Accuracy of IOL power calculations in the very elderly

Abstract

Background/objectives To analyze the refractive predictability and outcomes of cataract surgery in the very elderly (≥85 years old). Subjects/methods A retrospective case-series performed at the Shiley Eye Institute, University of California San Diego, USA. Electronically pulled data of 2444 surgeries revealed 147 surgeries on 133 very elderly patients. Chart review was conducted for all very elderly and corresponding control patients (75–84 years old). The first operated eyes of patients with final best-corrected visual acuity ≥20/40, axial length (AL) 22–26 mm, and implanted SN60WF IOL were included. Patients with ocular comorbidities and/or intra- or post-operative complications were excluded. Prediction errors of refractive outcome and percentage of eyes within ±0.50D and ±1.00D were compared between the groups for the Holladay 1 and Barrett Universal II (Barrett) formulas. Logistic regression analysis for achievement of ±1.00D was conducted. Results Final analysis included 90 eyes ( n = 44, very elderly, n = 46, control patients). Median absolute refractive error (MedAE) with Holladay 1, but not Barrett formula, was significantly higher in the older group ( p = 0.02 and p = 0.07, respectively). The MedAE in the older group was lower using the Barrett compared to Holladay 1 ( p = 0.02). Fewer older patients than younger patients achieved refraction within ±0.50D and ±1.00D from goal, using the Holladay 1 ( p = 0.049 and p = 0.002 respectively). Logistic regression analysis supported the relationship between Holladay 1 predictive refractive error of >1.00D and patient’s age ( p = 0.046). Conclusions Very elderly patients undergoing cataract surgery may be prone to reduced refractive precision, particularly with utilization of the Holladay 1 formula.

Intraocular lens power calculation in the elderly population using the Kane formula in comparison with existing methods

“…Selection criteria are detailed previously. 6 According to protocols for studies of intraocular lens formula accuracy described by Hoffer et al, 11 only patients with a final best spectacle-corrected visual acuity (BCVA) 20/40 or better and an axial length (AL) of 22-26 mm were included. Moreover, only patients who received the same IOL model (SN60WF, Alcon Laboratories, Inc., Fort Worth, TX) also were included.…”

“…All included patients had a documented follow-up visit 1-3 months post operatively, during which manifest refraction at an examination lane length of 20 feet was performed by an optometrist. Exclusion criteria, as specified by Sella et al, 6 included patients with missing follow-up data, low quality of biometry measurements defined by a signal-to-noise ratio (SNR) ≤ 2 by the IOLMaster with no alternative immersion ultrasound biometry, history of refractive surgery, eyes with significant ocular comorbidities, or surgical complications.…”

“…Addressing IOL power calculation accuracy in the elderly is essential, as the predictability of IOL calculation formulas may be age dependent. [4][5][6] A recent study by our group evaluated IOL power calculation using two formulas, the Holladay 1 and the Barrett Universal II (BUII), in the very elderly population (≥85 years old) and compared predicted refractive outcomes to those of their younger counterparts aged 75-84 years old. 6 There was reduced accuracy of the Holladay 1 formula in the very elderly population.…”

“…[4][5][6] A recent study by our group evaluated IOL power calculation using two formulas, the Holladay 1 and the Barrett Universal II (BUII), in the very elderly population (≥85 years old) and compared predicted refractive outcomes to those of their younger counterparts aged 75-84 years old. 6 There was reduced accuracy of the Holladay 1 formula in the very elderly population. Similar trends, though not statistically significant, were shown for the BUII formula.…”

Cataract Surgery in Very Old Patients: A Case-Control Study

“…Studies on cataract surgery outcomes in the elderly population (>85 or >90 years) have been reported in Japan [1], Sweden [2,4], UK [5][6][7], Denmark [8], Germany [9], Korea [10], USA [11][12][13], China [14], Turkey [15], and Israel [16]. However, none of these studies included a matched control in systemic and ocular comorbidity, which may confound the age effect [17].…”