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Related Experiment Video

Updated: Sep 4, 2025

Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
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Accuracy of Formulas for Intraocular Lens Power Calculation After Myopic Refractive Surgery.

Michele Lanza, Adriano Ruggiero, Jason Ha

    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |July 20, 2022
    PubMed
    Summary

    The Haigis-L and ASCRS average intraocular lens (IOL) power formulas are most accurate for cataract surgery after myopic refractive surgery. Caution is advised for long eyes or flat corneas, as hyperopic outcomes may occur.

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    Area of Science:

    • Ophthalmology
    • Refractive Surgery
    • Cataract Surgery

    Background:

    • Accurate intraocular lens (IOL) power calculation is crucial for visual outcomes after cataract surgery, especially in eyes with prior myopic refractive surgery.
    • Traditional formulas often perform poorly in these eyes due to altered corneal curvature and axial length.

    Purpose of the Study:

    • To evaluate the accuracy of five IOL power formulas (Barrett True-K No History, Emmetropia Verifying Optical 2.0 Post Myopic LASIK/PRK, Haigis-L, ASCRS average, and Shammas) in eyes that underwent previous myopic refractive surgery.
    • To compare formula performance independent of clinical history and corneal topography.

    Main Methods:

    • A retrospective analysis of 302 eyes from patients who had prior myopic refractive surgery and subsequent cataract surgery.
    • Calculation of predicted refraction using five IOL power formulas and comparison with actual refractive outcomes to determine prediction error.
    • Subgroup analysis based on axial length and mean keratometry.

    Main Results:

    • The Haigis-L formula demonstrated the lowest mean absolute prediction error (MAE) of 0.61 D, closely followed by the ASCRS average formula at 0.63 D.
    • Haigis-L showed a statistically significant lower MAE compared to most other formulas (P < .05), except for the ASCRS average.
    • All formulas exhibited a tendency towards hyperopic mean prediction errors in eyes with axial lengths >30 mm or mean keratometry ≤35.00 D.

    Conclusions:

    • The Haigis-L and ASCRS average formulas are the most accurate for IOL power calculation in eyes with prior myopic refractive surgery.
    • Clinicians should exercise caution with very long eyes or very flat corneas, as hyperopic refractive surprises may be more prevalent.