Determination of IOL power

The major components of IOL power calculation are –

1. Biometry

2. Formulae

3. Clinical variables
 Clinical
Biometry Formulae
Variables
• Axial length • 4 generations
• Corneal • Can be • Special
curvature personalised circumstances
• IOL position
Measuring Axial Length

• Axial length is the most important factor in biometry

calculations.
• A 1mm error in AL measurement results in an error of 2.5-3D
in IOL power

1. Contact method
2. Applanation method
3. Optical biometers
Characteristics of a good scan

• In case of proper alignment, the echoes will be higher in

amplitude, arise steeply from baseline and are shorter in
duration
• Characteristics of a good scan are-

1. Corneal echo is seen as a tall spike

2. Aqueous chamber does not produce any echo
3. Anterior and posterior lens capsule produce tall echoes
4. Vitreous produces few or no echoes
5. Retina produces tall, sharply rising echoes
6. Orbital fat produces medium to low echoes
Optical Biometry

• Include use of noncontact instruments that use optical

coherence reflectometry instead of ultrasound to measure
multiple parameters

• Can be used to measure – AL, Corneal power, ACD and IOL

power

• Examples include Lenstar LS 900 and the IOL Master

Corneal Power Measurement

• It is the second most important aspect in the calculation of IOL

• A 1D error in corneal power will result in 1.0D post operative
refractive error

• Central corneal power maybe measured by-

• Keratometry
• Penatcam
• IOL master
 Effective Lens Position

• ELP is defined as the effective distance between the anterior

surface of the cornea and the lens plane if the lens was
infinitely thin

• It is an important determinant of IOL power along with axial

length and keratometry

• However, it is the only parameter that cannot be measured

preoperatively

• Hence, the ELP is considered to be the main limiting factor for

refractive predictability after cataract surgery
FORMULAE
• Depending on the basis of their derivation, there are two types of
formulae
1. Theoretical Formulae
2. Regression Formuale
Theoretical formulae-

• They are based on theoretical, optical model of the eye

• An optics equation is solved to determine the IOL power

needed to focus light from a distant object onto the retina
 The variables considered include-
 The AL of the eyeball
 K-reading
 The estimated postoperative ACD

The various formulae include-

 Binkhorst formula
 Colenbrander-Hoffer Formula
 Gill’s Formula
 Clayman Formula
 Fyodorov Formula
• Regression formulae-

• The regression formulae or empirical formulae are derived

from empirical data

• This data is based on retrospective analysis of postoperative

refraction after IOL implantation.

• Unlike the theoretical formulae, no assumptions are made about

the optics of the eye
 SRK – 1 Formula

• Introduced by Sanders, Retzlaff and Kraff in 1980

• It is based on regression analysis of a large number of postoperative
refractions
• The postoperative ACD was not included, but was replaced with ‘A’
constant
• This constant is unique to each different type of IOL

• P=A−2.5 L−0.9 K
• where, P=Implant power to produce emmetropia
• L=Axial length (mm)
• K=Average keratometer reading
• A=Specific constant for each lens type and manufacture
• Drawback of SRK

• As this is a linear formula, it will underestimate the power of

high powered lenses and it will overestimate the power of the
low-powered lenses compared to the theoretical calculation.

• For example, if the Binkhorst formula predicts that a 28-

diopter lens should be used, the SRK formula will predict that a
26-diopter lens should be used

• In lenses with low power, if the Binkhorst formula predicts that

a 10-diopter lens is necessary, the SRK will predict that a 12-
diopter lens should be used.
• 2ND Generation Formulae

• Modified SRK formula –

• It is the same as the original SRK

formula, but has been modified on the
basis of Axial Length
• 3RD Generation Formulae

• Most of 3rd generation formulae are a hybrid of both theoretical

and regression formulae

• Include the SRK/T, Holladay I, Hoffer’s formula

• These formulae require only 2 parameters : AL and K values

• 4th Generation formulae

• Hollady II

• Haigis

• Olsen
Thank you