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Intraocular lens power calculation in challenging cases.

Jack X Ma1, Li Wang1, Douglas D Koch1

  • 1Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA.

Saudi Journal of Ophthalmology : Official Journal of the Saudi Ophthalmological Society
|December 10, 2025
PubMed
Summary

Accurate intraocular lens (IOL) power calculation is crucial in special eyes. Newer formulas and AI calculators offer improved outcomes for short, long, keratoconic, and post-refractive surgery eyes.

Keywords:
Intraocular lens power calculationkeratoconuskeratoplastylong eyespostrefractive eyesshort eyes

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Area of Science:

  • Ophthalmology
  • Biomedical Engineering
  • Optics

Background:

  • Accurate intraocular lens (IOL) power calculation is essential for achieving desired refractive outcomes after cataract surgery.
  • Special eyes, including short, long, keratoconic, and post-refractive surgery eyes, present unique challenges for conventional IOL power calculation methods.
  • Recent advancements in IOL calculation formulas and technology aim to improve accuracy in these complex cases.

Purpose of the Study:

  • To review and summarize recent advancements in intraocular lens (IOL) power calculation for eyes with unique anatomical or surgical characteristics.
  • To evaluate the effectiveness of new IOL calculation formulas and artificial intelligence (AI) based calculators in improving refractive outcomes.
  • To provide guidance on selecting appropriate IOL power calculation methods for various challenging eye conditions.

Main Methods:

  • Review of recently published literature on intraocular lens (IOL) power calculation in special eyes.
  • Analysis of the performance of different IOL calculation formulas, including AI-driven and specialized formulas.
  • Evaluation of outcomes in short, long, keratoconic, and post-keratoplasty eyes, as well as eyes with prior refractive surgery.

Main Results:

  • ZEISS AI calculator shows best outcomes for short eyes.
  • Axial length (AL) adjusted formulas and newer IOL formulas improve accuracy in long eyes.
  • New keratoconus-specific formulas (Barrett True K, Kane) introduced; accuracy is poor with keratometric values ≥50.0 D.
  • Targeted myopic shift recommended for combined Descemet membrane endothelial keratoplasty and cataract surgery.
  • Newer formulas incorporating anterior and posterior corneal measurements (Barrett True-K TK, Pearl-DGS, EVO 2.0, Hoffer QST) improve post-refractive surgery IOL calculation.

Conclusions:

  • Multiple IOL power calculation methods should be used, with consensus and emphasis on newer formulas for optimal results.
  • AI and specialized formulas demonstrate improved accuracy in challenging eyes.
  • Continued research and development of IOL calculation formulas are crucial for enhancing refractive outcomes in ophthalmology.