Original Article

J. Med. Sci. (Peshawar, Print) July 2014, Vol. 22, No. 3: 126-128

BIOMETRIC ASSESSMENT AND INTRAOCULAR LENS

POWER CALCULATION IN ADULTS
Asif Iqbal1, Muhammad Idrees2, Bilal Bashir1, Mubashir Rehman1, Omer Khan Orakzai1
Department of Ophthalmology, Hayatabad Medical Complex, Peshawar - Pakistan
Department of Ophthalmology, Lady Reading Hospital Peshawar, Peshawar - Pakistan

ABSTRACT
Objectives: To determine the keratometric readings, axial length of the eyeball and intraocular lens (IOL) power for
adults and whether or not it is advisable to implant intraocular lenses without proper pre- operative assessment.
Material and Methods: It was aprospective Observational study conducted from March 2010 to January 2013. Setting;
Community based Trust eye hospital in Tarakai village of District Swabi. All adult patients, undergoing cataract surgery
with IOL implantation were included in the study after informed consent and fulfilling the inclusion and exclusion criteria. Keratometric readings (K1 & K2), axial length and IOL power were calculated and data analyzed by using SPSS
software database.
Results: Out of 1100 patients with cataract 554 (50.4%) were males and 546(49.6%) were females. Right eye was
involved in 597(54.3%) patients whereas; left eye was involved in 503 (45.7%) patients. Mean K1 reading was 44.81
D with minimum reading of 39.50 D, maximum of 52 D and range was 12.50 D. Mean K2 reading was 44.92 D with
minimum reading of 37.50 D, maximum of 50.50 D and range was 13.00 D. 23.3% (n=257) patients had K1 reading
between 44- 44.99 D whereas, 20.9% (n=230) patients had K2 reading between 45- 45.99D. Mean axial length reading
was 23.11mm with minimum reading of 18.06mm, maximum of 31.81mm and range was 13.75mm. 36.6%(n=403)
patients had axial length between 23-23.99 mm. Mean IOL power in diopters was 20.11 D with minimum power of -2.00
D, maximum of 36.50 D and range was 38.50 D. 21%(n=230) patients had IOL power between 20- 20.50 D.
Conclusion: There is a wide range of keratometric readings, axial length and IOL power. Therefore, the biometric
readings vary greatly from patient to patient. Proper pre-operative biometric assessment is desirable for good post
operative vision.
Key Words: Biometry, Keratometric readings, Axial Length, Intraocular lens.

INTRODUCTION

Cataract is the commonest age related disease in
most countries Worldwide and is the leading cause of
preventable blindness1. According to WHO estimates,
285 million people are visually impaired worldwide, of
these 39 million people are blind and 246 million people
have low vision2. Globally cataract is the leading cause
of blindness and about 90% of blind people live in low
income countries2. Pakistan is the sixth most populous
country in the world with total population of over 170
million3. The number of blind people is 2 million, of
these 1.3 million are estimated blind due to cataract4. It
is expected that by year 2020, the elderly population of
60 years and above is expected to double from todays
number thus increasing the number of blind people due
to cataract even more5. According to Pakistan National
blindness and visual impairment survey 2007, cataract
accounts for 51.5% blindness while previous survey in
1989- 90 reported 66.7% cataract related blindness in
Address for Correspondence:
Dr. Asif Iqbal
Department of Ophthalmolgy, Hayatabad Medical
Complex, Peshawar - Pakistan
Cell: 0333- 911- 6370.
Email: [email protected]
126

Pakistan. This decrease in blindness due to cataract was

brought by increasing the surgical facility centers as well
as arranging the outreach surgical camps in the far flung
areas of the country3. Cataract extraction accounts for
more than half of all ophthalmic operations and is the
most common elective operation in many countries of
the world7.

Intraocular lens (IOL) implantation is the revolutionary breakthrough in Ophthalmology. Awareness
regarding IOL implantation is very high and almost
every patient demand for IOL during his/ her cataract
surgery. In most of the camps as well as in some tehsil
and district hospitals, IOLs are implanted without proper
pre- operative biometric assessment. IOL powers in the
range of 20-22 diopters (D) are randomly implanted
to the patients. To achieve a desired amount of post
operative refraction, IOL power is routinely calculated
pre- operatively. IOL power calculation is done using
different formulas like SRK, SRK II, SRK/T and Holladay
formulae installed in variety of biometers. Mostly SRK II
formula is used for IOL power calculation. Keratometric
readings (K readings) both for vertical and horizontal
corneal curvatures in dioptres, axial length (AL) of eye
ball in millimetres and A-constant provided by IOL
manufacturers are required for SRK II formula. The
two ocular parameters that need to be measured are

J. Med. Sci. (Peshawar, Print) July 2014, Vol. 22, No. 3

DISCUSSION

K readings and axial length. K readings are measured

on either manual or automated keratometers in both
horizontal and vertical meridians whereas axial length
is measured using A- scan of ophthalmic ultrasound,
which is available in all currently marketed biometers.
Accurate ocular axial length measurement is extremely
important for accurate IOL power calculation because
it is the major identifiable source of error in IOL power
calculation. To avoid error, it is commonly recommended that multiple A- scan readings should be taken sequentially. The objectives of the study were to determine
keratometric (K) readings, axial length (AL) of eye ball
and intraocular lens (IOL) power in adults.

Cataract is the leading cause of avoidable
blindness and commonest age related diseas in most
countries worldwide. Approximately 45 million people
are blind globally; almost 80% of these live in developing
countries and more than half are blind as a result of
cataract. These areas are underpreviliged and eye care
facilities are even scarce in such areas of the world7. In
this study, males were 50.4% and females were 49.6%.
This was in agreement with Naz MA8 who reported
66.4% males and 43.6% females. Similar results were
also reported by Chanchlani M et al9. Studies of Rashid
H10 and Saleem M et al3 reported female predominance.

MATERIAL AND METHODS

Most of the patients were from 61-70 years
(30.4%). This was in agreement with Rashid H10 and

It was a prospective, observational, cross sectional study conducted at community based trust eye
hospital in Tarakai village of district Swabi. Duration of
the study was three years from February 2010 to January 2013. All patients between 20-80 years, both male
and female. Co-operative patients having cataract were
included. Patients less than 20 years of age and very
old patients who cannot co-operate. Patients having
fixation problems like nystagmus, mentally unstable etc.
Patients having ocular surface irregularities like corneal
opacity, corneal dystrophy, corneal edema, keratitis,
advanced pterygium etc. Patients having anatomically
abnormal globe like pthysis, microphthalmia, buphthalmos. Patients having silicon oil in vitreous cavity were
excluded from the study.

Adult patients assessed properly and enrolled
for cataract extraction were assessed for inclusion and
exclusion criteria. Informed consent was taken from
every patient. K readings were measured with manual
keratometer using Schin Nippon keratometer (). The
axial length measured and IOL power calculated by
using A- scan (Quantel Medical). The IOL power calculated by SRKII formula using dense phakic mode built in
the A- scan software. Serial axial length measurements
were taken and average calculated by built-in software
to avoid error. A- constant of 118.3 was used for all
patients. Age, gender and laterality was also recorded
in the proforma. Data was entered into SPSS version
20, analyzed and presented as frequencies and percentages.

RESULTS

Total of 1100 patients were included in the study.
Males were 50.4% (n=554) and females were 49.6%
(n=546). 30.4% (n= 334) patients were in the age range
61-70 years and 26.9% (n=296) patients were between
51-60 years. Overall, right eye was involved in 54.3%
(n= 597) patients and left eye was involved in 45.7%
(n= 503). Vertical and horizental Keratometric readings
are shown in Table 1. Axial length (AL) measured in millimetres is shown Table 2. Intraocular lens (IOL) power
was calculated in diopters by using SRK-II formula and
is shown in Table 3.

Table 1: Keratometric readings Distribution

Power in Diopters (D)

Vertical Keratometry (K 1)

Horizontal
Keratometry
(K 2)

39.99 & Below

1 (0.1 %)

6 (0.5%)

40- 40.99

8 (0.8%)

8 (0.7%)

41- 41.99

28 (2.5%)

31 (2.8%)

42- 42.99

118 (10.7%)

93 (8.4%)

43- 43.99

171 (15.5%)

171 (15.5%)

44- 44.99

257 (23.3%)

228 (20.7%)

45- 45.99

211 (19.1%)

230 (20.9%)

46- 46.99

166 (15.1%)

175 (15.9%)

47- 47.99

88 (8%)

105 (9.5%)

48- 48.99

30 (2.8%)

34 (3.1%)

49- 49.99

15 (1.3%)

13 (1.2%)

50 & Above

7 (0.6%)

6 (0.5%)

Total

1100 (100.0%)

1100 (100.0%)

Table 2: Axial length Distribution

Axial Length (mm)

No. of cases and

percentage

18-18.99

02(0.2%)

19- 19.99

02(0.2%)

20- 20.99

33(3%)

21- 21.99

119(10.8%)

22- 22.99

362(33%)

23- 23.99

403(36.6%)

24- 24.99

129(11.7%)

25- 25.99

29(2.6%)

26- 26.99

07(0.6%)

27- 27.99

03(0.3%)

28- 28.99

03(0.3%)

29 & above

08(0.7%)

Total

1100(100.0 %)

J. Med. Sci. (Peshawar, Print) July 2014, Vol. 22, No. 3

127

Table 3: IOL Power Distribution

Axial Length (mm)

No. of cases and

percentage

14.50 & Below

38%3.5%)

15- 17.50

88 (8%)

18- 18.50

113 (10.3%)

19- 19.50

179 (16.3%)

20- 20.50

230 (21%)

21- 21.50

184 (16.7%)

22- 22.50

125 (11.4%)

23- 23.50

67 (5.8%)

24- 24.50

43 (3.9%)

25- 25.50

16 (1.4%)

26- 27.0

13 (1.1%)

27.50- 29.50

01 (0.1%)

30 & Above

03 (0.2%)

Total

1100 (100.0 %)

Chanchlani M et al9 who reported 62.2% and 43.6%

cases in same age group. Contrarily, studies of Saleem M et al3 and Naz MA8 reported 32.3% and 22.7%
respectively. Poverty, illiteracy, traditional medicines
use and lack of eye care facilities all contribute to high
prevalence of cataract in these patients. In this study,
23.3% cases had diopteric power of corneal vertical
meridian (K1) between 44- 44.99 D. This was contrary
to Rashid H10 and Saleem M et al3 who reported 40.8%
and 44.9% cases having K1 reading from 42- 44 D.

This study showed 20.9% patients were having
corneal horizontal meridian (K2) power between 4545.99 D. This was contrary to Rashid H10 and Saleem M
et al3 who reported K2 readings from 42- 44 D in 41.2%
and 49% cases respectively. Mean K1 reading was
44.81D and K2 reading was 44.92D. This was contrary
to Rashid H10 who reported K1 as 42.65 D and K2 as
42.48 D.

In this study, mean axial length (AL) was 23.11
mm, minimum reading of 18.06 mm and maximum of
31.81 mm and range was 13.75 mm. 69.6% had AL from
22- 24 mm. Rashid H10 reported AL range from 18 - > 28
mm with 39% cases in the range of 22- 23 mm. Saleem
M et al3 reported AL range from 19.5- 28mm while 58%
were 22- 23.5mm. Naz MA8 reported AL range from 2028 mm, with 54% between 22- 23 mm. Other studies
done by Krimmer JE11, Raz PS12 and Lesiews KA et al13
reported that majority of AL were between 22- 23 mm.

In this study, 70% cases had estimated IOL power
between 20- 20.50 D with minimum and maximum IOL
power of -2.00 D and 36.50 D respectively, mean IOL
power was 20.00 D. Rashid H10 reported mean IOL
power of 23.17 D and range from 6.50- 36.00 D. Naz
MA8 reported IOL power range from 4- 35 D, Elder14
reported it from 12- 27 D and Saleem MA et al3 reported
IOL power range from 10- 33 D and 52.5% cases had
128

IOL power between 20- 22 D. This wide range of IOL

power shows the importance of proper pre- operative
assessment.

CONCLUSION

Biometric readings vary greatly from patient to
patient so proper pre-operative biometric assessment
is desirable for good post operative vision.

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