Overall, the Barrett Universal II formula had the lowest prediction error for the 2 IOL models studied.

A three-part system that determines the correct power for an intraocular lens (IOL) to achieve a desired postoperative refraction is presented. The three components are (1) data screening criteria to identify improbable axial length and keratometry measurements, (2) a new IOL calculation formula that exceeds the current accuracy of other formulas for short, medium, and long eyes, and (3) a personalized "surgeon factor" that adjusts for any consistent bias in the surgeon's results, from any source, based on a reverse solution of the new formula; the reverse solution uses the postoperative stabilized refraction, the dioptric power of the implanted IOL, and the preoperative corneal and axial length measurements to calculate the personalized surgeon factor. The improved accuracy of the new formula was proven by performing IOL power calculations on 2,000 eyes from 12 surgeons and comparing the results to seven other currently used formulas.

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The 2 analytical methods are complimentary and permit thorough and quantitative evaluation of SIRCs and allow valid statistical comparisons within and between data sets. The DEQ allows comparison of refractive and visual results. The decrease in refractive predictability with higher corrections is well demonstrated by the SEQ and doubled-angle plots of the SIRC. Doubled-angle plots were particularly useful in interpreting errors of cylinder treatment amount and errors in alignment. The correlation between refractive and keratometric astigmatism was poor for preoperative, postoperative, and SIRC data, indicating the presence of astigmatic elements beyond the corneal surface (ie, intraocular astigmatism). Sources of error in refractive outcome statistics include the use of multiple lens systems in the phoropter, errors in vertex calculations, difficulty in accurately defining the axis of astigmatism, and failure to consider measurement errors when working with keratometric data. The analysis of this particular data set demonstrates the significant clinical benefits of refractive surgery: an 8-fold increase in UCVA, an 11-fold decrease in SEQ refractive error, as well as a 9-fold and nearly a 2 1/2-fold decrease in the magnitude and distribution of astigmatism, respectively.

Calculating the surgically induced refractive change following ocular surgery is important for evaluating the results of keratore-fractive procedures, smaller incisions and various wound closures for cataract surgery, and the effect of suturing techniques and suture removal following corneal transplant surgery. We present a ten-step method of calculating the spherical- and cylindrical-induced refractive change in a manner suitable for a programmable calculator or personal computer. Several applications are given including (1) adding the overrefraction to the spectacle correction, (2) determining the surgically induced refractive change from the preoperative and postoperative refractions, (3) determining the surgically induced refractive change from the K-readings, (4) rotating axes, (5) determining the power at meridians oblique to the principal meridians of a spherocylinder, (6) determining the coupling ratio, and (7) averaging axes. Standard methods for calculating and reporting aggregate results are also given.