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Axial Length Adjustment and AL/R Ratio Optimization of IOL Power Calculation in Extremely Long Eyes
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DOI：10.1016/j.ajo.2026.06.026.png)
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Abstract
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• In eyes with axial length (AL) ≥ 30.0 mm, we systematically evaluated modern IOL formulas and the impact of biometric parameters, including keratometry and the AL–to–corneal radius (AL/R) ratio, on refractive accuracy. • Holladay 1 combined with the non-linear polynomial Wang-Koch axial length adjustment (H1-PWK) achieved the most robust overall performance, while extreme AL and steep corneas were major drivers of hyperopic prediction error. • The AL/R ratio outperformed AL alone for biometric stratification, demonstrating a significant positive correlation with prediction error (PE) in the Ladas Super formula, Barrett Universal II, EVO, PEARL-DGS, and Hoffer QST formulas, with the transition point from myopic to hyperopic PE varying across these formulas.
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