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No-History IOL Power Calculation After Myopic Laser Vision Correction: A Multicenter Retrospective Database Study of 14 Formulas With and Without Posterior Corneal Curvature

American Journal of Ophthalmology·August 6Open Access
OphthalmologyPractice changingCataractPost-Myopic Laser Vision CorrectionRetrospective Database StudyIOL Power Calculation FormulaOptical BiometryAdultIOLMaster 700Barrett True K FormulaCooke K6 FormulaEVO 2.0 FormulaPEARL-DGS FormulaShammas-Cooke Formula

Summary

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What was studied

Retrospective multicenter comparison of 14 IOL power calculation formulas (with and without posterior corneal curvature [PCC] input) in 3,738 eyes with prior myopic laser vision correction (M-LVC) undergoing cataract surgery across U.S. centers (Oct 2017–Aug 2025), using IOLMaster 700 biometry and subjective refraction at 21–90 days postop.

Key findings

PCC-based formulas outperformed non-PCC counterparts (p <0.0001). Best PCC formulas: Cooke K6 (MAE 0.37 D), PEARL-DGS, EVO 2.0, and Barrett True K (all 0.38 D). Best non-PCC formulas: K6 and EVO 2.0 (both MAE 0.40 D). In short eyes (AL <23.5 mm) and steep corneas (K ≥43 D)—22% of the cohort—K6 gained >13% more eyes within ±0.50 D vs. Barrett True K; gains were clinically negligible in typical post-M-LVC eyes.

Study limitations

- M-LVC history was surgeon-reported without independent verification, risking misclassification. - No pre-LVC biometry available; no-history formulas only. - Study limited to eyes with satisfactory postoperative visual acuity, potentially excluding poor outcomes.

Clinical implications

For post-myopic LVC cataract surgery, use PCC-capable modern formulas (K6, EVO 2.0, PEARL-DGS, or Barrett True K with PCC) when full biometry is available—especially in short eyes (AL <23.5 mm) or steep corneas (K ≥43 D). When full biometry is unavailable, Shammas-Cooke is a reasonable fallback.

Caveats

  • M-LVC history was based solely on surgeon report without independent verification; misclassification of eyes cannot be excluded.
  • No pre-LVC biometry was available; all formulas evaluated are 'no-history' approaches only. Results may not generalize to history-based formula comparisons.
  • The impact_flag 'practice_changing' was applied because this is the largest multicenter dataset comparing modern PCC vs. non-PCC formulas post-M-LVC, but gains in typical eyes are described as clinically negligible—clinicians should interpret context-dependently.
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  • The study is retrospective and limited to eyes with satisfactory postoperative visual acuity, which may introduce selection bias.

Related Questions

Explore related topics

Which IOL formula is most accurate after myopic LASIK for cataract surgery?Does posterior corneal curvature measurement improve IOL calculations in post-refractive eyes?How do I calculate IOL power in short eyes after laser vision correction?

Publication Details

Year
2026
Journal
American Journal of Ophthalmology
Sample Size
n=3,738
Source
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