Original Investigation
December 2015

A 3-D “Super Surface” Combining Modern Intraocular Lens Formulas to Generate a “Super Formula” and Maximize Accuracy

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 2Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2015;133(12):1431-1436. doi:10.1001/jamaophthalmol.2015.3832

Importance  Cataract surgery is the most common eye surgery. Calculating the most accurate power of the intraocular lens (IOL) is a critical factor in optimizing patient outcomes.

Objectives  To develop a graphical method for displaying IOL calculation formulas in 3 dimensions, and to describe a method that uses the most accurate and current information on IOL formulas, adjustments, and lens design to create one “super surface” and develop an IOL “super formula.”

Design, Setting, and Participants  A numerical computing environment was used to create 3-D surfaces of IOL formulas: Hoffer Q, Holladay I, Holladay I with Koch adjustment, Haigis, and SRK/T. The surfaces were then analyzed to determine where the IOL powers calculated by each formula differed by more than 0.5, 1.0, and 1.5 diopters (D) from each of the other formulas. Next, based on the current literature and empirical knowledge, a super surface was rendered that incorporated the ideal portions from 4 of the 5 formulas to generate a super formula. Last, IOL power values of a set of 100 eyes from consecutive patients at an eye institute were calculated using the 5 formulas and super formula. The study was performed from December 11, 2014, to April 20, 2015. Analysis was conducted from February 18 to May 6, 2015.

Main Outcomes and Measures  Intraocular lens power value in diopters and the magnitude of disparity between an existing individual IOL formula and our super formula.

Results  In the 100 eyes tested, the super formula localized to the correct portion of the super surface 100% of the time and thus chose the most appropriate IOL power value. The individual formulas deviated from the optimal super formula IOL power values by more than 0.5 D 30% of the time in Hoffer Q, 16% in Holladay I, 22% in Holladay I with Koch adjustment, 48% in Haigis, and 24% in SRK/T.

Conclusions and Relevance  A novel method was developed to represent IOL formulas in 3 dimensions. An IOL super formula was formulated that incorporates the ideal segments from each of the existing formulas and uses the ideal IOL formula for an individual eye. The expectation is that this method will broaden the conceptual understanding of IOL calculations, improve clinical outcomes for patients, and stimulate further progress in IOL formula research.