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By Warren E. Hill, M.D., F.A.C.S.

Mesa, Ariz.

The Haigis Formula for IOL

Power Calculation
Using three constants, this
formula can be individually
adjusted for each surgeon/IOL
combination.
One of the final frontiers in ophthalmology is
the consistently accurate calculation of intraocular
lens (IOL) powers over a wide range of axial
lengths. After being properly personalized, any of
the modern IOL power calculation formulas will do
an excellent job from 22 mm to 24.5 mm. However,
for significantly longer or shorter eyes, a high degree
of accuracy remains elusive.
The present system of IOL constants simply
moves the predicted IOL power curve (determined by
the IOL geometry and the mathematics of the IOL
calculation formula) of the surgeons favorite IOL
power calculation program up or down. But this
curve is mostly fixed. The larger the IOL constant,
the more IOL power the formula will recommend for
the same set of measurements. And the smaller the
number, the less IOL power the same formula will
recommend for the same set of measurements.
Currently, we use these three IOL formulas:
The SRK/T formula, which uses an A-constant
The Holladay 1 formula, which uses a surgeon
factor
The Holladay 2 formula and the Hoffer Q formula, which both use an anterior chamber depth
(ACD) factor.
These standard IOL constants are mostly interchangeable. Knowing one, you can calculate the
others. In this way, surgeons can move from one
formula to another for the same IOL implant. Some
formulas, like Holladay 1, work very well for eyes

of normal to moderately long axial lengths, while

other formulas, like Hoffer Q, work better for
shorter axial lengths. The Holladay 2 formula
works well over a very wide range of axial lengths.
My experience has been that the SRK/T formula
tends to underestimate IOL power for shorter axial
lengths and overestimate IOL power for longer
axial lengths.
Variations in keratometers, biometry calibration, and surgical technique all can have an effect on
refractive outcomes because they add variables. By
personalizing the lens constant, it is possible to
adjust for various practice-specific variables to
achieve the most predictable refractive results,
whatever formula is being used.
Unfortunately, the IOL power curve generated
by each formula remains the same. Changing the
lens constant just moves the curve up or down
(more power recommended, less power recommened).
Another problem with the commonly used twovariable prediction formulas is that they rely on the
axial length and the central corneal power to predict
the postoperative position of the IOL implant.
These formulas assume that the longer the axial
length, the deeper the anterior chamber, and the
shorter the axial length, the shallower the anterior
chamber. Holladay and Gills have shown that this
often is not the case. Eyes with axial lengths of less
than 20 mm often have large lenses but otherwise
completely normal anterior chamber anatomy. This
basic assumption creates a mathematical limitation
and is another reason why these formulas are not
accurate over a wide range of axial lengths. The
Holladay 2 formula has done a good job of overcoming this limitation by using the measured ACD
and several other variables, such as lens thickness
and corneal diameter, to better predict the final
position of the IOL implant.
Continued on page 20

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New IOL Constants

A recent exception to this is the Haigis formula,
which can be found as part of the Zeiss IOLMaster
software package.
The Haigis formula differs in a very important
way. Rather than simply move a fixed, formula-specific outcomes curve up (more IOL power recommended) or down (less IOL power recommended), the
Haigis formula uses three constants: a0, a1 and a2,
such that:
d = the effective lens position, where
d = a0 + (a1 * ACD) + (a2 * AL)
ACD is the measured anterior chamber depth of
the eye (corneal surface to the anterior lens capsule),
and AL is the axial length of the eye (the distance from
the corneal surface to the vitreoretinal interface).
The a0 constant basically moves the curve up or
down in much the same way that the A-constant, surgeon factor or ACD does for the Holladay 1,
Holladay 2, Hoffer Q and SRK/T formulas.
The a1 constant is tied to the measured ACD. The
a2 constant is tied to the measured axial length.
So, rather than using a single number, the Haigis
formula recommends IOL power based on a threevariable (a0, a1 and a2) function.
The a0, a1 and a2 constants are set by optimizing
a set of surgeon- and IOL-specific outcomes for a wide
range of ALs and ACDs. By double-regression analysis, the a0, a1 and a2 constants are adjusted to match
the results for a specific surgeon and IOL. This means
that the mathematics of the Haigis formula can be
adjusted for each surgeon/IOL combination.
At present, this can be done by requesting a Haigis
formula optimization Excel spreadsheet by e-mail
from Dr. Wolfgang Haigis in Germany
(w.haigis@augenklinik.uni-wuerzburg.de) or from me
here in North America (hill@a-scan.net).

Innovative approach
Dr. Haigis gets very high marks for this innovative approach. Using a three-variable function rather
than a single number gives the Haigis formula a
completely new level of mathematical flexibility not
yet seen in ophthalmology.
As the a0, a1 and a2 Haigis constants for the
more commonly used IOLs become established and
if the Haigis formula begins to be included with biometry devices other than the Zeiss IOLMaster, I
expect that this formula will gain in popularity here
in the United States. OM