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Accuracy of New-Generation Intraocular Lens Power Calculation Formulas for Highly Myopic Eyes: A Multicenter Study in
Masaki Kinoshita1, So Goto2, Yosai Mori3
1From the Department of Ophthalmology, Graduate School of Medicine, The University of Osaka, Suita, Japan.
American Journal of Ophthalmology
|August 12, 2025
Summary
New-generation intraocular lens (IOL) power calculation formulas and the Holladay 1 WK formula show improved accuracy for highly myopic eyes. These advanced methods outperform traditional formulas in refractive prediction.
Area of Science:
- Ophthalmology
- Biomedical Engineering
- Optics
Background:
- Accurate intraocular lens (IOL) power calculation is crucial for achieving optimal visual outcomes after cataract surgery, especially in eyes with high myopia.
- Traditional IOL power calculation formulas often exhibit significant prediction errors in eyes with axial lengths (AL) of 26.0 mm or longer.
Purpose of the Study:
- To compare the refractive prediction accuracy of 13 intraocular lens (IOL) power calculation formulas in highly myopic eyes (AL ≥ 26.0 mm).
- To evaluate seven new-generation formulas available on the European Society of Cataract and Refractive Surgeons (ESCRS) calculator against traditional formulas.
Main Methods:
- Retrospective case series involving 326 eyes of 326 patients across four surgical sites in Japan.
- Comprehensive preoperative ophthalmic evaluations were performed.
- Postoperative spherical equivalent prediction error (SEQ-PE) was assessed for 13 formulas, including traditional (Haigis, Hoffer Q, Holladay 1, SRK/T, Holladay 1 WK, SRK/T WK) and new-generation (Barrett Universal II, EVO 2.0, Hill-RBF, Hoffer QST, Kane, Cooke K6, Pearl-DGS) formulas.
- Predictive performance was evaluated using root-mean-square absolute error (RMSAE).
Main Results:
- The mean axial length (AL) was 27.28 ± 0.98 mm.
- Hoffer QST, Holladay 1 WK, and SRK/T WK formulas showed myopic shifts in SEQ-PE; other formulas exhibited hyperopic shifts.
- Haigis, Hoffer Q, and Holladay 1 formulas had relatively large hyperopic errors (≥ 0.27 D) with RMSAE exceeding 0.7.
- Holladay 1 WK and six new-generation formulas (excluding Pearl-DGS) demonstrated the best performance with RMSAE < 0.53.
Conclusions:
- New-generation IOL power calculation formulas and the Holladay 1 WK formula provide superior refractive prediction accuracy in highly myopic eyes.
- These advanced formulas offer a significant improvement over traditional methods for optimizing visual outcomes in this patient population.
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