IOL Power Calculation Formulae

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IOL power calculation formulae

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Published on Mar 10, 2014
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Dr. Ivo Ferreira Rios M.D. , Cataract Surgeon, Researcher, Software Development, Artificial Intelligence,
Entrepreneur & Keynote Speaker. at INSTITUTO DE OFTALMOLOGIA F.A.P. Conde de Valenciana, I.A.P.
Excellent Presentation. Congratulations!
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蔡俊斌 , 醫師 at 慶明眼科
Nice presentation!
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Prem kumar , Student at ARAVIND EYE HOSPITAL (Inst. Code - 470), THENI
2 months ago
alaa saleh , Student at King Saud University

2 months ago
Arpit Sharma , Opthalmology at MGM Eye Institute - India

3 months ago
Girish Dev , Training Specialist at VIVO Healthcare

3 months ago
Sajjan Sangai
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IOL power calculation formulae
1. 1. IOL power calculation FORMULAE

2. 2. Generations! • First – SRK 1 & Binkhorst formula • Second – SRK2 • Third – SRK T , Hoffer Q , Holladay •
Fourth – Holladay 2 , Haigis
3. 3. • Theoretical formulae – based on mathematical principles revolving around the schematic eye • Regression
formulae – working backwards on post operative outcomes • 3rd and 4th generation – mix of both.
4. 4. A closer look 1. SRK formula • P = IOL Power • K = avg central corneal power in Diopters • L = axial
length in mm. P = A – 0.9K – 2.5L Range - 22mm – 24.5mm
5. 5. 2. SRK 2 formula – An attempt to OPTIMIZATION A1 =(A–0.5) for axial lengths greater than 24.5 A1 =A
for axial lengths between 22 and 24.5 A1 =(A+1) for axial lengths between 21 and 22 A1 =(A+2) for axial
lengths between 20 and 21 A1 =(A+3) for axial lengths less than 20
6. 6. Why Optimize??
7. 7. • All formulae work well within the range of 22.5-26 mm AL • A constant computed based on Avg AL
23.5mm • Assumption Reason?? AL α ACD K α ACD Dr Holladay
8. 8. • SRK/T formula — uses "A-constant" • Holladay 1 formula — uses "Surgeon Factor" • Holladay 2 formula
— uses "Anterior Chamber Depth" • Hoffer Q formula — uses "Pseudophakic Anterior Chamber Depth"
9. 9. • Hoffer-Q formula • Dr Kenneth Hoffer – 1993 • P = f (A,K,Rx,pACD) • A = AL • K = avg corneal ref

power • Rx = previous refraction
10. 10. • pACD = The personalized ACD (pACD) is set equal to the manufacturer's ACD-constant, if the
calculation was selected to be based on the ACD-constant. In case the A-constant was chosen, pACD is derived
from the A-constant [HOFFER, 1998] according to [HOLLADAY et al, 1988] pACD = ACD-const = 0.58357
* A-const - 63.896 .
11. 11. Haigis formula • Gernet, Ostholt, Werner -1970 (GOW70 formula) • D = a0 + a1 ACD+ a2 AL • a0
constant moves the power prediction curve up or down • a1 constant is tied to the measured anterior chamber
depth • a2 constant is tied to the measured axial length
12. 12. Holladay 2 • Currently – most sophisticated formula ACCURACY PREDICTABILITY
13. 13. 2 reasons for success
14. 14. • 7 PARAMETERS Axial length White to white AC depth Previous refraction Age of pt Lens thickness
Central corneal power
15. 15. Effective lens position • Human eye – a dual lens system In any dual lens system, if the primary lens and
the distance of the screen are fixed, then the effective power of the system will depend on the power and
position of the second lens
16. 16. Factors affecting ELPo • Anatomical factors 1. K value 2. AL 3. Limbal white to white dist 4. Pre-op AC
depth 5. Lens thickness • IOL related factors 1. Shape 2. Length 3. Flexibility 4. Anterior angulation (if any) 5.
Material of haptic 6. Shape, design material of optic
17. 17. • Surgeon’s technique 1. CCC 2. Inadequate visco removal 3. Capsular fibrosis Bag to Sulcus shift
18. 18. • AL = 22.5-26mm Almost any modern • K = 41D-46D formula Outside this range ???? Haigis formula
Holladay 2
19. 19. Special cases
20. 20. Post ref sx IOL calculation
21. 21. • Require pre ref sx data 1. Clinical History method (manifest refraction, K values) 2. Feiz–Mannis method
(manifest refraction, K values) 3. Topographic method based on adjusting the measured effective refractive
power (EffRP) (manifest refraction)
22. 22. • Do not require 1. CL overrefraction (adjusting corneal power using a correcting factor) 2. Orbscan
topography 3. Maloney method
23. 23. MESA-GUTIÉRREZ JC1, RUIZ-LAPUENTE C2,INTRAOCULAR LENS POWER CALCULATION
AFTER CORNEAL PHOTOREFRACTIVE SURGERY; LITERATURE REVIEW. ARCH SOC ESP
OFTALMOL 2009; 84: 283-292
24. 24. Clinical history method Postop K = (K before ref sx) – (change in refraction at corneal plane induced by the
sx) Corr-Kpost = Kpre - SEpre + SEpost *SE = spherical equivalent
25. 25. Feiz Mannis method • Best used when good historical data is present • Least likely to cause post op
hyperopia IOL pre – (∆D / 7) = IOL post where…… IOL pre = the power of IOL using pre LASIK keratometry
∆D = the stable refractive change aftr LASIK at the spectacle plane then… IOL post = the estimated power of
the IOL to be implanted following LASIK
26. 26. • It is helpful to keep in mind that the sign convention for the change in refractive error (∆D) following
myopic LASIK is a negative number. Using the above formula, the new calculated IOL power will always
result in a larger number.
27. 27. The Koch-Wang Method • We perform a corneal topography and take the value of EffRp (effective
refractive power). Corr-Kpost = EffRp (∆D x 0.19)
28. 28. The Hammed Method • We also take the EffRp value and calculate the correction as follows: Corr-Kpost =
EffRPadj = EffRp-(∆D/0.15)
29. 29. The Shammas Formula • Kpost(Shammas)=1.14 K-6.8. • Kpost(Shammas)=1.14*44.25-6.8=50.45-6.8 •
Kshammas=43.65D
30. 30. The contact lens Method • Subjective refraction → place rigid PMMA CL → refraction • If refraction
same…cornea has same power as CL • If refraction is myopic… CL has more power than cornea • Opposite in
hypermetropia
31. 31. The contact lens Method Rpost=Refraction in post-op eyeglasses = -1D Rlc= Correction with the contact
lens = +1D. Base Curve =CB=40 DR (Difference in Refraction)=Rlc-Rpost=+1-(-1)=+2 Corr-
Kpost=CB+DR=39.25+2=41.25 D.
32. 32. Silicon oil • There are presently two viscosities of silicone oil in use: • 1,000 mPa.s. silicone oil (Silikon,
Alcon Laboratories, Ft. Worth, Texas) slows sound waves to a little more than half the speed (980 m/sec) of
normal vitreous and can attenuate the returning sound wave during ultrasonography so much that a good echoes
are difficult, if not impossible, to obtain. • 5,000 mPa.s. silicone oil (ADATO SIL-ol 5000, Bausch & Lomb
Surgical, San Dimas, California) has a somewhat higher density, and slows sound waves to approximately
1,040 m/sec. Typically, when ultrasound measurements are made through silicone oil, hugely erroneous axial
lengths (such as 35 mm) are displayed.
33. 33. • Without IOL master • each component of the eye had to be individually measured (usually at 1,532 m/sec)
and the true axial length calculated using the velocity conversion equation (TAL = Vc / Vm x AAL) for the lens
thickness and the vitreous cavity.
34. 34. Holladay et al Biconvex IOL PMMA plano convex lens with plano side towards vitreous…….over an intact
capsule Silicone lens
35. 35. • The additional power that must be added to the original IOL calculation for a convex-plano IOL is
determined by the following relationship, as described in 1995 by Patel and confirmed by Meldrum: • Ns =
refractive index of silicone oil (1.4034). • Nv = refractive index of vitreous (1.336). • AL = axial length in mm.
• ACD = anterior chamber depth in mm. • Additional IOL power (diopters) = ((Ns - Nv) / (AL - ACD)) x 1,000
36. 36. Average eye with silicon oil - +3 to +3.5D
37. 37. Posterior staphyloma • 70% eyes with AL >33.5mm • Pathological myopia Difficulty in obtaining posterior
retinal spike ???????? Posterior staphyloma
38. 38. • Anatomic AL ≠ refractive AL • The simplest method • Optical biometry using either the 1. Haag-Streit
Lenstar or the 2. Zeiss IOL Master. • If the patient's visual acuity is good enough, have him or her look directly
at the red fixation light, and the axial length measurement will typically be to the center of the macula.
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IOL power calculation formulae

Published on Mar 10, 2014

Published in: Education

alaa saleh , Student at King Saud University

Arpit Sharma , Opthalmology at MGM Eye Institute - India

Girish Dev , Training Specialist at VIVO Healthcare

IOL power calculation formulae

1. 1. IOL power calculation FORMULAE

9. 9. • Hoffer-Q formula • Dr Kenneth Hoffer – 1993 • P = f (A,K,Rx,pACD) • A = AL • K = avg corneal ref

Office 2016 for Educators

Elearning Techniques: Visual Design

Biometry: Iol calculation

Noor Munirah Aab

Biometry for Cataract

Post lasik iol Surgery

IOL power calculation special situations

LinkedIn Corporation © 2018

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