Purpose: To evaluate the features of the axial length-to-corneal radius (AL/CR) ratio in Japanese patients with cataracts and to determine the accuracy of intraocular lens (IOL) power calculation formulas according to the AL/CR features and the axial length (AL). Design: Retrospective observational case series. Methods: Setting was a clinical practice. Patient population was a total of 1,135 eyes (1,135 patients) with cataracts. Observation procedures included measurement of the AL and corenal radius (CR) by optical biometry and evaluation of the refractive outcomes by using the SRK/T, Holladay 1, Hoffer Q, Haigis, and Barrett Universal II formulas. Main outcome measurements were the features of the AL/CR ratio and the accuracy of IOL power calculations based on the AL/CR ratio and the AL. Results: The mean AL/CR ratio was 3.15 ± 0.19. Significant weak negative correlations were observed between the spherical equivalent (SE) and AL (r = −0.7489; P < .001) and between the SE and AL/CR ratio (r = −0.8069; P < .001); no correlation was found between the SE and CR (r = 0.0208, P = .483). For medium ALs and high AL/CR ratios, the SRK/T formula performed less accurately. For long ALs and high AL/CR ratios, the Holladay 1 and Hoffer Q formulas performed less accurately. The Barrett Universal II formula performed well across a range of ALs and AL/CR ratios. Conclusions: The AL/CR ratio explained the total variation in the SE better than the AL alone. Surgeons should pay attention to the selection of IOL power calculation formulas in eyes with high AL/CR ratios.
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