Effect of the equivalent refractive index on intraocular lens power prediction with ray tracing after myopic laser in situ keratomileusis

Abstract

To determine the impact of the equivalent refractive index (ERI) on intraocular lens (IOL) power prediction for eyes with previous myopic laser in situ keratomileusis (LASIK) using custom ray tracing. AMO B.V., Groningen, the Netherlands, and the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. Retrospective data analysis. The ERI was calculated individually from the post-LASIK total corneal power. Two methods to account for the posterior corneal surface were tested; that is, calculation from pre-LASIK data or from post-LASIK data only. Four IOL power predictions were generated using a computer-based ray-tracing technique, including individual ERI results from both calculation methods, a mean ERI over the whole population, and the ERI for normal patients. For each patient, IOL power results calculated from the four predictions as well as those obtained with the Haigis-L were compared with the optimum IOL power calculated after cataract surgery. The study evaluated 25 patients. The mean and range of ERI values determined using post-LASIK data were similar to those determined from pre-LASIK data. Introducing individual or an average ERI in the ray-tracing IOL power calculation procedure resulted in mean IOL power errors that were not significantly different from zero. The ray-tracing procedure that includes an average ERI gave a greater percentage of eyes with an IOL power prediction error within ±0.5 diopter than the Haigis-L (84% versus 52%). For IOL power determination in post-LASIK patients, custom ray tracing including a modified ERI was an accurate procedure that exceeded the current standards for normal eyes.