{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T15:04:45Z","timestamp":1774364685203,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Eye Bank Association Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To evaluate the performance of traditional vergence formulas with segmented axial length (AL) compared to traditional composite AL in extremely long eyes, and to determine whether the segmented AL can be extended to the new-generation formulas, including the Barrett Universal II, Emmetropia Verifying Optical 2.0 (EVO2), Hill-RBF 3.0 (Hill3), Kane, and Ladas Super formula (LSF) formulas in extremely long eyes. Setting: National Hospital. Organization, Tokyo Medical Center, Japan. Design: Retrospective case series. Methods: Consecutive patients who underwent uncomplicated cataract surgery implanted with a three-piece intraocular lens between December 2015 and March 2021 were retrospectively reviewed. The composite AL was measured with a swept-source optical coherence tomography (SS-OCT) biometer using a mean refractive index. The segmented AL was calculated by summing the geometric lengths of the ocular segments (cornea, aqueous, lens, and vitreous) using multiple specific refractive indices based on the data obtained by the SS-OCT-based biometer. When refraction was measured at three months postoperatively, the median absolute errors (MedAEs) were calculated with two ALs for each formula. Results: The study included 31 eyes of 22 patients. The segmented AL (30.45 \u00b1 1.23 mm) was significantly shorter than the composite AL (30.71 \u00b1 1.28 mm, p &lt; 0.001). The MedAEs were significantly reduced when using segmented AL for SRK\/T, Haigis, Hill3, and LSF, compared to those obtained using composite AL (0.38 vs. 0.62, 0.48 vs. 0.79, 0.50 vs. 0.90, 0.34 vs. 0.61, p &lt; 0.001 for all formulas, respectively). On the contrary, the MedAE obtained by Kane with segmented AL was significantly worse compared to the one with composite AL (0.35 vs. 0.27, p = 0.03). Conclusion: In extremely high myopic eyes, the segmented AL improves the performance of SRK\/T, Haigis, Hill3, and LSF formulas compared to the composite AL, while the segmented AL worsens the prediction accuracy of the Kane formula.<\/jats:p>","DOI":"10.3390\/jcm12226959","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T11:25:31Z","timestamp":1699356331000},"page":"6959","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of Segmented Optical Axial Length on the Performance of New-Generation Intraocular Lens Power Calculation Formulas in Extremely Long Eyes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4171-0781","authenticated-orcid":false,"given":"So","family":"Goto","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita 565-0871, Osaka, Japan"},{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"},{"name":"Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA 94720, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6509-9054","authenticated-orcid":false,"given":"Naoyuki","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita 565-0871, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kota","family":"Uehara","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maki","family":"Matsumaru","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saori","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiko","family":"Ohnuma","sequence":"additional","affiliation":[{"name":"Laboratorio de Lente Verde, 98-1 Nozomino, Sodegaura 299-0251, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2800-126X","authenticated-orcid":false,"given":"Tjundewo","family":"Lawu","sequence":"additional","affiliation":[{"name":"VO, 3-10-20 Honcho, Toda 335-0023, Saitama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.preteyeres.2012.06.004","article-title":"The complex interactions of retinal, optical and environmental factors in myopia aetiology","volume":"31","author":"Flitcroft","year":"2012","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/ceo.12206","article-title":"Myopia and the long-term incidence of cataract and cataract surgery: The Blue Mountains Eye Study","volume":"42","author":"Kanthan","year":"2014","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.jcrs.2011.05.042","article-title":"Optimizing intraocular lens power calculations in eyes with axial lengths above 25.0 mm","volume":"37","author":"Wang","year":"2011","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ophtha.2017.08.027","article-title":"Accuracy of Intraocular Lens Calculation Formulas","volume":"125","author":"Melles","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s10792-022-02466-4","article-title":"Comparing the accuracy of the new-generation intraocular lens power calculation formulae in axial myopic eyes: A meta-analysis","volume":"43","author":"Li","year":"2022","journal-title":"Int. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ajo.2020.09.019","article-title":"Accuracy of Artificial Intelligence Formulas and Axial Length Adjustments for Highly Myopic Eyes","volume":"223","author":"Cheng","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jcrs.2018.10.039","article-title":"A comparison of two methods to calculate axial length","volume":"45","author":"Cooke","year":"2019","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.ophtha.2018.12.046","article-title":"Calculation of axial length using a single group refractive index versus using different refractive indices for each ocular segment: Theoretical study and refractive outcomes","volume":"126","author":"Wang","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4474","DOI":"10.1038\/s41598-020-61391-7","article-title":"Comparison of composite and segmental methods for acquiring optical axial length with swept-source optical coherence tomography","volume":"10","author":"Goto","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0002-9394(98)00113-5","article-title":"Partial coherence interferometry: A novel approach to biometry in cataract surgery","volume":"126","author":"Drexler","year":"1998","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1111\/j.1755-3768.2007.00879.x","article-title":"Calculation of intraocular lens power: A review the statistical","volume":"85","author":"Olsen","year":"2007","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jcrs.2007.10.031","article-title":"Sources of error in intraocular lens power calculation","volume":"34","author":"Norrby","year":"2008","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"13736","DOI":"10.1038\/s41598-017-13800-7","article-title":"Precision of a new ocular biometer in eyes with cataract using swept source optical coherence tomography combined with Placido-disk corneal topography","volume":"7","author":"Wang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_15","first-page":"16","article-title":"Evaluation of six biometers based on different optical technologies","volume":"48","year":"2021","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S0886-3350(13)80339-2","article-title":"An improved universal theoretical formula for intraocular lens power prediction","volume":"19","author":"Barrett","year":"1993","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_17","unstructured":"Warren, E.H. (2020, December 30). Hill-RBF Calculator Version 3.0. Available online: https:\/\/rbfcalculator.com\/online\/index.html."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e000251","DOI":"10.1136\/bmjophth-2018-000251","article-title":"Comparison of the Kane formula with existing formulas for intraocular lens power selection","volume":"4","author":"Connell","year":"2019","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1001\/jamaophthalmol.2015.3832","article-title":"A 3-D super surface combining modern intraocular lens formulas to generate a super formula and maximize accuracy","volume":"133","author":"Ladas","year":"2015","journal-title":"JAMA Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.jcrs.2018.07.049","article-title":"Modified axial length adjustment formulas in long eyes","volume":"44","author":"Wang","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/j.ophtha.2019.04.011","article-title":"Update on Intraocular Lens Calculation Formulas","volume":"126","author":"Melles","year":"2019","journal-title":"Ophthalmology"},{"key":"ref_22","first-page":"S0002-9394(23)00375-6","article-title":"Network Meta-analysis of IOL Power Calculation Formula Accuracy in 1016 Eyes with Long Axial Length","volume":"17","author":"Ma","year":"2023","journal-title":"Am. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Moshirfar, M., Durnford, K.M., Jensen, J.L., Beesley, D.P., Peterson, T.S., Darquea, I.M., Ronquillo, Y.C., and Hoopes, P.C. (2022). Accuracy of Six Intraocular Lens Power Calculations in Eyes with Axial Lengths Greater than 28.0 mm. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195947"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Omoto, M., Sugawara, K., Torii, H., Yotsukura, E., Masui, S., Shigeno, Y., Nishi, Y., and Negishi, K. (2022). Investigating the Prediction Accuracy of Recently Updated Intraocular Lens Power Formulas with Artificial Intelligence for High Myopia. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164848"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ajo.2020.02.023","article-title":"Effect of Axial Length Adjustment Methods on Intraocular Lens Power Calculation in Highly Myopic Eyes","volume":"214","author":"Zhang","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.jcrs.2017.08.003","article-title":"Pursuing perfection in intraocular lens calculations: III. Criteria for analyzing outcomes","volume":"43","author":"Wang","year":"2017","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.ophtha.2020.07.005","article-title":"Update on Intraocular Lens Power Calculation Study Protocols","volume":"128","author":"Hoffer","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/j.jcrs.0000000000000370","article-title":"Review and recommendations for univariate statistical analysis of spherical equivalent prediction error for IOL power calculations","volume":"47","author":"Holladay","year":"2021","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/j.jcrs.0000000000000702","article-title":"Evaluating the prediction accuracy of the Hill-RBF 3.0 formula using a heteroscedastic statistical method","volume":"48","author":"Tsessler","year":"2022","journal-title":"J. Cataract Refract. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/22\/6959\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:18:34Z","timestamp":1760131114000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/22\/6959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":29,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jcm12226959"],"URL":"https:\/\/doi.org\/10.3390\/jcm12226959","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,7]]}}}