David L Cooke1, Timothy L Cooke2. 1. Great Lakes Eye Care, Saint Joseph, Michigan; Department of Neurology and Ophthalmology, Michigan State University, College of Osteopathic Medicine, East Lansing, Michigan. Electronic address: davidlcooke@gmail.com. 2. Great Lakes Eye Care, Saint Joseph, Michigan.
Abstract
PURPOSE: To present the Cooke-modified axial length (CMALInitial) method, which closely approximates sum-of-segments AL. Notably, sum-of-segments AL has been shown to improve predictions of many intraocular lens (IOL) power formulas; however, calculating this AL requires information that is not readily available. DESIGN: Comparative case series. PATIENTS: Distinct datasets of 215 eyes and 1442 eyes, which were measured before cataract surgery with a commercially available optical biometer (Lenstar LS 900), were identified. The AL measured by this machine was labeled "traditional AL." MAIN OUTCOME MEASURE: Prediction Error. METHODS: The CMALInitial, sum-of-segments AL, and traditional AL methods with Bland-Altman plots and r2 values were compared, along with graphs of prediction errors. RESULTS: The CMALInitial was developed from 215 eyes and evaluated in the 1422-eye validation dataset. The r2 for CMALInitial versus the sum-of-segments AL was 0.99983. The predictions based on CMALInitial were compared with those based on traditional AL using the Hoffer Q, Holladay 1, SRK/T, and Holladay 2 IOL formulas. The CMALInitial produced more accurate predictions in all four formulas (P < .001). Eyes in all datasets were then combined to create the final recommendation: CMALFinal = 1.23853 + 0.95855 × traditional AL - 0.05467 × lens thickness (all measurements in millimeters). CONCLUSIONS: A modified AL method (CMAL) was easy to calculate. Using CMAL improved predictions for at least four IOL power prediction formulas, especially at extreme ALs. Caution is advised if using CMAL with other formulas.
PURPOSE: To present the Cooke-modified axial length (CMALInitial) method, which closely approximates sum-of-segments AL. Notably, sum-of-segments AL has been shown to improve predictions of many intraocular lens (IOL) power formulas; however, calculating this AL requires information that is not readily available. DESIGN: Comparative case series. PATIENTS: Distinct datasets of 215 eyes and 1442 eyes, which were measured before cataract surgery with a commercially available optical biometer (Lenstar LS 900), were identified. The AL measured by this machine was labeled "traditional AL." MAIN OUTCOME MEASURE: Prediction Error. METHODS: The CMALInitial, sum-of-segments AL, and traditional AL methods with Bland-Altman plots and r2 values were compared, along with graphs of prediction errors. RESULTS: The CMALInitial was developed from 215 eyes and evaluated in the 1422-eye validation dataset. The r2 for CMALInitial versus the sum-of-segments AL was 0.99983. The predictions based on CMALInitial were compared with those based on traditional AL using the Hoffer Q, Holladay 1, SRK/T, and Holladay 2 IOL formulas. The CMALInitial produced more accurate predictions in all four formulas (P < .001). Eyes in all datasets were then combined to create the final recommendation: CMALFinal = 1.23853 + 0.95855 × traditional AL - 0.05467 × lens thickness (all measurements in millimeters). CONCLUSIONS: A modified AL method (CMAL) was easy to calculate. Using CMAL improved predictions for at least four IOL power prediction formulas, especially at extreme ALs. Caution is advised if using CMAL with other formulas.
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