IOL Power Calculation
IOL Power Calculation
IOL Power Calculation
Introduction
The aim of an accurate intraocular lens power
calculation is to provide an intraocular lens (IOL)
that fits the specific needs and desires of the
individual patient.
The development of better instrumentation for
measuring the eye's axial length (AL) and the use
of more precise mathematical formulas to perform
the appropriate calculations have significantly
improved the accuracy with which the surgeon
determines the IOL power.
In order to determine the power of intraocular
lens several values need to be known:
• Eye's axial length (AL)
• Corneal power (K)
• Postoperative IOL position within the eye
known as estimated lens position (ELP)
• The anterior chamber constant: A-constant or
another lens related constant
First two are measured before the implantation,
the third parameter, the ELP, need to be
estimated mathematically before the
implantation and the last parameter is provided
by the manufacturer of the intraocular lens.
Axial Length
The axial length (AL) is the distance between the
anterior surface of the cornea and the fovea and
usually measured by A-scan ultrasonography or
optical coherence biometry.
The AL is the most important factor in IOL
calculation: A 1-mm error in AL measurement
results in a refractive error of approximately 2.88
D or about 3.0-3.5 D error of IOL power in an
average eye.
A mean shortening of 0.25–0.33mm can translate
into an error of IOL power by approximately 1 D
A high-quality A-scan should have five
spikes clearly defined and of
approximately the same amplitude.
Techniques to measure the AL
1: A-scan ultrasonography
2: Optical coherence biometry.
Ultrasonography
In A-scan ultrasound biometry, a crystal oscillates to
generate a high-frequency sound wave that
penetrates into the eye.
When the sound wave encounters a media interface,
part of the sound wave is reflected back toward the
probe.
These echoes allow us to calculate the distance
between the probe and various structures in the eye.
Ultrasonography does not measure the distance but rather
the time required for a sound pulse to travel from the
cornea to the retina. The speed of sound varies in different
parts of the eye.
The eye is divided ultrasonographically into four
components:Cornea, Anterior chamber, Lens thickness
and Vitreous cavity.
The velocity of sound in these compartments are 1620,
1532, 1641, 1532 m/s respectively. Through normal eyes
an average velocity of 1555 m/s is accepted for
calculation.
A-scan ultrasound biometry
Techniques.
a) Contact applanation biometry.
b) Immersion A-scan biometry
Contact applanation biometry.
This technique requires placing an ultrasound
probe on the central cornea with attached slit lamp
Since the compression error is variable, it cannot
be compensated for by a constant. IOL power
calculations using these measurements will lead
to an overestimation of the
IOL power.
Error chances
IOL power calculations using these measurements
will lead to an overestimation of the IOL power. In
shorter eyes, this effect is amplified.
Probe indenting the cornea results the shallowing
of the anterior chamber. This will lead to an
overestimation of the IOL power.
Mean shortening of 0.25–0.33 mm in axial length can
cause an error of IOL power by approximately 1 D.
Disadvantage: Poor image resolution due to the
use of a relatively long, low-resolution wavelength
(10 MHz)
Procedure
Explain the procedure
Use topical anesthesia
clean the probe
Probe is placed on the cornea
The probe is attached with the device that deliver the
adjustable sound waves
The measurements are displayed as spikes on screen of a
visual monitor
The appearance of the spikes and the distance between
them can be corelated to the within the eye and the distance
between them
Probe position
The probe lightly touches the cornea and is
positioned, such that the barrel of the probe is
aligned with the optical axis of the visual axis
of the eye. The aim is the probe towards the
macula
Alignment with the optical
axis is indicated by high lens
spikes and a high retina
spike on the scan graph.
Immersion A-scan biometry
P=A-(2.5L-0.9K)
P=IOL power
A= constant specific for each lens
L= axial length
K= average keratometry in diopters
SRKII
P=A-(2.5L-0.9K)
But A is modified on the basis of the axial length
If L is < 20 mm then A +3.0
If L is 20-20.99 mm then A +2.0
If L is 21-21.99 mm then A +1.0
If L is 22-24 mm then A
If L is >24 mm then A-0.50
Where P =IOL power
A =IOL specific constant
K =average corneal refractive power in diopter
L= length of the eye in mm
The SRK II formula adjusts the A constant utilized
depending on the axial length: increasing the A constant
for short eyes and decreasing the A constant for long
eyes.
Remember