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Related Experiment Video

Updated: Jan 9, 2026

Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
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Accuracy of IOL Power Calculation in Eyes Needing a Myopic Target.

Francesco Biagini1, Kenneth J Hoffer2,3, David L Cooke4

  • 1From San Martino Hospital, Genoa, Italy.

Journal of Refractive Surgery (Thorofare, N.J. : 1995)
|December 10, 2025
PubMed
Summary

Newer intraocular lens (IOL) power calculation formulas show good accuracy for myopic targets. Older formulas, particularly Holladay 1, are less accurate and not recommended for these cases.

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Area of Science:

  • Ophthalmology
  • Biomedical Engineering
  • Optics

Background:

  • Accurate intraocular lens (IOL) power calculation is crucial for achieving desired refractive outcomes after cataract surgery.
  • Intentional myopic targets are sometimes used to manage specific visual needs or conditions.
  • Evaluating the performance of various IOL power calculation formulas in these specific scenarios is essential for clinical practice.

Purpose of the Study:

  • To compare the accuracy of several modern and traditional formulas for intraocular lens (IOL) power calculation in eyes targeted for myopia between -2.50 and -3.00 diopters.
  • To assess the predictive error and accuracy thresholds of different IOL calculation formulas based on implanted IOL models.

Main Methods:

  • A retrospective study involving patients undergoing phacoemulsification with a planned myopic target.
  • IOL power was calculated using newer formulas (Barrett Universal II, Cooke K6, EVO 2.0, Hoffer QST, Kane) and older formulas (Haigis, Hoffer Q, Holladay 1 and 2, SRK/T).
  • Comparison of trueness, precision, and accuracy of prediction error (PE), with analysis of PE thresholds for eyes implanted with iSert255 or SN60WF IOLs.

Main Results:

  • No significant difference in trueness was found among formulas due to optimization.
  • The Holladay 1 formula demonstrated lower accuracy compared to newer formulas (Cooke K6, EVO 2.0, Kane) in the iSert 255 group (P < .05).
  • In the SN60WF group, Holladay 1 showed lower accuracy versus Barrett Universal II, EVO 2.0, Hoffer QST, and Kane (P < .005). Newer formulas achieved higher percentages of eyes within 0.50 D PE (77-85%) compared to Holladay 1 (58-69%).

Conclusions:

  • Modern IOL power calculation formulas exhibit good accuracy for eyes with intentional myopic targets.
  • The use of older formulas, especially the Holladay 1 formula, is not recommended for achieving accurate refractive outcomes in myopic target eyes.
  • Clinical adoption of newer formulas may improve refractive predictability in specific patient populations requiring myopic outcomes.