song and associates recently reported mean ACD measurements by Pentacam, Sirius, and IOLMaster 700 systems to be 3.26 ± 0.26 mm, 3.30 ± 0.26 mm, and 3.22 ± 0.25, respectively. Despite insignificant differences between Pentacam-IOLMaster 700 and Pentacam-Sirius, IOLMaster 700 significantly underestimated ACD compared with Sirius. Nonetheless, these ACD measurements were highly correlated across devices (Pearson’s r > .96) 34 . Our findings also showed that Sirius and IOLMaster 700 had the greatest and lowest mean ACD measurements, respectively (3.41 ± 0.36mm and 3.36 ± 0.36mm), and the ACD values were significantly different across all pairwise comparisons. Beyond statistical significance, it is suggested that differences of less than 0.25D in refractive outcomes could be considered as clinically acceptable in agreement studies 35 , 36 . Notably, according to the Kane IOL power formula, a change of 0.18 mm in ACD and 30 µm in CCT also translates to 0.10 D and 0.04 D in refractive power, respectively. Interestingly, in their review of 66 studies, only three reported an inter-device MD between ocular biometric parameters, corresponding to a difference greater than 0.25 D in the implanted IOL 37 . The LoAs regarding CCT and ACD were a maximum of ± 25 µm and ± 0.2 mm across any pairwise devices, respectively. This conclusion is also supported by the high ICC values exceeding 0.95 and the Hedges g effect size, which were relatively negligible. These values correspond to clinically acceptable variations in the mentioned formula and may thus be considered interchangeable for that task. The current literature supports our findings, as these mentioned parameters were repeatedly shown to be highly correlated between systems that are based on the Scheimpflug camera and SS-OCT technologies, with varying and mostly clinically minor discrepancies in their mean measurements 33 – 35 , 38 – 41 . Nevertheless, the statistical findings should never replace the clinical or case-by-case considerations. Our results regarding keratometry values show more variability. Correspondingly, comparing Pentacam AXL and IOLMaster 700, Saadettin and associates reported a significant increase by 0.23 ± 0.15 D in mean keratometry (LoA range = [-0.52: 0.07]) and 0.04 ± 0.02 mm in ACD measurements (LoA range = [0.00: 0.09]) when using Pentacam AXL, suggesting that, contrary to the ACD, mean keratometry cannot be used interchangeably. Notably, the CA (J0) and CA (J45) were not significantly different 42 . Moreover, Shajari and associates showed no significant differences between the flat and steep radii of the anterior surface of the cornea (FRf and FRs, respectively) between the Pentacam AXL and IOLMaster 700 43 . Another study by Abdi and associates compared measurements derived from Pentacam HR and Sirius, revealing a good to excellent agreement in the ACD (ICC = 0.82; LoA: [-0.38: 0.40]), FRf (ICC = 0.98; LoA: [-0.02: 0.18]), FRs (ICC = 0.97; LoA: [-0.05: 0.15]), CA (ICC = 0.95; LoA: [-0.66: 0.28]), and mean keratometry (ICC = 0.98; LoA: [-0.24: 0.70]) measurements 32 . Similarly, Lu and associates evaluated the repeatability and agreement of anterior segment measurements, including flat, steep, and mean keratometry, as well as CA and Jackson cross-cylinder vectors, ACD, CCT, aqueous depth, and WTW between Sirius and IOLMaster 700. They concluded that high intraobserver repeatability and inter-device agreement existed between the devices, and their measurements could be used interchangeably. However, they noted that the IOLMaster 700 reported keratometry and corneal diameter measurements by 0.1 D and 0.1 mm higher than Sirius, respectively, but the 95% LoA range was narrow 44 . Furthermore, Lee and associates assessed the inter-rater agreement between a SS-OCT tomographer (Casia SS-1000) and a combined dual Scheimpflug-Placido disc-based tomographer (Galilei G2) in two groups of normal and myopic patients who had undergone correctional refractive surgery. The two systems utilize relatively the same technology as IOLMaster 700 and Sirius. Interestingly, their findings revealed that these two systems showed excellent agreement in terms of anterior flat, steep, mean keratometry, and CCT measurements in both groups (ICC > 0.98 for all), which was in line with our findings 45 . Moreover, another study by ÖZYOL et al. on the agreement of Pentacam HR and IOLMaster 700 measurements revealed that although no significant difference was observed for the CA (J0), CA (J45), CCT, and ACD measurements, IOLMaster 700 produced significantly higher average keratometries than Pentacam HR (43.2 ± 1.3 vs 43.0 ± 1.3) with a LoA ranging from − 0.38D to -0.02D, suggesting that these measurements are not interchangeable 46 . Similarly, our findings support that IOLMaster 700 significantly overestimated the keratometry parameters compared with Pentacam HR, and the LoA were − 0.64 to 1.01D, -0.40 to 0.78D, and − 0.32 to 0.72D for Sim-K1, Sim-K2, and Sim-Km, respectively. The judgment on the interchangeable use of these keratometry measurements is complex. Although the ICC(2,1) and ICC(3,1) values exceeded 0.95 for all keratometry measurements, we found MDs of 0.19 D and 0.20 D when comparing Sim-Km values between Pentacam HR-Sirius and IOLMaster 700-Pentacam HR, respectively. Recently, it has been repeatedly reported that a significant proportion of post-cataract surgery PE falls within the ± 0.25 D and ± 0.50 D thresholds 47 – 50 . This makes differences of 0.19 and 0.20 D in Sim-Km values noteworthy and clinically unacceptable. Besides precise biometry and improved IOL power formulas, constant optimization has also been introduced to further reduce median absolute error following IOL implantation surgeries 51 . Constant optimization refers to the process aimed at achieving a mean PE of zero in an analyzed sample of patients when evaluating the accuracy of IOL power formulas. This step is essential for eliminating any systematic biases originating from factors such as the physical properties and design of the IOL, biometric devices, and the surgical techniques 15 , 52 . Similar to how IOL factors affect the accuracy of IOL power formulas, the slight variations in readings of different systems could be attributed to differences in imaging techniques, processing algorithms, and calibration status of the devices, all of which may follow a systematic trend and even heavily affect their inter-device agreement. Furthermore, accommodation effects from varying light sources might impact the accuracy of some of the parameters 53 . We tried to first evaluate whether the observed differences reflect random variability or systematic bias using two types of ICCs and check to what extent a poor agreement could be adjusted using a constant value, a practice inherently similar to constant optimization. These findings underscore the importance of comprehensive systematic evaluation when interpreting agreement across different imaging systems and establish a practical framework for future studies to more accurately assess the agreement of readings derived from imaging systems. To the best of our knowledge, this is the first study to assess absolute agreement and consistency of measurements across three established imaging systems through effect size calculation, as well as the Bland-Altman and dual ICC analyses. The potential for inter-device adjustment was further explored by examining the disparity between ICC(2,1) and ICC(3,1). However, our study had several limitations. Firstly, it was limited to otherwise healthy ametropic eyes. Therefore, evaluating the agreement of measurements in pathological conditions, such as corneal ectatic disorders or post-refractive surgery, would be valuable. Moreover, although the disparity between the ICC(2,1) and ICC(3,1) rises from a fixed systematic bias equal to the mean difference of measurements, their arithmetic adjustment could be more complex and might depend on the magnitude of measurements, necessitating the need for special regression analyses, which lie beyond the scope of the current study. A greater sample size could also enhance the reliability of agreement analysis and more precisely determine the mean difference, which plays a central role in arithmetic adjustments. Therefore, it is recommended that future agreement studies cover a wide range of imaging systems, examine the inter-device variabilities to check whether they are randomly distributed or follow a systematic pattern, explore optimal strategies for arithmetic adjustment, and consider clinical implications rather than pure statistical significance when interpreting the findings. Conclusions In conclusion, the ACD and CCT may be used interchangeably across these three systems for tasks like IOL power calculation. On the other hand, the keratometry parameters may not be used interchangeably due to their wide pairwise LoAs, especially between Pentacam HR-Sirius and IOLMaster 700-Pentacam HR. The agreement of WTW measurements between Pentacam HR-Sirius could be remarkably increased through an arithmetic adjustment. The WTW measurements between the IOLMaster 700 and either Sirius or Pentacam HR could not be used interchangeably, even with adjustment. Clinicians should take these discrepancies into account when switching across imaging systems during patient assessments, and in cases of uncertainty, utilizing multimodal imaging may provide more reliable assessments. Declarations Disclosure of financial and proprietary interests for all authors: In accordance with ethical standards and transparency practices, all authors involved in this study have disclosed their financial and proprietary interests. Each author has provided a detailed account of any potential conflicts of interest or explicitly stated that they have no such interests to declare. Acknowledgement Not applicable. Author contributions Conceptualization: A.D., F.S. and A.E.; Data Preparation: A.D., Ma.G., Mo.G., A.H.K.; Data Analysis and Interpretation: A.D., F.S.; Methodology: A.D., F.S., A.E.; Project Administration: A.D., Ma.G., Mo.G., A.H.K.; Resources: A.E.; Supervision: A.E. and A.D.; Data Visualization: A.D., F.S.; Table Preparation: A.D.; Writing – Original Draft: A.D., F.S., Ma.G., and A.H.K.; Writing – Review and Editing: A.D., F.S., Mo.G., and A.E. All authors contributed to and reviewed the manuscript. Funding No funding or financial support was provided for this study. Data availability The data supporting the results of this study are not publicly available due to privacy concerns regarding the participants. However, they can be accessed from the corresponding author upon reasonable request. Ethics approval and consent to participate The study received ethical approval from the institutional review board of Mashhad University of Medical Sciences (Ethics ID: IR.MUMS.MEDICAL.REC.1403.238; clinical trial registration: not applicable). All procedures were conducted in full accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their enrollment in the study. Consent for publication Not applicable. Competing interests The authors have no competing interests to declare. References Stopyra, W., Langenbucher, A. & Grzybowski, A. Intraocular lens power calculation formulas—a systematic review. Ophthalmol. Therapy . 12 , 2881–2902 (2023). 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06:37:36","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":151721,"visible":true,"origin":"","legend":"","description":"","filename":"6def9c70f52643d8b3fa35d952cede941structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/01cdd0b5949a84a6bd2b2732.xml"},{"id":93995337,"identity":"7353ec66-6497-4e65-8b37-fe69819c78b9","added_by":"auto","created_at":"2025-10-21 06:53:36","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164104,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/f7641f6aa7f5a76d8ad8f0ad.html"},{"id":93994150,"identity":"a01136bf-9abb-481c-ba9a-a6896fe799af","added_by":"auto","created_at":"2025-10-21 06:37:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8107565,"visible":true,"origin":"","legend":"\u003cp\u003eBland-Altman plots illustrating inter-device agreement for anterior chamber depth (ACD), horizontal corneal white-to-white distance (WTW), and central corneal thickness (CCT). The red dashed line represents the linear regression of the differences across the measurement range, indicating trends and potential proportional bias.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/550b11a3a722e27c1e8e730d.png"},{"id":93994892,"identity":"9993b5a8-e29a-4d24-9387-64e605be0662","added_by":"auto","created_at":"2025-10-21 06:45:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7032528,"visible":true,"origin":"","legend":"\u003cp\u003eBland-Altman plots illustrating inter-device agreement for simulated flat keratometry (Sim-K1), simulated steep keratometry (Sim-K2), and simulated mean keratometry (Sim-Km). The red dashed line represents the linear regression of the differences across the measurement range, indicating trends and potential proportional bias.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/ea178b4bae304d2e4f7f3f2c.png"},{"id":93995335,"identity":"0945ce8a-9cd0-4b6d-ac29-4dae720ab98e","added_by":"auto","created_at":"2025-10-21 06:53:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8509504,"visible":true,"origin":"","legend":"\u003cp\u003eBland-Altman plots illustrating inter-device agreement for corneal astigmatism (CA) and the corresponding Jackson power vectors (CA (J0) and CA (J45)). The red dashed line represents the linear regression of the differences across the measurement range, indicating trends and potential proportional bias.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/4ce68ea7097c226f0d0a0a53.png"},{"id":93994894,"identity":"1deed25c-e3d3-44dc-b43f-418368d12d50","added_by":"auto","created_at":"2025-10-21 06:45:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1653059,"visible":true,"origin":"","legend":"\u003cp\u003eBland-Altman plots illustrating inter-device agreement of horizontal corneal white-to-white distance (WTW) between Pentacam HR and Sirius before and after adjustment. The red dashed line represents the linear regression of the differences across the measurement range, indicating trends and potential proportional bias.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/5e4aa5c5f9e5cd3ae1a34f07.png"},{"id":105755072,"identity":"76af572f-6947-4baa-b553-f679506a58e9","added_by":"auto","created_at":"2026-03-30 16:25:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":27562764,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7864944/v1/e93e63ea-df60-466b-9033-a2d7144c0cdb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging the Gap Between Biometric Systems: Agreement and Adjustment of Key Anterior Segment Parameters","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAchieving desirable outcomes in cataract and refractive surgeries heavily depends on the precise measurement of corneal and anterior segment parameters, as minor disparities in these measurements can heavily influence surgical outcomes and the effectiveness of lens implantations\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In this sense, various imaging technologies have been developed to improve the accuracy of these measurements, including corneal topography, ocular biometry, or more recently, optical coherence tomography (OCT). Imaging systems even combine various technologies to enhance the diagnostic accuracy.\u003c/p\u003e\u003cp\u003eThe Scheimpflug camera is one of the most accurate and widely used technologies, which was developed to precisely measure the corneal parameters. Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Germany) is one of the most commonly used devices in clinics that uses a single rotating Scheimpflug camera to capture detailed images from different angles while a monochromatic 475 nm slit-light source illuminates the cornea. These data are further analyzed to construct a three-dimensional model from up to 138,000 elevation points of the cornea, allowing the clinicians to make a fully precise assessment of the anterior segment\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Sirius (CSO, Florence, Italy) employs a combination of a single Scheimpflug camera and a Placido disc-based topographer of 22 rings, along with a 475-nm blue LED light. The Scheimpflug system can capture 25 radial sections of the cornea with one Placido top-view image in approximately a 5 to 6-second acquisition period, covering a 12mm area of the cornea. The anterior corneal surface data from both the Placido and Scheimpflug images are merged using a proprietary method. Additionally, all measurements for the internal structures are derived exclusively from the Scheimpflug data.\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The IOLMaster 700 (Carl Zeiss, Jena, Germany) is a non-invasive optical biometer that uses swept Source Optical Coherence Tomography (SS-OCT) to produce two-dimensional OCT cross-sectional eye scans. It operates at wavelengths ranging from 1035 to 1080 nm, with a scanning rate of 2 kHz and a scan depth of 44 mm. The images are generated based on the longitudinal information from the cornea to the retina in six meridians: 0°, 30°, 60°, 90°, 120°, and 150°. Each meridional scan is created by averaging three individual scans, and it is used to obtain all essential axial biometry measurements\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe keratometry parameters, along with pachymetry and biometric indices, including ACD anterior chamber depth (ACD), central corneal thickness (CCT), and horizontal white-to-white distance of cornea (WTW), are among the most widely used anterior segment parameters in intraocular lens (IOL) power calculation formulas, refractive, and implantable collamer lens (ICL) surgeries planning\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is necessary that the agreement of measurement obtained from different systems be assessed to ensure the interpretation of their data is valid and whether their measurements could be used interchangeably, particularly across visits. Pentacam HR, Sirius, and IOL master 700 imaging devices were investigated in the current study due to their widespread use in clinics. Although the agreement of measurements derived from these devices has already been widely investigated, to the best of our knowledge, the current literature on agreement studies largely lacks a universal and robust methodology; the interpretations of findings are sometimes flawed, the distinction between clinical and statistical significance is often unclear, and the potential for arithmetic adjustment in cases of poor agreement has been rarely explored. Hence, we aimed to conduct a comprehensive agreement analysis to shed light on the different aspects of the measurements’ agreement between these devices and address their clinical interchangeability.\u003c/p\u003e\n\u003ch3\u003eStudy Design and Ethics\u003c/h3\u003e\n\u003cp\u003eThis cross-sectional study was conducted at the Noorafarin Eye Clinic from December 2023 to February 2024. The institutional review board of Mashhad University of Medical Sciences approved the study protocol, and the permission was registered under the following number: IR.MUMS.MEDICAL.REC.1403.238. All procedures in the study were performed in accordance with the principles of the Declaration of Helsinki of 1975 (revised in 1983). After fully explaining the study procedures and goals, written informed consent was gathered from all of the participants.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study involved 111 left virgin eyes of 111 individuals who were candidates for keratorefractive surgery. To closely align patients based on their demographic profiles, all participants were selected from the same ethnicity.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria included the following: poor fixation, any corneal pathology (e.g., a history of confirmed or suspected keratoconus), previous ocular surgery, corneal scarring, glaucoma, confirmed macular pathology, severe ocular trauma, use of rigid contact lenses within the past month, or use of soft contact lenses within the week preceding the examination.\u003c/p\u003e\n\u003cp\u003eAll of the participants underwent a full optometric examination, followed by a complete set of anterior segment imaging using the Pentacam HR (software version 1.21r.65), Sirius (phoenix v3.7.01.08), and ZEISS IOLMaster 700 (software version 1.50) devices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe imaging protocol for each device was as follows: The participants were asked to put their chin on the chin rest and slightly push their forehead against the forehead strap. Afterward, they were asked to blink fully to establish a proper tear film on the cornea. They were instructed not to move their head or blink while the device was operating, staring directly at the center of the light source while keeping their eyes wide open. Meanwhile, a cover was placed on their head to provide a fully dark environment, which was only disturbed by the light beams emitted during the device\u0026apos;s operation to ensure proper and equal lighting conditions for measuring the pupil diameter. All measurements were device-automated only after the operator had manually positioned the screen marker of each device at the center of the cornea and initiated the automatic operation. The same professional operator performed the imaging protocol, with at least five-minute intervals between acquisitions to prevent visual asthenopia. All participants were examined between 10 am and 12 pm. The operator performed daily calibrations according to the manufacturer\u0026apos;s instructions to ensure the measurement\u0026rsquo;s precision and reliability.\u003c/p\u003e\n\u003cp\u003eKeratometry parameters, WTW, CCT, and ACD were recorded for each patient. Keratometry measurements consisted of simulated flat keratometry (Sim-K1), simulated steep keratometry (Sim-K2), simulated mean keratometry (Sim-Km), and corneal astigmatism (CA). Moreover, power vector analysis was conducted for the CA to obtain the regular component at 0 \u0026deg;/90 \u0026deg; and the oblique component at 45 \u0026deg;/135 \u0026deg;, known as J0 and J45, respectively. The Sim-K1 and Sim-K2 were calculated solely based on the radii of the anterior curvature of the cornea and the customary refractive index of 1.3375. To calculate the simulated values, the Pentacam HR and Sirius measure the radii of the anterior surface of the cornea in a 3mm circular zone centered at the corneal vertex, while the IOLMaster 700 covers an approximately 2.5mm circular zone\u003csup\u003e13,14\u003c/sup\u003e. The other keratometry parameters were derived based on the following formulas (\u0026theta; stands for the astigmatic axis):\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003eThe ACD was defined as the distance measured from the corneal epithelium to the anterior surface of the crystalline lens\u003csup\u003e15\u003c/sup\u003e. It is worth noting that Sirius employs a different convention to display some parameters, as WTW is marked as HVID (Horizontal Visible Iris Diameter), and ACD is not shown directly but as the arithmetic sum of the aqueous depth and CCT (AD + CCT). Moreover, Pentacam HR reports two different ACD values, ACD(int) and ACD(ext), which align with our definition of aqueous depth and ACD, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis and visualization were carried out in Python 3.11, utilizing the following libraries:\u0026nbsp;Pandas (version 2.3.2), Numpy (version 1.24.0), Matplotlib (version 3.7.2), Pingouin (version 0.5.4), and Seaborn (version 0.12.2). Initially, the data were examined to detect and handle missing values and outliers. Then, we conducted agreement analysis between the devices using two types of intraclass correlation coefficient (ICC), according to the convention of McGraw and Wong\u003csup\u003e16\u003c/sup\u003e. ICC(2,1) (absolute agreement) was used to assess the absolute agreement (interchangeability), considering both systematic and random measurement errors. ICC(2,1), which is based on the assumption of two-way random effects, absolute agreement, and single rater/measurement, evaluates whether the measurements from one set align perfectly with those from the other set. On the other hand, ICC(3,1) (consistency) is based on a two-way mixed effects, consistency, single rater/measurement assumption and examines the consistency of measurements, emphasizing the correlation between the measurements rather than the absolute agreement. If two sets of measurements show disparity in their values through a constant mean difference (MD), but the ranking of observations is preserved, ICC(3,1) remains high\u003csup\u003e16-18\u003c/sup\u003e. A large discrepancy between these two types of ICCs indicates a fixed systematic bias and suggests the potential for adjustment\u003csup\u003e19,20\u003c/sup\u003e. Although the interpretation of ICC values is contextual, this study categorized ICC values of \u0026lt; 0.50, 0.50 to 0.74, 0.75 to 0.89, and \u0026nbsp;0.90 to 1 as representative of poor, moderate, good, and excellent agreement, respectively \u003csup\u003e17\u003c/sup\u003e. Whenever a large discrepancy between ICC(2,1) and ICC(3,1) was present (an excellent ICC(3,1) and a sub-optimal ICC(2,1)), we explored the feasibility of an adjustment between the two devices. First, we checked for the presence of potential proportional bias (varying bias considering different ranges of the variable of interest). It was done through fitting a simple regression line to the scatter-plot of pair-wise measurement differences and checking whether its slope (beta coefficient) is significantly different from zero. If not (proportional bias precluded), a constant (equal to MD) was added to each individual measurement of the device with the lower mean measurement, and the Bland-Altman plot and the LoAs were regenerated\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The coefficient of determination of simple linear regression (R\u003csup\u003e2\u003c/sup\u003e) was also calculated to represent the correlation of measurements. A similar interpretation to that of ICCs could also be applied to R\u003csup\u003e2\u0026nbsp;\u003c/sup\u003evalues. Furthermore, we compared the means of the measurements across the three systems using the repeated-measures analysis of variances (ANOVA) and pairwise paired-samples t-tests, followed by calculating the effect size (Hedges\u0026rsquo; g) to shed light on the magnitude of the difference\u003csup\u003e22\u003c/sup\u003e. Thresholds of \u0026nbsp; \u0026lt; 0.2, 0.2 to 0.5, 0.5 to 0.8, and \u0026gt; 0.8 were chosen to represent negligible, small, medium, and large magnitudes of effect, respectively\u003csup\u003e23\u003c/sup\u003e. \u0026nbsp;A P-value less than 0.05 was considered statistically significant. Eventually, the 95% limits of agreement (LoA) and confidence intervals of the upper and lower limits of agreement in the reference population are demonstrated through the Bland-Altman analysis.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 111 healthy left eyes of 111 participants, with an average age of 41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 years, consisting of 34 men (31%) and 77 women (69%). The mean subjective spherical refraction and ocular astigmatism were \u0026minus;\u0026thinsp;1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 D (diopters) and 1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 D, respectively. The logMAR (Logarithm of the Minimum Angle of Resolution) visual acuity was 0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03.\u003c/p\u003e\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which demonstrates the agreement of measurements across the three systems, except for the WTW, the agreement was excellent for all of the parameters (ICC(2,1) and ICC(3,1)\u0026thinsp;\u0026gt;\u0026thinsp;0.90). Notably, the inter-device agreement for CA and its power vectors was still good yet slightly inferior compared to the other parameters (ICC(2,1) and ICC(3,1): 0.87\u0026ndash;0.90). On the other hand, the absolute agreement (ICC(2,1)\u0026thinsp;=\u0026thinsp;0.52, 95% CI = [0.24\u0026ndash;0.69]) and consistency of measurements (ICC(3,1)\u0026thinsp;=\u0026thinsp;0.65, 95% CI = [0.56\u0026ndash;0.73]) were revealed to be considerably poorer for the WTW. This indicated a relatively moderate inter-device agreement, with no notable improvement in the ICC(3,1) compared to the ICC(2,1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe agreement of the measurements between the IOLMaster 700, Pentacam HR, and Sirius\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasurement \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eICC(2,1)\u003c/p\u003e\u003cp\u003eCI 95% \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eICC(3,1)\u003c/p\u003e\u003cp\u003eCI 95% \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWTW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003cp\u003e(0.24\u0026ndash;0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003cp\u003e(0.56\u0026ndash;0.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e(0.96\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003cp\u003e(0.97\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003cp\u003e(0.90\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003cp\u003e(0.95\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-K1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003cp\u003e(0.92\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003cp\u003e(0.93\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-K2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e(0.96\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003cp\u003e(0.97\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-Km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e(0.95\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e(0.96\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003cp\u003e(0.86\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003cp\u003e(0.86\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA (J0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003cp\u003e(0.82\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003cp\u003e(0.82\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA (J45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003cp\u003e(0.83\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003cp\u003e(0.84\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e Each measurement; ACD: Anterior Chamber Depth, WTW: White-to-White diameter of cornea, CCT: Central Corneal Thickness, Sim-K1: Flat Keratometry, Sim-K2: Steep Keratometry, Sim-Km: Mean Keratometry, CA: Corneal Astigmatism, CA (J0): Regular component of Corneal Astigmatism (0 \u0026deg;/90 \u0026deg;), CA (45): Oblique component of Corneal Astigmatism (45 \u0026deg;/135 \u0026deg;)\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e ICC(2,1): Intraclass correlation coefficient (2,1) shows the absolute agreement of measurements across the three systems (CI: 95% confidence Interval)\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e ICC(3,1): Intraclass correlation coefficient (3,1) shows the consistency of measurements across the three systems (CI: 95% confidence Interval)\u003c/p\u003e\u003cp\u003e* The P-value was \u0026lt;\u0026thinsp;0.001 for all of the ICC values.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the Bland-Altman analysis showed narrow LoA for most parameters, suggesting good absolute agreement across systems. For Pentacam HR-Sirius, the LoA ranged from \u0026minus;\u0026thinsp;12.9 to 20.5 \u0026micro;m for CCT, \u0026minus;\u0026thinsp;0.2 to 0.16 mm for ACD, \u0026minus;\u0026thinsp;0.66 to \u0026minus;\u0026thinsp;0.06 mm for WTW, \u0026minus;\u0026thinsp;1.1 to 0.7 D for Sim-K1, \u0026minus;\u0026thinsp;0.8 to 0.4 D for Sim-K2 and Sim-Km, \u0026minus;\u0026thinsp;1.0 to 0.9 D for CA, \u0026minus;\u0026thinsp;0.7 to 0.7 D for CA (J0), and \u0026minus;\u0026thinsp;0.4 to 0.3 D for CA (J45). For IOLMaster 700-Sirius, the LoA ranged from \u0026minus;\u0026thinsp;11.0 to 25.4 \u0026micro;m for CCT, \u0026minus;\u0026thinsp;0.2 to 0.1 mm for ACD, \u0026minus;\u0026thinsp;0.86 to 0.64 mm for WTW, \u0026minus;\u0026thinsp;1.1 to 1.1 D for Sim-K1, \u0026minus;\u0026thinsp;0.7 to 0.7 D for Sim-K2, \u0026minus;\u0026thinsp;0.8 to 0.8 D for Sim-Km, \u0026minus;\u0026thinsp;1.0 to 1.0 D for CA, \u0026minus;\u0026thinsp;0.6 to 0.7 D for CA (J0), and \u0026minus;\u0026thinsp;0.3 to 0.4 D for CA (J45). For IOLMaster 700-Pentacam HR, the LoA ranged from \u0026minus;\u0026thinsp;10.4 to 17.3 \u0026micro;m for CCT, \u0026minus;\u0026thinsp;0.16 to 0.1 mm for ACD, \u0026minus;\u0026thinsp;0.41 to 0.91 mm for WTW, \u0026minus;\u0026thinsp;0.6 to 1.0 D for Sim-K1, \u0026minus;\u0026thinsp;0.4 to 0.8 D for Sim-K2, \u0026minus;\u0026thinsp;0.3 to 0.7 D for Sim-Km, \u0026minus;\u0026thinsp;0.9 to 0.9 D for CA, \u0026minus;\u0026thinsp;0.5 to 0.5 D for CA (J0), and \u0026minus;\u0026thinsp;0.3 to 0.4 D for CA (J45).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e represents more details regarding the pairwise agreement analysis of WTW across the devices. The ICC(2,1) values were generally close in all pairwise comparisons, ranging from 0.47 to 0.59, representing a relatively moderate absolute agreement. However, the ICC(3,1) values differed significantly across the comparisons, ranging from a still moderate 0.49 for IOLMaster 700-Sirius and 0.58 for IOLMaster 700-Pentacam HR to an excellent agreement of 0.90 for Pentacam HR-Sirius. This huge gap between the ICC values of Pentacam HR-Sirius, in contrast to IOLMaster 700-Sirius and IOLMaster 700-Pentacam HR, disclosed the fact that there could be a fixed or linear systematic bias between their WTW measurements. After ruling out the presence of proportional bias (beta-coefficient = -0.08, P value\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and adding a constant of 0.36 mm to each Pentacam HR WTW measurement, the LoAs reached from [-0.66, -0.06] to [-0.30, 0.30] mm (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Moreover, lCC(2,1) rose from 0.59 to 0.90.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe pairwise agreement analysis of the white-to-white diameter of the cornea between the IOLMaster 700, Pentacam HR, and Sirius\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eICC(2,1)\u003c/p\u003e\u003cp\u003eCI 95% \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eICC(3,1)\u003c/p\u003e\u003cp\u003eCI 95% \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eR\u003csup\u003e2 \u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePentacam HR-\u003c/p\u003e\u003cp\u003eSirius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003cp\u003e(-0.07\u0026ndash;0.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003cp\u003e(0.86\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOLMaster 700-\u003c/p\u003e\u003cp\u003eSirius\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003cp\u003e(0.31\u0026ndash;0.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003cp\u003e(0.34\u0026ndash;0.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOLMaster 700-\u003c/p\u003e\u003cp\u003ePentacam HR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003cp\u003e(0.13\u0026ndash;0.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003cp\u003e(0.44\u0026ndash;0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e ICC(2,1): Intraclass correlation coefficient (2,1) shows the absolute agreement of measurements between the two systems (CI: 95% confidence Interval)\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e ICC(3,1): Intraclass correlation coefficient (3,1) shows the consistency of measurements between the two systems (CI: 95% confidence Interval)\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e The coefficient of determination of simple linear regression\u003c/p\u003e\u003cp\u003e* The P-value was \u0026lt;\u0026thinsp;0.001 for all of the ICC and R2 values.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents a detailed device-by-device pairwise comparison for all measurements. A minor disparity was noted in the keratometry and CA parameters among the devices, with the difference being minimal and negligible (Hedges' g\u0026thinsp;\u0026lt;\u0026thinsp;0.2). Moreover, slightly more pronounced differences were observed in the CCT and ACD measurements between the IOLMaster 700 and Sirius (Hedges' g\u0026thinsp;=\u0026thinsp;0.24 and \u0026minus;\u0026thinsp;0.14, respectively) compared to Pentacam HR-Sirius and IOLMaster 700-Pentacam HR comparisons. However, a substantial significant disparity was identified in the WTW measurements between the Pentacam HR and Sirius (11.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34 vs 11.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Hedges' g = -1.03), previously highlighted as potentially adjustable. Additionally, moderate to large disparities were observed in the WTW measurements between the IOLMaster 700 and the other two devices; however, no practical arithmetic adjustments could be proposed due to the ICC(3,1) values (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe pairwise comparison of the measurements between the IOLMaster 700, Pentacam HR, and Sirius\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasurement \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDevices\u003c/p\u003e\u003cp\u003e(A - B)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMD\u0026thinsp;\u0026plusmn;\u0026thinsp;SE \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value \u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHedges \u003csup\u003e\u003cem\u003ee\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWTW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eACD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e536.04\u0026thinsp;\u0026plusmn;\u0026thinsp;28.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e532.25\u0026thinsp;\u0026plusmn;\u0026thinsp;29.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e539.47\u0026thinsp;\u0026plusmn;\u0026thinsp;30.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e532.25\u0026thinsp;\u0026plusmn;\u0026thinsp;29.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e539.47\u0026thinsp;\u0026plusmn;\u0026thinsp;30.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e536.04\u0026thinsp;\u0026plusmn;\u0026thinsp;28.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-K1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-K2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSim-Km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA (J0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP - S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA (45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI \u0026ndash; S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI - P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e Each measurement; ACD: Anterior Chamber Depth, WTW: White-to-White diameter of cornea, CCT: Central Corneal Thickness, Sim-K1: Simulated Flat Keratometry, Sim-K2: Simulated Steep Keratometry, Sim-Km: Simulated mean Keratometry, CA: Corneal Astigmatism, CA (J0): Regular component of Corneal Astigmatism (0 \u0026deg;/90 \u0026deg;), CA (45): Oblique component of Corneal Astigmatism (45 \u0026deg;/135 \u0026deg;); all keratometry values are reported as diopter, ACD, and WTW values are reported as mm, and CTT values are reported as micrometer.\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (standard deviation) measured by each device\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e Mean Difference\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Error\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e Bonferroni corrected P-values; asterisk (*) indicates a significant P-value (\u0026lt;\u0026thinsp;0.05). (The repeated-measures ANOVA tests were initially conducted for all of the measurements, obtaining a significant P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001. As a result, the pairwise comparisons were subsequently performed using the paired-samples t-test)\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ee\u003c/em\u003e\u003c/sup\u003e effect size\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe levels of agreement and possible interchangeability of measurements derived from various imaging systems are of great importance to ensure the validity of planning and to avoid repetition of scans. However, limited evidence exists on the possibility of arithmetic adjustments in the case of poor inter-device agreement. Our results showed that, from a clinical perspective, Pentacam HR, Sirius, and IOLMaster 700 measurements of CCT and ACD may be used interchangeably, particularly for IOL power calculation purposes. However, WTW showed greater variability, with poor to moderate consistency across devices. However, applying an arithmetic adjustment for WTW between Pentacam HR and Sirius yielded excellent agreement, unlike IOLMaster 700\u0026ndash;Pentacam HR and IOLMaster 700\u0026ndash;Sirius. This could be a leap forward towards increasing the level of agreement between WTW measurements and the robustness of using either of these two devices for tasks like phakic IOL size estimation. Caution is warranted for deciphering the interchangeability of keratometry measurements. Notwithstanding their excellent consistency across any pair-wise device comparisons, the pair-wise LoAs are relatively large and may thus render individual measurements not interchangeable.\u003c/p\u003e\u003cp\u003eThis great variability in unadjusted WTW measurements has been well-documented in the literature\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Horizontal WTW was traditionally used as the main estimator of horizontal sulcus-to-sulcus (STS) distance, which is the most critical parameter in phakic IOL size estimation. Although internal distances, like STS and angle-to-angle (ATA) distances, were always preferred over WTW for this purpose, WTW is still widely used owing to its widely available reports and its employment, along with internal ACD, in STAAR Surgical Online Calculation and Ordering System (OCOS\u0026trade;, Staar Surgical, USA) to predict the best lens size\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Most complications following ICL surgery occur due to inappropriate sizing of the ICL. Oversizing may lead to inadequate vaulting and hence pupillary block, angle closure, elevated intraocular pressure (IOP), and malignant glaucoma, whereas implantation of an undersized lens is a risk factor for developing anterior subcapsular cataract or zonular damage combined with ICL dislocation\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The estimation of ICL size usually involves adding a constant value, ranging from 0.5 to 1mm, to WTW\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Nonetheless, previous studies raised concern regarding the inter-device variability of WTW measurements and the weaker correlation between WTW and STS among particular populations\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. A recent study by Huang et al. demonstrated that the correlation between WTW and STS becomes less reliable in patients with an AL\u0026thinsp;\u0026gt;\u0026thinsp;28.5mm, suggesting that the anterior chamber width (ACW) is a better predictor than WTW or ATA\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Furthermore, there is growing evidence that automated systems provide a larger WTW compared to surgical calipers\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Still, there are discrepancies in WTW measurements across various imaging systems, utilizing a wide range of different technologies\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. For instance, Salouti and colleagues reported WTW measurements of 11.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 mm and 11.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42 mm for the IOLMaster 700 and Pentacam HR, respectively (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; LoA range = [-0.17: 0.78])\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Ferrer-Blasco and associates reported that IOLMaster 700 recorded significantly higher WTW measurements compared to Sirius (12.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40 vs 11.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37 mm; LoA range = [-0.10: 0.65])\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Abdi and associates demonstrated that Sirius presented significantly higher WTW values than Pentacam (12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 vs. 12.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41), revealing an MD of 0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 (ICC\u0026thinsp;=\u0026thinsp;0.95; LoA range: [-0.47: 0.01])\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. A recent systematic review by Muzyka-Woźniak and associates investigating the agreement of WTW measurements across 41 studies involving 19 ocular biometers and 4595 eyes also revealed that the MD in WTW measurements between devices differed from 0.01 mm to 0.96 mm, and the LoA ranges varied between 0.31 and 2.45 mm (median: 0.65 mm), requiring significant consideration when planning for phakic IOL surgeries\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. These discrepancies in WTW measurement across automated systems may arise from the inherent difficulty in precisely identifying the cornea\u0026ndash;sclera boundary\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e; however, we hypothesized that these disparities may follow a fixed systematic bias that could be adjusted through adding a constant, as was shown between Pentacam HR and Sirius, according to our findings. Interestingly, a similar practice was traditionally used to predict ICL size based on WTW (typically 0.5 to 1 mm) and could partly address inter-device agreement and internal distance correlation issues. Nevertheless, larger studies across different systems and populations are needed to confirm this observation.\u003c/p\u003e\u003cp\u003eOther than WTW, our findings indicated nearly excellent inter-device agreement for CCT and ACD. Song and associates recently conducted a study on the consistency of CCT measurement in 269 healthy myopic patients using the same devices as the current study and found that the mean CCT measurements were reported as 541.63\u0026thinsp;\u0026plusmn;\u0026thinsp;31.67 \u0026micro;m, 541.74\u0026thinsp;\u0026plusmn;\u0026thinsp;33.36 \u0026micro;m, and 548.90\u0026thinsp;\u0026plusmn;\u0026thinsp;34.19 \u0026micro;m by Pentacam, Sirius, and IOLMaster 700, respectively\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Unlike the Pentacam-Sirius pairwise comparison, significant differences were detected when comparing IOLMaster 700-Sirius and IOLMaster 700-Pentacam. However, they also reported that the measurements were excellently correlated, demonstrating Pearson\u0026rsquo;s r greater than 0.96 across all pairwise correlations. Their findings align with ours, as IOLMaster 700 produced slightly higher CCT values compared with the other devices. Excellent pairwise correlations also existed between the measurements. However, it\u0026rsquo;s imperative to highlight that there are some considerations when interpreting the statistical findings. The absolute agreement was evaluated in their study through the pairwise comparison of the mean measurements, leading to significant differences when comparing IOLMaster 700 measurements with other devices. As a principle, the statistical tests tend to detect even minor differences as significant when the sample size grows larger. Therefore, it is recommended to provide the effect size to give a better understanding of practical rather than statistical significance.\u003c/p\u003e\u003cp\u003eOur results regarding the agreement of ACD values align with the current scholarly literature. Another study by Song and associates recently reported mean ACD measurements by Pentacam, Sirius, and IOLMaster 700 systems to be 3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26 mm, 3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26 mm, and 3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25, respectively. Despite insignificant differences between Pentacam-IOLMaster 700 and Pentacam-Sirius, IOLMaster 700 significantly underestimated ACD compared with Sirius. Nonetheless, these ACD measurements were highly correlated across devices (Pearson\u0026rsquo;s r\u0026thinsp;\u0026gt;\u0026thinsp;.96)\u003csup\u003e34\u003c/sup\u003e. Our findings also showed that Sirius and IOLMaster 700 had the greatest and lowest mean ACD measurements, respectively (3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36mm and 3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36mm), and the ACD values were significantly different across all pairwise comparisons.\u003c/p\u003e\u003cp\u003eBeyond statistical significance, it is suggested that differences of less than 0.25D in refractive outcomes could be considered as clinically acceptable in agreement studies\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Notably, according to the Kane IOL power formula, a change of 0.18 mm in ACD and 30 \u0026micro;m in CCT also translates to 0.10 D and 0.04 D in refractive power, respectively. Interestingly, in their review of 66 studies, only three reported an inter-device MD between ocular biometric parameters, corresponding to a difference greater than 0.25 D in the implanted IOL\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The LoAs regarding CCT and ACD were a maximum of \u0026plusmn;\u0026thinsp;25 \u0026micro;m and \u0026plusmn;\u0026thinsp;0.2 mm across any pairwise devices, respectively. This conclusion is also supported by the high ICC values exceeding 0.95 and the Hedges g effect size, which were relatively negligible. These values correspond to clinically acceptable variations in the mentioned formula and may thus be considered interchangeable for that task. The current literature supports our findings, as these mentioned parameters were repeatedly shown to be highly correlated between systems that are based on the Scheimpflug camera and SS-OCT technologies, with varying and mostly clinically minor discrepancies in their mean measurements\u003csup\u003e\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the statistical findings should never replace the clinical or case-by-case considerations.\u003c/p\u003e\u003cp\u003eOur results regarding keratometry values show more variability. Correspondingly, comparing Pentacam AXL and IOLMaster 700, Saadettin and associates reported a significant increase by 0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 D in mean keratometry (LoA range = [-0.52: 0.07]) and 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02 mm in ACD measurements (LoA range = [0.00: 0.09]) when using Pentacam AXL, suggesting that, contrary to the ACD, mean keratometry cannot be used interchangeably. Notably, the CA (J0) and CA (J45) were not significantly different\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Moreover, Shajari and associates showed no significant differences between the flat and steep radii of the anterior surface of the cornea (FRf and FRs, respectively) between the Pentacam AXL and IOLMaster 700\u003csup\u003e43\u003c/sup\u003e. Another study by Abdi and associates compared measurements derived from Pentacam HR and Sirius, revealing a good to excellent agreement in the ACD (ICC\u0026thinsp;=\u0026thinsp;0.82; LoA: [-0.38: 0.40]), FRf (ICC\u0026thinsp;=\u0026thinsp;0.98; LoA: [-0.02: 0.18]), FRs (ICC\u0026thinsp;=\u0026thinsp;0.97; LoA: [-0.05: 0.15]), CA (ICC\u0026thinsp;=\u0026thinsp;0.95; LoA: [-0.66: 0.28]), and mean keratometry (ICC\u0026thinsp;=\u0026thinsp;0.98; LoA: [-0.24: 0.70]) measurements\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Similarly, Lu and associates evaluated the repeatability and agreement of anterior segment measurements, including flat, steep, and mean keratometry, as well as CA and Jackson cross-cylinder vectors, ACD, CCT, aqueous depth, and WTW between Sirius and IOLMaster 700. They concluded that high intraobserver repeatability and inter-device agreement existed between the devices, and their measurements could be used interchangeably. However, they noted that the IOLMaster 700 reported keratometry and corneal diameter measurements by 0.1 D and 0.1 mm higher than Sirius, respectively, but the 95% LoA range was narrow\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Furthermore, Lee and associates assessed the inter-rater agreement between a SS-OCT tomographer (Casia SS-1000) and a combined dual Scheimpflug-Placido disc-based tomographer (Galilei G2) in two groups of normal and myopic patients who had undergone correctional refractive surgery. The two systems utilize relatively the same technology as IOLMaster 700 and Sirius. Interestingly, their findings revealed that these two systems showed excellent agreement in terms of anterior flat, steep, mean keratometry, and CCT measurements in both groups (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.98 for all), which was in line with our findings\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMoreover, another study by \u0026Ouml;ZYOL et al. on the agreement of Pentacam HR and IOLMaster 700 measurements revealed that although no significant difference was observed for the CA (J0), CA (J45), CCT, and ACD measurements, IOLMaster 700 produced significantly higher average keratometries than Pentacam HR (43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 vs 43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3) with a LoA ranging from \u0026minus;\u0026thinsp;0.38D to -0.02D, suggesting that these measurements are not interchangeable\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Similarly, our findings support that IOLMaster 700 significantly overestimated the keratometry parameters compared with Pentacam HR, and the LoA were \u0026minus;\u0026thinsp;0.64 to 1.01D, -0.40 to 0.78D, and \u0026minus;\u0026thinsp;0.32 to 0.72D for Sim-K1, Sim-K2, and Sim-Km, respectively. The judgment on the interchangeable use of these keratometry measurements is complex. Although the ICC(2,1) and ICC(3,1) values exceeded 0.95 for all keratometry measurements, we found MDs of 0.19 D and 0.20 D when comparing Sim-Km values between Pentacam HR-Sirius and IOLMaster 700-Pentacam HR, respectively. Recently, it has been repeatedly reported that a significant proportion of post-cataract surgery PE falls within the \u0026plusmn;\u0026thinsp;0.25 D and \u0026plusmn;\u0026thinsp;0.50 D thresholds\u003csup\u003e\u003cspan additionalcitationids=\"CR48 CR49\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. This makes differences of 0.19 and 0.20 D in Sim-Km values noteworthy and clinically unacceptable.\u003c/p\u003e\u003cp\u003eBesides precise biometry and improved IOL power formulas, constant optimization has also been introduced to further reduce median absolute error following IOL implantation surgeries\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Constant optimization refers to the process aimed at achieving a mean PE of zero in an analyzed sample of patients when evaluating the accuracy of IOL power formulas. This step is essential for eliminating any systematic biases originating from factors such as the physical properties and design of the IOL, biometric devices, and the surgical techniques\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. Similar to how IOL factors affect the accuracy of IOL power formulas, the slight variations in readings of different systems could be attributed to differences in imaging techniques, processing algorithms, and calibration status of the devices, all of which may follow a systematic trend and even heavily affect their inter-device agreement. Furthermore, accommodation effects from varying light sources might impact the accuracy of some of the parameters\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e. We tried to first evaluate whether the observed differences reflect random variability or systematic bias using two types of ICCs and check to what extent a poor agreement could be adjusted using a constant value, a practice inherently similar to constant optimization. These findings underscore the importance of comprehensive systematic evaluation when interpreting agreement across different imaging systems and establish a practical framework for future studies to more accurately assess the agreement of readings derived from imaging systems.\u003c/p\u003e\u003cp\u003eTo the best of our knowledge, this is the first study to assess absolute agreement and consistency of measurements across three established imaging systems through effect size calculation, as well as the Bland-Altman and dual ICC analyses. The potential for inter-device adjustment was further explored by examining the disparity between ICC(2,1) and ICC(3,1). However, our study had several limitations. Firstly, it was limited to otherwise healthy ametropic eyes. Therefore, evaluating the agreement of measurements in pathological conditions, such as corneal ectatic disorders or post-refractive surgery, would be valuable. Moreover, although the disparity between the ICC(2,1) and ICC(3,1) rises from a fixed systematic bias equal to the mean difference of measurements, their arithmetic adjustment could be more complex and might depend on the magnitude of measurements, necessitating the need for special regression analyses, which lie beyond the scope of the current study. A greater sample size could also enhance the reliability of agreement analysis and more precisely determine the mean difference, which plays a central role in arithmetic adjustments. Therefore, it is recommended that future agreement studies cover a wide range of imaging systems, examine the inter-device variabilities to check whether they are randomly distributed or follow a systematic pattern, explore optimal strategies for arithmetic adjustment, and consider clinical implications rather than pure statistical significance when interpreting the findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the ACD and CCT may be used interchangeably across these three systems for tasks like IOL power calculation. On the other hand, the keratometry parameters may not be used interchangeably due to their wide pairwise LoAs, especially between Pentacam HR-Sirius and IOLMaster 700-Pentacam HR. The agreement of WTW measurements between Pentacam HR-Sirius could be remarkably increased through an arithmetic adjustment. The WTW measurements between the IOLMaster 700 and either Sirius or Pentacam HR could not be used interchangeably, even with adjustment. Clinicians should take these discrepancies into account when switching across imaging systems during patient assessments, and in cases of uncertainty, utilizing multimodal imaging may provide more reliable assessments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure of financial and proprietary interests for all authors:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with ethical standards and transparency practices, all authors involved in this study have disclosed their financial and proprietary interests. Each author has provided a detailed account of any potential conflicts of interest or explicitly stated that they have no such interests to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: A.D., F.S. and A.E.; Data Preparation: A.D., Ma.G., Mo.G., A.H.K.; Data Analysis and Interpretation: A.D., F.S.; Methodology: A.D., F.S., A.E.; Project Administration: A.D., Ma.G., Mo.G., A.H.K.; Resources: A.E.; Supervision: A.E. and A.D.; Data Visualization: A.D., F.S.; Table Preparation: A.D.; Writing \u0026ndash; Original Draft: A.D., F.S., Ma.G., and A.H.K.; Writing \u0026ndash; Review and Editing: A.D., F.S., Mo.G., and A.E. All authors contributed to and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or financial support was provided for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the results of this study are not publicly available due to privacy concerns regarding the participants. However, they can be accessed from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the institutional review board of Mashhad University of Medical Sciences (Ethics ID: IR.MUMS.MEDICAL.REC.1403.238; clinical trial registration: not applicable). All procedures were conducted in full accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their enrollment in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStopyra, W., Langenbucher, A. \u0026amp; Grzybowski, A. Intraocular lens power calculation formulas\u0026mdash;a systematic review. \u003cem\u003eOphthalmol. Therapy\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e, 2881\u0026ndash;2902 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcAlinden, C., Khadka, J. \u0026amp; Pesudovs, K. A comprehensive evaluation of the precision (repeatability and reproducibility) of the Oculus Pentacam HR. \u003cem\u003eInvestig. Ophthalmol. Vis. 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Experimental Ophthalmol.\u003c/em\u003e \u003cb\u003e255\u003c/b\u003e, 2399\u0026ndash;2406 (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"IOLMaster 700, Pentacam HR, Sirius, WTW, agreement, ICL sizing, Phakic IOL","lastPublishedDoi":"10.21203/rs.3.rs-7864944/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7864944/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe aimed to evaluate the absolute agreement, consistency, and the potential of arithmetic adjustment for measurements across a swept-source optical coherence tomography biometer (IOLMaster 700), a single Scheimpflug-based tomographer (Pentacam HR), and a combined Scheimpflug-Placido disc-based tomographer (Sirius). This cross-sectional study analyzed the corneal keratometry parameters (Sim-K1, Sim-K2, and Sim-Km, corneal astigmatism (CA), and its Jackson power vectors (J0 and J45), central corneal thickness (CCT), anterior chamber depth (ACD), and the horizontal white-to-white distance (WTW) of 111 healthy eyes. The inter-device agreement was assessed using the Bland-Altman and two types of intraclass correlation coefficient (ICC) analyses. A mean difference (MD) translating to less than 0.25D in refractive outcomes was considered clinically acceptable. Except for the WTW (ICC(2,1)\u0026thinsp;=\u0026thinsp;0.52, ICC(3,1)\u0026thinsp;=\u0026thinsp;0.65), the inter-device agreement was excellent for all parameters (ICC(2,1) and ICC(3,1)\u0026thinsp;\u0026gt;\u0026thinsp;0.90), with the CA and its power vectors (ICC(2,1) and ICC(3,1): 0.87\u0026ndash;0.90) being slightly inferior. WTW values varied substantially across devices, but applying a constant adjustment (MD\u0026thinsp;=\u0026thinsp;0.36) between Pentacam HR and Sirius improved agreement (ICC(2,1) rising from 0.59 to 0.90), whereas adjustment was not feasible with IOLMaster 700. CCT and ACD may be considered interchangeable across the three, particularly in intraocular lens (IOL) power calculation. Keratometry values exhibited clinically relevant MDs, limiting their direct interchangeability. Although WTW showed the greatest variability, the agreement between Pentacam HR\u0026ndash;Sirius could be improved through an arithmetic adjustment. These findings highlight the potential of arithmetic adjustment of WTW, an important variable in implantable collamer lens sizing, similar to constant optimization in the IOL power formulas.\u003c/p\u003e","manuscriptTitle":"Bridging the Gap Between Biometric Systems: Agreement and Adjustment of Key Anterior Segment Parameters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 06:37:31","doi":"10.21203/rs.3.rs-7864944/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-22T07:48:16+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"151831664758909452096144464107613454894","date":"2025-11-13T16:54:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T16:25:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246133049221382109029756353377700148362","date":"2025-11-13T09:12:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T17:10:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119804867623549466534396796080432307250","date":"2025-10-27T06:52:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-20T13:48:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-20T11:00:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-17T05:31:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-17T05:28:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-15T07:20:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9aa5ac94-96aa-4171-8953-6e8ee2cc7043","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":56587268,"name":"Health sciences/Diseases"},{"id":56587269,"name":"Health sciences/Health care"},{"id":56587270,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-03-30T16:17:58+00:00","versionOfRecord":{"articleIdentity":"rs-7864944","link":"https://doi.org/10.1038/s41598-026-42204-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-03-26 16:10:00","publishedOnDateReadable":"March 26th, 2026"},"versionCreatedAt":"2025-10-21 06:37:31","video":"","vorDoi":"10.1038/s41598-026-42204-9","vorDoiUrl":"https://doi.org/10.1038/s41598-026-42204-9","workflowStages":[]},"version":"v1","identity":"rs-7864944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7864944","identity":"rs-7864944","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}