Standardizing constants for ultrasonic biometry, keratometry, and intraocular lens power calculations

Purpose: To provide a method and values that facilitate standardization of constants for ultrasonic biometry, keratometry, and intraocular lens (IOL) power calculations. Setting: University of Texas Medical School, Houston, Texas, USA. Methods: Keratometry and ultrasonic biometry provide the two measured input variables for the six variable vergence equations used to calculate the appropriate IOL power for a specific patient with a cataract. A review of the literature reflecting the past 156 years of research and development reveals the appropriate index of refraction to be used with the keratometer for net optical corneal power, the location of the principal planes of the cornea, the nominal value for retinal thickness, and the appropriate velocities for ultrasonic measurement of the axial length. The relationship of the thick IOL to the thin IOL is derived along with the physical location of the thick lens. Two methods are described that provide the best IOL constant to be used by a manufacturer to minimize the prediction error for a surgeon using the lens for the first time. The formulas for phakic IOLs and secondary piggyback IOLs are also derived and applied to methods described above for standard IOLs. Results: Using a standardized net index of refraction of 4/3 for the cornea eliminates a variability of 0.56 diopter (D) in the predicted refraction. Using a standardized 1532 m/s velocity for axial length measurements and adding a value of 0.28 mm reduces the tolerance of axial length measurements to ±0.03 mm for any length eye. The physical location of the thick IOL’s secondary principal plane must be anterior to the thin lens equivalent by approximately the separation of the principal planes of the thick lens. For biconvex poly(methyl methacrylate) IOLs, the separation in the principal planes is approximately 0.10 mm. Using these relationships, the physical position of the thick lens within the eye can be used to confirm the lens constant for any IOL style. Conclusions: Standardizing the constants for keratometry, ultrasonic biometry, and IOL power calculations can significantly improve the predictability of refractive outcomes. Back‐calculating and physically measuring the position of the lens within the eye can provide surgeons with an initial lens constant known to have a standard error of the mean of ±0.05 mm (±0.10 D). Other parameters such as the cardinal points of a lens, the shape factor, the lens‐haptic plane, and the center lens thickness would allow further refinement of IOL power calculations.