Axial Length Adjustment and AL/R Ratio Optimization of IOL Power Calculation in Extremely Long Eyes.

Yingyan Qin; L U Qin; Xiaoran Zhao; Yujie Ding; Liangping Liu; Mingxing Wu

doi:10.1016/j.ajo.2026.06.026

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Axial Length Adjustment and AL/R Ratio Optimization of IOL Power Calculation in Extremely Long Eyes.

Yingyan Qin·L U Qin·Xiaoran Zhao·Yujie Ding·Liangping Liu·Mingxing Wu

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Abstract

PURPOSE: To evaluate the accuracy of modern intraocular lens (IOL) power calculation formulas and axial length (AL) adjustment methods in eyes with AL ≥ 30.0 mm. DESIGN: Retrospective consecutive cross-sectional study. PARTICIPANTS AND CONTROLS: A total of 308 eyes (308 patients) with AL ≥ 30.00 mm were included. METHODS: Accuracy of modern online formulas, alone or with established AL adjustments methods, was analyzed. Subgroup analyses were performed based on AL, keratometry (K), anterior chamber depth (ACD), lens thickness (LT), and AL-to-corneal radius (AL/R) ratio. MAIN OUTCOME MEASURES: Predictive accuracy was evaluated using the formula performance index (FPI), root mean square absolute prediction error (RMSAE), standard deviation (SD) of prediction error (PE), and percentage of eyes within ±0.25 and ±0.50 diopters (D). RESULTS: Overall, Holladay 1 combined with the nonlinear polynomial Wang-Koch axial length adjustment (H1-PWK) demonstrated the best overall performance, achieving the lowest SD (0.40), RMSAE (0.40), and highest FPI (0.494). A tendency toward hyperopic error was observed in eyes with AL ≥ 32.0 mm, K ≥ 46.0 D. The AL/R ratio showed a significant positive correlation with PE in the Ladas Super formula, Barrett Universal II, EVO, PEARL-DGS, and Hoffer QST formulas. Spline-based regression analysis indicated that the transition point of AL/R from myopic to hyperopic PE varied across different formulas. CONCLUSIONS: H1-PWK provides robust refractive accuracy in extremely long eyes. The AL/R ratio may provide a useful composite biometric stratification parameter compared to AL alone.

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Humans Axial Length, Eye Lenses, Intraocular Retrospective Studies Cross-Sectional Studies Biometry Female Optics and Photonics Male Refraction, Ocular Lens Implantation, Intraocular Aged Visual Acuity Middle Aged Anterior Chamber Phacoemulsification Reproducibility of Results Journal Article

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Yingyan Qin, L U Qin, Xiaoran Zhao, Yujie Ding, Liangping Liu, Mingxing Wu. 2026-06-19. Axial Length Adjustment and AL/R Ratio Optimization of IOL Power Calculation in Extremely Long Eyes.. https://doi.org/10.1016/j.ajo.2026.06.026

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Journal Article resource Aged subject Cross-Sectional Studies subject Female subject Humans subject Journal Article subject Male subject Middle Aged subject

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