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Published on: September 16, 2025
The accuracy of intraocular lens calculation varies by age in the Infant Aphakia Treatment Study
Isdin Oke1, Deborah K VanderVeen1, Thaddeus S McClatchey2
1Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Insights
Intraocular lens (IOL) calculation errors in children decrease significantly with age. As age doubles, prediction errors reduce by 0.25 D, showing improved accuracy over time.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Biomedical Engineering
Background:
- Intraocular lens (IOL) calculation formulas demonstrate inaccuracies in pediatric populations.
- Accurate refractive outcomes are crucial for visual development in children.
Purpose of the Study:
- To quantify the relationship between age and refractive prediction error in children using IOL calculation formulas.
- To determine if age influences the accuracy of IOL power calculations independent of biometric data.
Main Methods:
- Utilized biometry measurements from the Infant Aphakia Treatment Study (IATS) for children ≤7 months old.
- Calculated theoretical refractions using the Holladay 1 formula with axial length, keratometry, and IOL power.
- Compared predicted refractions to actual refractions to determine absolute prediction error (APE).
Main Results:
- Median APE decreased from 1.60 D at a mean age of 0.20 years to 1.11 D at 10.60 years.
- A statistically significant inverse relationship was found between age and APE.
- For every doubling of age, APE decreased by 0.25 D (95% CI, 0.09-0.40 D).
Conclusions:
- The accuracy of intraocular lens calculations in children improves with age.
- Age is an independent factor that enhances the precision of refractive predictions, beyond biometric measurements and IOL power.
Abstract:
Refraction predictions from intraocular lens (IOL) calculation formulae are inaccurate in children. We sought to quantify the relationship between age and prediction error using a model derived from the biometry measurements of children enrolled in the Infant Aphakia Treatment Study (IATS) when they were ≤7 months of age. We calculated theoretical predicted refractions in diopters (D) using axial length, average keratometry, and IOL powers at each measurement time point using the Holladay 1 formula. We compared the predicted refraction to the actual refraction and calculated the absolute prediction error (APE). We found that the median APE was 1.60 D (IQR, 0.73-3.11 D) at a mean age (corrected for estimated gestational age) of 0.20 ± 0.14 years and decreased to 1.11 D (IQR, 0.42-2.20 D) at 10.60 ± 0.27 years. We analyzed the association of age with APE using linear mixed-effects models adjusting for axial length, average keratometry, and IOL power and found that as age doubled, APE decreased by 0.25 D (95% CI, 0.09-0.40 D). The accuracy of IOL calculations increases with age, independent of biometry measurements and IOL power.
