Ultrasound is a high frequency sound that you

cannot hear, but it can be emitted and

. detected by special machines
Ultrasound travels freely through fluid and soft
tissues. However, ultrasound is reflected back
(it bounces back as 'echoes') when it hits a
more solid (dense) surface. For example, the
ultrasound will travel freely though blood in a
heart chamber. But, when it hits a solid valve,
a lot of the ultrasound echoes back. Another
example is that when ultrasound travels
though bile in a gallbladder it will echo back
strongly if it hits a solid gallstone.
So, as ultrasound 'hits' different structures in
the body of different density, it sends back
.echoes of varying strength

A-Scan ultrasound biometry, commonly

referred to as an scan, is routine type of
diagnostic test used in ophthalmology.
This equipment provides data on the
length of the eye, which is a major
determinant in common sight disorders.
The most common use is to determine
eye length for calculation of intraocular
lens power. Briefly, the total refractive
power of the emetropic eye is
approximately 60. Of this power, the
cornea provides roughly 40 diopters,

By measuring both the length of the eye and

the power of the cornea (keratometry), a simple
formula can be used to calculate the best fit of
intraocular lens. There are several different
forumlas that can be used depending on the
.actual characteristics of the eye
The other major use of the A-Scan is to
determine the size and ultrasound
characteristics of masses in the eye, in order to
. determine the type of mass
Instruments used in this type of test require
direct contact with the cornea, however a noncontact instrument has been reported.
Disposable covers, which come in actual contact
.with the eye, have also been evaluated

The A-scan probe projects a

thin sound beam that travels
through liquid or tissue. When
the sound beam encounters
the interface of a substance
that is dissimilar from the
substance it is traveling
through, part of the sound
beam energy is reflected, and
part of the sound energy
projects through the new
substance. The more
dissimilar the substances are,
the stronger the reflection, or
.echo, is

When the A-scan beam is projected

into the phakic (natural lens) eye it
travels through the aqueous humor
and encounters a dissimilar substance
in the anterior lens surface. Energy is
reflected back to the transducer in the
probe tip. The instrument displays the
intensity of the reflection as a spike
above the baseline (which represents
.distance) on a graph
Strong reflections also occur as the
sound beam encounters the posterior
lens surface and the retina. Spikes
representing these reflections appear
at their corresponding positions along
the baseline. The first spike
represents the probe tip as it comes
.into contact with the cornea

Since ultrasound does not travel

through air, the A-scan probe must
come into contact with the cornea,
either directly or through a liquid. If a
corneal-contact method is used, there is
a danger of the probe putting too much
pressure on the cornea, causing the
cornea to compress, which results in an
artificial shortening of the axial eye
.length
This is a significant potential error
source. A .4mm compression error can
result in a 1 diopter error in the
.calculated IOL power

Special care must be taken

when performing
pseudophakic scans because
of the presence of
reverberation echoes. Your
instrument may mistake one
of these echoes for the retina
echo and produce an
.inaccurate axial length
The figure to the right depicts
anterior (A) and posterior (B)
lens echoes from an IOL and
two reverberation spikes (C,
.and D)

Some instruments use measuring

"gates" that measure the first
spike to reach a threshold height
within a specified distance along
a baseline. Make sure a
reverberation spike does not
appear within the retina gate. In
the figure to the right a reverb
spike is within the retina gate at
point A. The gate would need to
be moved or resized to avoid this
spike. Otherwise the instrument
will read the spike at point A as
.being the retina spike

Some instruments use "lights" that

attach to spikes that reach a
threshold height, no matter where
they occur on the baseline. In the
aphakic mode there may only be
two lights; one for the cornea, and
one for the retina. Make sure the
retina light attaches to the retina
spike and not a reverb spike. In the
figure to the right the retina light
has attached to a reverb spike (A).
You will need to manually move it to
.the retina spike (B)
It is sometimes easier to identify
reverberation spikes if the gain is
turned down. The manual to your
instrument will tell you how to
adjust gates or move lights, if
.necessary

Sometimes cataract surgery

results in a post-operative
refractive "surprise". Perhaps we
were aiming for plano and the eye
ended up with a -3.00 D refractive
error. In these cases we would like
to pinpoint the cause of the error.
We will want to confirm that the
axial length was correctly
.measured

It is always a good idea to have K

readings and A-scan measurements
on both eyes before cataract surgery
is performed. Since both eyes have
similar measurements in most
people, this provides a double-check
of the measurement. If the fellow
eye has an IOL inserted by another
doctor, you may not have access to
the IOL specifications and/or the
.measurement information

It is sometimes necessary to replace an

IOL that was inserted many months or
years ago. Even if you have IOL
specifications and measurement
information from the previous surgery, it
is nice to have the confirmation of a
current measurement. It is necessary to
have a new measurement if a scleral
buckling procedure, which lengthens
the eye, has been done since the IOL
.was inserted