Patient Case: IOL calculations

3892cdf053510bdcf79ba1f0ac41c84fdca2f20eSERMO physicians consult on tough patient cases hundreds of times every month.  This post comes from an Ophthalmologist needing insights about a recent patient.  If you’re a physician, join us and read more.


I have a 60 something man who had RK on his right eye 20+ years ago (4 incision, no pre op info available) who then developed consecutive hyperopia in this eye of +1.50.   He had LASIK on this eye and did well, until about 4 months ago when a cataract worsened and his vision dropped to the 20/40 range, worse with glare testing.

When calculating the a post refractive IOL I’ve always used the ASCRS post keratorefractive surgery calculations online getting as much presurgical info I can.  Without pre op history I will use the Hagis-L formula on my IOL Master.    This has mostly given good results for me in the past.

The question here is: How to calculate the IOL in an eye with a history of a myopic RK treatment, then a hyperopic LASIK treatment.  (My guess is the patient was about -1.00 in OD prior to RK as it was only a 4 incision treatment, and OS was left intact for monovision, and the correction there was -1.25.)

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