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Simulated Keratometry Versus Total Corneal Power by Ray Tracing: A Comparison in Prediction Accuracy of Intraocular Lens Power

Savini, Giacomo MD*; Hoffer, Kenneth J. MD, FACS†,‡; Lomoriello, Domenico Schiano MD*; Ducoli, Pietro MD*

doi: 10.1097/ICO.0000000000001343
Clinical Science

Purpose: To investigate the relationship between corneal powers measured by simulated keratometry (Sim-K) and ray tracing and understand whether their difference influences intraocular lens (IOL) power calculation.

Methods: In a first sample of healthy eyes, corneal curvature was measured using a rotating Scheimpflug camera (Sirius, CSO). Sim-K was obtained from anterior corneal curvature using the 1.3375 keratometric index. Ray tracing was performed through both corneal surfaces to calculate the total corneal power (TCP). The difference between Sim-K and TCP was correlated with various parameters. In a second sample of patients undergoing cataract surgery, IOL power was subsequently calculated using both Sim-K and TCP.

Results: In the first sample (114 eyes), Sim-K (43.64 ± 1.44 D) was higher than TCP (43.07 ± 1.41 D, P < 0.0001); the difference ranged between 0.07 and 1.95 D and correlated with the anterior/posterior (A/P) ratio (r = 0.7292, P < 0.0001), which ranged between 1.10 and 1.30. In the second sample (107 eyes), the A/P ratio influenced the outcomes of the Holladay 1 and SRK/T, but not Haigis and Hoffer Q formulas. However, using TCP, which takes the A/P ratio into account, did not improve the prediction error of any formula.

Conclusions: Sim-K provides a higher corneal power compared with TCP. This difference is not constant but depends on the A/P ratio and can influence the refractive outcome of IOL power calculation by theoretical formulas. However, TCP values do not improve the results of these formulas, as they were developed for keratometric values such as Sim-K.

*Fondazione G.B. Bietti IRCCS, Rome, Italy;

Stein Eye Institute, University of California, Los Angeles, CA; and

St. Mary's Eye Center, Santa Monica, CA.

Reprints: Giacomo Savini, MD, Fondazione G.B. Bietti IRCCS, Via Livenza, 3, 00198 Rome, Italy (e-mail:

Supported by Italian Ministry of Health, Fondazione Roma.

Dr. G. Savini is a consultant for SIFI Medtech. Dr. K. J. Hoffer licenses the registered trademark name Hoffer to ensure accurate programming of his formulas to Carl Zeiss-Meditec (IOLMasters), Haag-Streit (LenStar), Oculus (Pentacam AXL), Movu (Argos), Nidek (AL-Scan), Tomey (OA-2000), Topcon EU/Visia Imaging (Aladdin), Ziemer (Galilei G6) and all A-scan biometer manufacturers. The remaining authors have no conflicts of interest to disclose.

Received April 17, 2017

Received in revised form June 06, 2017

Accepted July 03, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.