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Xu J, Zhang L, Mo E, Zhu K, Zhu Y, Feng K, Wu Z, Zheng Y, Huang F, Gong X, Li J. The effect of corneal power on the accuracy of 14 IOL power formulas. BMC Ophthalmol 2024; 24:126. [PMID: 38504225 PMCID: PMC10949746 DOI: 10.1186/s12886-024-03395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND This study evaluates the impact of corneal power on the accuracy of 14 newer intraocular lens (IOL) calculation formulas in cataract surgery. The aim is to assess how these formulas perform across different corneal curvature ranges, thereby guiding more precise IOL selection. METHODS In this retrospective case series, 336 eyes from 336 patients who underwent cataract surgery were studied. The cohort was divided into three groups according to preoperative corneal power. Key metrics analyzed included mean prediction error (PE), standard deviation of PE (SD), mean absolute prediction error (MAE), median absolute error (MedAE), and the percentage of eyes with PE within ± 0.25 D, 0.50 D, ± 0.75 D, ± 1.00 D and ± 2.00 D. RESULTS In the flat K group (Km < 43 D), VRF-G, Emmetropia Verifying Optical Version 2.0 (EVO2.0), Kane, and Hoffer QST demonstrated lower SDs (± 0.373D, ± 0.379D, ± 0.380D, ± 0.418D, respectively) compared to the VRF formula (all P < 0.05). EVO2.0 and K6 showed significantly different SDs compared to Barrett Universal II (BUII) (all P < 0.02). In the medium K group (43 D ≤ Km < 46 D), VRF-G, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS recorded lower MAEs (0.307D to 0.320D) than Olsen (OLCR) and Castrop (all P < 0.03), with RBF3.0 having the second lowest MAE (0.309D), significantly lower than VRF and Olsen (OLCR) (all P < 0.05). In the steep K group (Km ≥ 46D), RBF3.0, K6, and Kane achieved significantly lower MAEs (0.279D, 0.290D, 0.291D, respectively) than Castrop (all P < 0.001). CONCLUSIONS The study highlights the varying accuracy of newer IOL formulas based on corneal power. VRF-G, EVO2.0, Kane, K6, and Hoffer QST are highly accurate for flat corneas, while VRF-G, RBF3.0, BUII, Karmona, K6, EVO2.0, Kane, and Pearl-DGS are recommended for medium K corneas. In steep corneas, RBF3.0, K6, and Kane show superior performance.
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Affiliation(s)
- Jialin Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Lu Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Er Mo
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 618 East Fengqi Road, Hangzhou, Zhejiang, 310000, China
| | - Kaiyi Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Yitong Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Ke Feng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Zunting Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Yangran Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Fang Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China
| | - Xianhui Gong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China.
| | - Jin Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Wenzhou Medical University Eye Hospital, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China.
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Wei Y, Liu Y, Li H, Song H. Theoretical Accuracy of the Raytracing Method for Intraocular Calculation of Lens Power in Myopic Eyes after Small Incision Extraction of the Lenticule. Klin Monbl Augenheilkd 2024; 241:221-229. [PMID: 37722612 PMCID: PMC10898958 DOI: 10.1055/a-2177-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
AIM To evaluate the accuracy of the raytracing method for the calculation of intraocular lens (IOL) power in myopic eyes after small incision extraction of the lenticule (SMILE). METHODS Retrospective study. All patients undergoing surgery for myopic SMILE between May 1, 2020, and December 31, 2020, with Scheimpflug tomography optical biometry were eligible for inclusion. Manifest refraction was performed before and 6 months after refractive surgery. One eye from each patient was included in the final analysis. A theoretical model was invited to predict the accuracy of multiple methods of lens power calculation by comparing the IOL-induced refractive error at the corneal plane (IOL-Dif) and the SMILE-induced change of spherical equivalent (SMILE-Dif) before and after SMILE surgery. The prediction error (PE) was calculated as the difference between SMILE-Dif-IOL-Dif. IOL power calculations were performed using raytracing (Olsen Raytracing, Pentacam AXL, software version 1.22r05, Wetzlar, Germany) and other formulae with historical data (Barrett True-K, Double-K SRK/T, Masket, Modified Masket) and without historical data (Barrett True-K no history, Haigis-L, Hill Potvin Shammas PM, Shammas-PL) for the same IOL power and model. In addition, subgroup analysis was performed in different anterior chamber depths, axial lengths, back-to-front corneal radius ratio, keratometry, lens thickness, and preoperative spherical equivalents. RESULTS A total of 70 eyes of 70 patients were analyzed. The raytracing method had the smallest mean absolute PE (0.26 ± 0.24 D) and median absolute PE (0.16 D), and also had the largest percentage of eyes within a PE of ± 0.25 D (64.3%), ± 0.50 D (81.4%), ± 0.75 D (95.7%), and ± 1.00 D (100.0%). The raytracing method was significantly better than Double-K SRK/T, Haigis, Haigis-L, and Shammas-PL formulae in postoperative refraction prediction (all p < 0.001), but not better than the following formulae: Barrett True-K (p = 0.314), Barrett True-K no history (p = 0.163), Masket (p = 1.0), Modified Masket (p = 0.806), and Hill Potvin Shammas PM (p = 0.286). Subgroup analysis showed that refractive outcomes exhibited no statistically significant differences in the raytracing method (all p < 0.05). CONCLUSION Raytracing was the most accurate method in predicting target refraction and had a good consistency in calculating IOL power for myopic eyes after SMILE.
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Affiliation(s)
- Yinjuan Wei
- Department of Cataract, Tianjin Eye Hospital, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yianzhu Liu
- Department of Cataract, Tianjin Eye Hospital, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Hongyu Li
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Hui Song
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin, China
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Fernández-Rosés J, Lamarca J, Piñero DP, Barraquer RI. Intraocular lens power calculation in virgin eyes: Accuracy of the Barrett Universal II formula and a Ray tracing software. Eur J Ophthalmol 2021; 32:2954-2960. [PMID: 34854773 DOI: 10.1177/11206721211065552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the accuracy of Sirius ray tracing software with the Barrett Universal II formula for intraocular lens power prediction in virgin eyes. METHODS Retrospective case series including 86 eyes that have undergone uneventful cataract surgery with SN60WF implantation. The median absolute error, mean prediction error, variance, and the percentage of eyes within ± 0.25 D, ± 0.50 D, ± 0.75 D, and ± 1.00 D of the prediction error in refraction were calculated. The correlation of prediction error with different baseline parameters was investigated. RESULTS No differences were found between the median absolute error of the Barrett Universal II formula (0.226 D) and the ray tracing software with different intraocular lens centerings; apex (0.331 D), limbus (0.345 D), and pupil (0.342 D) (p = 0.084). The variance, from lowest to highest, was the Barrett Universal II (0.144 D2), ray tracing-limbus (0.285 D2), ray tracing-pupil (0.285 D2), and ray tracing-apex (0.287 D2) (p = 0.027). The Barrett Universal II formula showed a higher percentage of eyes within ± 0.25 D (56.98%), ± 0.50 D (82.56%), and ± 0.75 D (93.02%) compared to ray tracing software (p < 0.01). A significant correlation between the prediction error of the Barrett Universal II formula and corneal diameter (r = 0.322, p = 0.002) and pupil diameter (r = 0.230, p = 0.033) was found. Also, a positive correlation between the prediction error of Sirius ray tracing and axial length (p < 0.001) and pupil diameter (p = 0.01) was found. CONCLUSION There is a trend of the Barrett Universal II formula to be more accurate than Sirius ray tracing software for intraocular lens power calculation in virgin eyes. This should be confirmed in future prospective comparative studies.
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Affiliation(s)
- Joaquim Fernández-Rosés
- 16360Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Lamarca
- 16360Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,16760Universitat Internacional de Catalunya, Barcelona, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, 16718University of Alicante, Alicante, Spain
| | - Rafael I Barraquer
- 16360Centro de Oftalmología Barraquer, Barcelona, Spain.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,16760Universitat Internacional de Catalunya, Barcelona, Spain
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Kane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology 2020; 128:e94-e114. [PMID: 32798526 DOI: 10.1016/j.ophtha.2020.08.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022] Open
Abstract
The refractive outcome of cataract surgery is influenced by the choice of intraocular lens (IOL) power formula and the accuracy of the various devices used to measure the eye (including intraoperative aberrometry [IA]). This review aimed to cover the breadth of literature over the previous 10 years, focusing on 3 main questions: (1) What IOL power formulas currently are available and which is the most accurate? (2) What biometry devices are available, do the measurements they obtain differ from one another, and will this cause a clinically significant change in IOL power selection? and (3) Does IA improve refractive outcomes? A literature review was performed by searching the PubMed database for articles on each of these topics that identified 1313 articles, of which 166 were included in the review. For IOL power formulas, the Kane formula was the most accurate formula over the entire axial length (AL) spectrum and in both the short eye (AL, ≤22.0 mm) and long eye (AL, ≥26.0 mm) subgroups. Other formulas that performed well in the short-eye subgroup were the Olsen (4-factor), Haigis, and Hill-radial basis function (RBF) 1.0. In the long-eye group, the other formulas that performed well included the Barrett Universal II (BUII), Olsen (4-factor), or Holladay 1 with Wang-Koch adjustment. All biometry devices delivered highly reproducible measurements, and most comparative studies showed little difference in the average measures for all the biometric variables between devices. The differences seen resulted in minimal clinically significant effects on IOL power selection. The main difference found between devices was the ability to measure successfully through dense cataracts, with swept-source OCT-based machines performing better than partial coherence interferometry and optical low-coherence reflectometry devices. Intraoperative aberrometry generally improved outcomes for spherical and toric IOLs in eyes both with and without prior refractive surgery when the BUII and Hill-RBF, Barrett toric calculator, or Barrett True-K formulas were not used. When they were used, IA did not result in better outcomes.
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Affiliation(s)
- Jack X Kane
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - David F Chang
- University of California, San Francisco, San Francisco, California
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