Corneal power correction factor for photorefractive keratectomy.

BACKGROUND: Studies of corneal power changes resulting from photorefractive keratectomy generally rely on keratometer or videokeratograph measurements. These instruments convert corneal radius of curvatures values to optical powers by means of the single refracting surface formula, which incorporates an index of refraction value of 1.3375. This index approximates that of the tears but not the 1.376 index of the corneal epithelium or stroma. A hypothetical optical model was used to determine the most appropriate index to be chosen with respect to corneal power calculations relative to photorefractive keratectomy.
METHODS: The contribution of each refractive element in the tear lens-corneal surface to the total power of the eye was calculated in order to identify which index of refraction was most appropriate for the corneal power calculation.
RESULTS: The outer tear surface has significant optical power but the tear layer as a whole has nearly zero power due to the offsetting negative power of the posterior test surface. There is no significant difference in the effective power of light leaving the corneal anterior surface when considered with or without the tear layer. Photorefractive keratectomy changes the epithelium and anterior surface of the corneal stroma, but does not affect the posterior stroma or other ocular media. Hence the refractive index for the corneal epithelium or stroma of 1.376 should be used in converting radius to optical power values. The error in assuming a corneal index of 1.3375 is a constant proportion equal to 11.4% of the corneal power reading.
CONCLUSIONS: Photorefractive keratectomy presents a situation in which the actual corneal refractive index of 1.376 should be used for correct corneal radius to power conversions. This may be accomplished by changing the index value in the instrument algorithm for keratometry and videokeratography to 1.376 or by adding a correction factor of either 11.4% of the regular reading to its value or multiplying by the factor 1.114. In other applications of keratometry or videokeratography, the index 1.3375 may be more appropriate.