Comparison of Intraocular Lens Calculation Formulas for Phacoemulsification after Corneal Refractive Surgery in Asian Eyes
Cris Martin Jacoba, MD, DPBO1, Mary Ellen Sy, MD, DPBO2, Isa Mulingbayan Jacoba, MD3
1 Beetham Eye Institute, Joslin Diabetes Center, Harvard Department of Ophthalmology, Boston, MA, USA
2 American Eye Center, Mandaluyong, Philippines
3 University of the East Ramon Magsaysay Medical Center, Quezon City, Philippines
Correspondence: Cris Martin Jacoba, MD, DPBO One Joslin Place, Boston, MA, USA. 02215
Disclosure: The authors report no conflicts of interest.
Objective: To compare the different intraocular lens (IOL) calculation formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) IOL power calculator website among Asian eyes with previous corneal refractive surgery.
Methods: A retrospective cohort study of 84 eyes in 68 Asian patients who had phacoemulsification with previous LASIK or photorefractive keratectomy (PRK) was done. Using the post-phacoemulsification manifest refraction spherical equivalent (MRSE) as target refraction, IOL prediction error (PE) for each formula was calculated as the implanted minus the predicted IOL power. Refractive PE was determined by calculating that 1 diopter (D) of IOL PE produces 0.7 D of refractive error at the spectacle plane.
Results: Comparing the Shammas, Haigis-L, Barrett True-K No History, ASCRS Average IOL Power No History, Barrett True-K, and ASCRS Average IOL Power with Change in Manifest Refraction (ΔMR), the mean IOL PEs ranged from -0.23 to -0.62 D, with the Barrett True-K having the lowest PE. The median refractive PEs for all formulas were similar at 0.35 D, except for the Haigis-L at 0.53 D. The ASCRS average with ΔMR had a statistically higher percentage of eyes within 0.5 D of target refraction versus other formulas (p<0.05). The Haigis-L IOL PE and refractive PE were significantly higher than the Barrett True-K (p<0.001), and the ASCRS average with ΔMR (p<0.001) respectively. The ASCRS average with ΔMR produced a significantly smaller variance of IOL PE (p<0.05).
Conclusion: Accounting for PEs and variance, the ASCRS average IOL power with ΔMR is recommended, followed by the ASCRS average IOL power No History if without historical data.
Keywords: LASIK, PRK, ASCRS, IOL Calculation, Refractive Surgery