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Biometry and Intraocular Lens Power Calculation in Eyes with Prior Laser Vision Correction (LVC) - A Review.

Jascha Wendelstein1,2,3, Michael Heath4, Kamran M Riaz5

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Intraocular lens (IOL) power calculation after laser vision correction (LVC) is challenging. Effective corneal power measurements and advanced formulas like Barrett True-K or EVO improve accuracy for better patient outcomes.

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Area of Science:

  • Ophthalmology
  • Refractive Surgery
  • Biomedical Engineering

Background:

  • Intraocular lens (IOL) power calculation in eyes with prior laser vision correction (LVC) presents significant challenges for accuracy and patient expectations.
  • Conventional methods often fail due to altered corneal measurements post-LVC.

Purpose of the Study:

  • To review the difficulties associated with IOL power calculation following LVC.
  • To provide an overview of current methodologies for IOL power calculation in post-LVC eyes.

Main Methods:

  • Analysis of factors affecting IOL calculation post-LVC, including corneal radii, central corneal thickness (CCT), and asphericity.
  • Evaluation of conventional versus advanced IOL calculation formulas.

Main Results:

  • IOL calculation accuracy is significantly impaired in eyes with prior LVC compared to non-operated eyes.
  • Accurate calculation requires considering effective corneal power, incorporating anterior and posterior corneal curvature, CCT, and asphericity.

Conclusions:

  • Formulas utilizing total keratometry (e.g., Barrett True-K, EVO, Haigis) or the Barrett True-K with anterior K values offer good results.
  • The American Society of Cataract and Refractive Surgery (ASCRS) calculator aids comparison by averaging results from multiple formulas.
  • Further studies are needed to evaluate tomography-based raytracing and newer formulas like Kane and Castrop.