Pediatric IOL power calculation: Factors and considerations

This narrative review aims to compare and document various studies on pediatric intraocular lens (IOL) power calculation, highlighting the differences from adult IOL power calculations and assessing the need for accurate ophthalmic biometry and targeted refraction to improve visual outcomes and reduce amblyopia risk. A comprehensive search of the PubMed database was conducted using keywords such as "pediatric cataract surgery," "IOL power calculation," "ocular biometry," and "IOL formulas." Relevant articles were identified by evaluating titles and abstracts, followed by full-text examination. References were reviewed for thorough coverage. Pediatric eyes pose unique challenges for IOL power calculation due to smaller size, changing axial length, and corneal curvature. Accurate biometry, particularly axial length and keratometry, is crucial. Studies comparing IOL formulas, primarily developed for adults, show varying prediction errors in pediatric cases. Newer-generation formulas such as Barrett's Universal II and Kane demonstrate superior accuracy compared to older formulas (e.g., SRK/T). Undercorrection strategies account for myopic shifts due to eye growth, but consensus on the best formula and target refraction is lacking. Premium IOLs, such as multifocal and toric, offer benefits but require further long-term evaluation. Accurate IOL power calculation is critical for optimal visual outcomes in pediatric cataract surgery. While newer IOL formulas show promise, the unpredictable nature of eye growth and myopic shifts complicates long-term predictions. Premium IOLs offer potential advantages but necessitate careful consideration. Continuous advancements in IOL technology and personalized approaches to target refraction are essential to improve the quality of life of pediatric patients.