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Minimizing the IOL Power Error Induced by Keratometric Power

Camps, Vicente J.*; Piñero, David P.*; de Fez, Dolores*; Mateo, Verónica

Optometry and Vision Science: July 2013 - Volume 90 - Issue 7 - p 639–649
doi: 10.1097/OPX.0b013e3182972f50
Original Articles

Purpose To evaluate theoretically in normal eyes the influence on IOL power (PIOL) calculation of the use of a keratometric index (nk) and to analyze and validate preliminarily the use of an adjusted keratometric index (nkadj) in the IOL power calculation (PIOLadj).

Methods A model of variable keratometric index (nkadj) for corneal power calculation (Pc) was used for IOL power calculation (named PIOLadj). Theoretical differences (ΔPIOL) between the new proposed formula (PIOLadj) and which is obtained through Gaussian optics (



) were determined using Gullstrand and Le Grand eye models. The proposed new formula for IOL power calculation (PIOLadj) was prevalidated clinically in 81 eyes of 81 candidates for corneal refractive surgery and compared with Haigis, HofferQ, Holladay, and SRK/T formulas.

Results A theoretical PIOL underestimation greater than 0.5 diopters was present in most of the cases when nk = 1.3375 was used. If nkadj was used for Pc calculation, a maximal calculated error in ΔPIOL of ±0.5 diopters at corneal vertex in most cases was observed independently from the eye model, r1c, and the desired postoperative refraction. The use of nkadj in IOL power calculation (PIOLadj) could be valid with effective lens position optimization nondependent of the corneal power.

Conclusions The use of a single value of nk for Pc calculation can lead to significant errors in PIOL calculation that may explain some IOL power overestimations with conventional formulas. These inaccuracies can be minimized by using the new PIOLadj based on the algorithm of nkadj.



Grupo de Óptica y Percepción Visual, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain (VJC, DPP, DdF, VM); and Foundation for the Visual Quality (Fundación para la Calidad Visual-FUNCAVIS), Alicante, Spain (DPP).

© 2013 American Academy of Optometry